Arie Ariche - Academia.edu (original) (raw)
Papers by Arie Ariche
Tissue Engineering Part A, 2014
Introduction: The liver is the natural microenvironment for hepatocytes transplantation but unfor... more Introduction: The liver is the natural microenvironment for hepatocytes transplantation but unfortunately engraftment efficiency is low. Cell-laden microhydrogels made of fibrinogen attached to poly(ethylene glycol) (PEG)-diacrylate side chains, were used as a cell carrier, for intravascular transplantation. This approach may reduce shear stress and immediate immunological pressure after intravascular transplantation and provide biomatrix for environmental support. Aims: In vitro assessment of HuH-7 viability and function after polymerization within PEGylated fibrinogenhydrogel. In vivo assessment of intraportal transplantation of cell-laden microhydrogels with rat adult parenchymal cells. Methods: (1) In vitro assessment of HuH-7 cell viability and function, after cell-laden hydrogel (hydrogel volume 30 mL) fabrication, by propidium iodide (PI)/fluorescein diacetate (FDA), and MTT assays, albumin concentration and CYP1A activity. (2) Fabrication of cell-laden microhydrogels and their intraportal transplantion. Engraftment efficiency in vivo was evaluated by real-time qPCR of Y chromosome (SRY gene) and histology. Results: The viability of cells in hydrogels in culture was comparable to viability of not embedded cells during the first 48 h. However, the viability of cells in hydrogels was reduced after 72 h compared with not embedded cells. Activity of CYP1A in hydrogel was comparable to that of not embedded cells (4.33-1 pmole/mg DNA/4 h vs. 5.13-1 pmole/mg DNA/4 h, respectively). Albumin concentration increased at day 3 in hydrogels to 1.4-0.6 mg/ 10 4 /24 h and was greater to that of free cells, 0.3-0.1 mg/10 4 /24 h. Cell-laden microhydrogels at a size of 150-150-600 mm (6 • 10 6 cells/rat) showed better engraftment efficiency at 21 days post-transplantation, compared with isolated cell transplantation (54.6%-5% vs. 1.8%-1.2%, p < 0.001). Conclusions: The in vitro HuH-7 viability and function after polymerization in PEGylated fibrinogen hydrogel was comparable to cells without the hydrogel. Long-term survival and engraftment efficiency of intravascular transplanted adult hepatocytes is much better in within cell-laden microhydrogels compared with isolated cells. The overall efficiency of the procedure needs to be improved.
HPB, 2014
Background: Portal vein arterialization (PVA) has been used as a salvage inflow technique when he... more Background: Portal vein arterialization (PVA) has been used as a salvage inflow technique when hepatic artery (HA) reconstruction is deemed impossible in liver transplantation (LT) or hepatopancreatobiliary (HPB) surgery. Outcomes and the management of possible complications have not been well described. Methods: The present study analysed outcomes in 16 patients who underwent PVA during the period from February 2005 to January 2011 for HA thrombosis post-LT (n = 7) or after liver resection (n = 1), during curative resection for locally advanced HPB cancers (requiring HA interruption) (n = 7) and for HA resection without reconstruction (n = 1). In addition, a literature review was conducted. Results: Nine patients were women. The median age of the patients was 58 years (range: 30-72 years). Recovery of intrahepatic arterial signals and PVA shunt patency were documented using Doppler ultrasound until the last follow-up (or until shunt thrombosis in some cases). Of five postoperative deaths, two occurred as a result of haemorrhagic shock, one as a result of liver ischaemia and one as a result of sepsis. The fifth patient died at home of unknown cause. Three patients (19%) had major bleeding related to portal hypertension (PHT). Of these, two underwent re-exploration and one underwent successful shunt embolization to control the bleeding. Four patients (25%) had early shunt thrombosis, two of whom underwent a second PVA. After a median follow-up of 13 months (range: 1-60 months), 10 patients (63%) remained alive with normal liver function and one submitted to retransplantation. Conclusions: Portal vein arterialization results in acceptable rates of survival in relation to spontaneous outcomes in patients with completely de-arterialized livers. The management of complications (especially PHT) after the procedure is challenging. Portal vein arterialization may represent a salvage option or a bridge to liver retransplantation and thus may make curative resection in locally advanced HPB cancers with vascular involvement feasible.
Chemotherapy, 2009
Compared with systemic therapy, hepatic arterial infusion (HAI) increases the response to fluorop... more Compared with systemic therapy, hepatic arterial infusion (HAI) increases the response to fluoropyrimidines. Thirty-one patients with non-resectable, colorectal cancer (CRC) liver metastases received irinotecan 120 mg/m(2), followed by leucovorin (LV) 20 mg/m(2) and 5-fluorouracil (5-FU) 500 mg/m(2) administered by HAI every 2 weeks, plus UFT (tegafur-uracil) 200 mg/m(2)/day with LV 30 mg/day on days 1-22, followed by a 6-day rest. The objective response rate was 65% (all 20 patients achieving a partial response). Ten patients (32%) had stable disease. The median time to progression (TTP) and overall survival (OS) were 12 and 36 months. OS was similar in patients with low versus high expression of thymidylate synthase (TS) and/or dihydropyrimidine dehydrogenase (DPD). The regimen was well tolerated. UFT with LV plus HAI irinotecan and 5-FU/LV was a feasible and effective treatment for non-resectable CRC liver metastases, increasing response, TTP and OS. TS and DPD levels in liver metastases did not predict outcome.
European Journal of Radiology, 2010
The liver and the peritoneum are two common sites for metastatic cancer spread. When there is iso... more The liver and the peritoneum are two common sites for metastatic cancer spread. When there is isolated cancer spread to either of these organs, surgical resection of the metastatic disease has led to a significant improvement in the overall and disease-free survival both in selected patients compared to systemic chemotherapy alone which was previously the standard of care. At the same time, it is not uncommon for peritoneal metastases (PM) and liver metastases (LM) to occur synchronously. In patients undergoing resection of LM from various primary sites, chiefly colorectal LM, PM may be an incidental finding during the preoperative workup or during the surgical exploration itself. Similarly, in patients with PM being treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), one or more LM may be detected on preoperative imaging. Though the presence of two sites of metastases was initially a contraindication for a curative approach at either site...
Villous adenomas of the upper gastrointestinal tract are rare [1], residing mostly in the duodenu... more Villous adenomas of the upper gastrointestinal tract are rare [1], residing mostly in the duodenum (80%) and ampulla of Vater (15%). Villous adenomas of the extrahepatic bile ducts are exceptional and only a few cases have been reported in the medical literature worldwide [2]. The adenomatous polyp to carcinoma on the large bowel sequence is well known. However, in the absence of evidence of this sequence in the biliary duct a conclusion cannot be drawn from one case report on the adenoma-carcinoma sequence. We present a case of cholangiocarcinoma of the common bile duct arising from a villous adenoma.
Journal of the Pancreas, Mar 9, 2011
Metastatic and locally advanced disease is unfortunately a common clinical occurrence in patients... more Metastatic and locally advanced disease is unfortunately a common clinical occurrence in patients affected by pancreatic cancer. The most frequent sites of metastasis are the liver and the peritoneal lining. The falciform and round ligaments are routinely resected and sent for pathology, but no metastases have ever been reported. In this study, we assess whether the falciform and round ligaments are possible sites for metastases and if routine pathology examination of these structures is justified. Retrospective, single institution study. The charts of all patients who underwent pancreatic resection from June 2005 through January 2011 were reviewed retrospectively. Data on age, gender, type of operation performed, preoperative CA 19-9 levels, vascular and perineural invasion, tumor differentiation and pathological staging were retrieved from the hospital electronic data base. Only patients with malignant lesions of the pancreas were included in the study. Presence of pancreatic meta...
Annals of Surgical Oncology, 2001
Surgical resection is the most effective treatment for colorectal liver metastases but only a min... more Surgical resection is the most effective treatment for colorectal liver metastases but only a minority of patients are candidates for a potentially curative resection. Our experience with neoadjuvant chemotherapy followed by resection and five years survival analysis of the patients treated is presented. Between February of 1988 and September of 1996, 701 patients with unresectable colorectal liver metastases were treated with neoadjuvant chemotherapy. Four categories of nonresectable disease were defined: large size, ill location, multinodularity, and extrahepatic disease. Liver resection was performed in those patients whose disease became resectable. After resection, the patients were followed up every 3 months. A 5-year survival analysis by the different categories described was performed. Ninety-five patients (13.5%) were found to be resectable on reevaluation and underwent a potentially curative resection. There was no perioperative mortality, and the complication rate was 23%. As of December of 1999, 87 patients have completed 5 years of follow-up. The overall 5-year survival is 35% from the time of resection and 39% from the onset of chemotherapy. Respective 5-year survival rates are 60% for large tumors, 49% for ill-located lesions, 34% for multinodular disease, and 18% for liver metastases with extrahepatic disease. In this latter category, however, a 35% 5-year survival was found when all the patients with extrahepatic disease were analyzed rather than only those for whom extrahepatic disease was the main cause of nonresectability. Neoadjuvant chemotherapy enables liver resection in some patients with initially unresectable colorectal metastases. Long-term survival is similar to that reported for a priori surgical candidates.
Annals of Surgical Oncology
Annals of Surgical Oncology
HepatoBiliary Surgery and Nutrition
Clinical and Translational Gastroenterology
Journal of Clinical Oncology
HepatoBiliary Surgery and Nutrition
Background: Two-stage hepatectomy (TSH) with portal vein embolization (PVE) is associated with hi... more Background: Two-stage hepatectomy (TSH) with portal vein embolization (PVE) is associated with high morbidity and mortality and may result in liver failure due to insufficient future liver remnant. The objectives of this investigation were to evaluate the short-term outcomes of patients with colorectal cancer liver metastasis who underwent TSH with PVE, and to critically review the selection criteria for TSH-PVE. Methods: A retrospective review of all patients who were operated due to bi-lobar CRLM during the years 2007-2017 was performed. Patients who underwent TSH-PVE were compared to those who underwent right hepatectomy (RH) only. Results: Twenty-nine patient underwent TSH, 25 of whom (86.2%) completed both stages. These patients demonstrated a major complication rate of 17%, and a 90-day mortality rate of 3.4%. Most complications (80%) were related to the colonic resection, and one patient developed liver failure. Patients who suffered complications had a trend towards more baseline comorbidities and more liver lesions. Ablative techniques were utilized in 76%. When compared to 35 patients who underwent sole RH, no significant difference was demonstrated in major complication rate (20%) or mortality (0%). Conclusions: TSH is a relatively safe procedure in selected patients. Ablative techniques can reduce the occurrence of liver insufficiency and should be used liberally when possible. Factors such as number of lesions, comorbidities and the timing of colonic resection should be considered and evaluated in order to improve the outcomes of the procedure.
Vascular and Endovascular Surgery
A 67-year-old male with a history of an aortic dissection was found to have a large hepatic and c... more A 67-year-old male with a history of an aortic dissection was found to have a large hepatic and celiac artery aneurysm. Due to the extent of the dissection within the aorta, a bypass was performed from his iliac artery to the hepatic bifurcation, followed by exclusion and ligation of the aneurysms.
Hepatobiliary surgery and nutrition, 2015
The liver is the most frequently injured intraperitoneal organ, despite its relatively protected ... more The liver is the most frequently injured intraperitoneal organ, despite its relatively protected location. The liver consisting of a relatively fragile parenchyma contained within the Glisson capsule, which is thin and does not provide it with great protection. The management of hepatic trauma has undergone a paradigm shift over the past several decades with significant improvement in outcomes. Shifting from mandatory operation to selective nonoperative treatment, and, presently, to nonoperative treatment with selective operation. Operative management emphasizes packing, damage control, and utilization of interventional radiology, such as angiography and embolization. Because of the high morbidity and mortality, liver resection seems to have a minimal role in the management of hepatic injury in many reports, but in a specialized referral center, like our institute, surgical treatment becomes, in many cases, the only life-saving treatment. Innovations in liver transplant surgery, liv...
Plastic & Reconstructive Surgery, 1997
... Surgery for Bone Sarcomas of the Distal Femur: A Proposed Classification of Muscle Transfers.... more ... Surgery for Bone Sarcomas of the Distal Femur: A Proposed Classification of Muscle Transfers. Meller, Isaac MD; Ariche, Arié MD; Sagi, Amiram MD. Article Outline. Collapse Box Author Information. Tel-Aviv and Beer-Sheva, Israel. ...
Tissue Engineering Part A, 2014
Introduction: The liver is the natural microenvironment for hepatocytes transplantation but unfor... more Introduction: The liver is the natural microenvironment for hepatocytes transplantation but unfortunately engraftment efficiency is low. Cell-laden microhydrogels made of fibrinogen attached to poly(ethylene glycol) (PEG)-diacrylate side chains, were used as a cell carrier, for intravascular transplantation. This approach may reduce shear stress and immediate immunological pressure after intravascular transplantation and provide biomatrix for environmental support. Aims: In vitro assessment of HuH-7 viability and function after polymerization within PEGylated fibrinogenhydrogel. In vivo assessment of intraportal transplantation of cell-laden microhydrogels with rat adult parenchymal cells. Methods: (1) In vitro assessment of HuH-7 cell viability and function, after cell-laden hydrogel (hydrogel volume 30 mL) fabrication, by propidium iodide (PI)/fluorescein diacetate (FDA), and MTT assays, albumin concentration and CYP1A activity. (2) Fabrication of cell-laden microhydrogels and their intraportal transplantion. Engraftment efficiency in vivo was evaluated by real-time qPCR of Y chromosome (SRY gene) and histology. Results: The viability of cells in hydrogels in culture was comparable to viability of not embedded cells during the first 48 h. However, the viability of cells in hydrogels was reduced after 72 h compared with not embedded cells. Activity of CYP1A in hydrogel was comparable to that of not embedded cells (4.33-1 pmole/mg DNA/4 h vs. 5.13-1 pmole/mg DNA/4 h, respectively). Albumin concentration increased at day 3 in hydrogels to 1.4-0.6 mg/ 10 4 /24 h and was greater to that of free cells, 0.3-0.1 mg/10 4 /24 h. Cell-laden microhydrogels at a size of 150-150-600 mm (6 • 10 6 cells/rat) showed better engraftment efficiency at 21 days post-transplantation, compared with isolated cell transplantation (54.6%-5% vs. 1.8%-1.2%, p < 0.001). Conclusions: The in vitro HuH-7 viability and function after polymerization in PEGylated fibrinogen hydrogel was comparable to cells without the hydrogel. Long-term survival and engraftment efficiency of intravascular transplanted adult hepatocytes is much better in within cell-laden microhydrogels compared with isolated cells. The overall efficiency of the procedure needs to be improved.
HPB, 2014
Background: Portal vein arterialization (PVA) has been used as a salvage inflow technique when he... more Background: Portal vein arterialization (PVA) has been used as a salvage inflow technique when hepatic artery (HA) reconstruction is deemed impossible in liver transplantation (LT) or hepatopancreatobiliary (HPB) surgery. Outcomes and the management of possible complications have not been well described. Methods: The present study analysed outcomes in 16 patients who underwent PVA during the period from February 2005 to January 2011 for HA thrombosis post-LT (n = 7) or after liver resection (n = 1), during curative resection for locally advanced HPB cancers (requiring HA interruption) (n = 7) and for HA resection without reconstruction (n = 1). In addition, a literature review was conducted. Results: Nine patients were women. The median age of the patients was 58 years (range: 30-72 years). Recovery of intrahepatic arterial signals and PVA shunt patency were documented using Doppler ultrasound until the last follow-up (or until shunt thrombosis in some cases). Of five postoperative deaths, two occurred as a result of haemorrhagic shock, one as a result of liver ischaemia and one as a result of sepsis. The fifth patient died at home of unknown cause. Three patients (19%) had major bleeding related to portal hypertension (PHT). Of these, two underwent re-exploration and one underwent successful shunt embolization to control the bleeding. Four patients (25%) had early shunt thrombosis, two of whom underwent a second PVA. After a median follow-up of 13 months (range: 1-60 months), 10 patients (63%) remained alive with normal liver function and one submitted to retransplantation. Conclusions: Portal vein arterialization results in acceptable rates of survival in relation to spontaneous outcomes in patients with completely de-arterialized livers. The management of complications (especially PHT) after the procedure is challenging. Portal vein arterialization may represent a salvage option or a bridge to liver retransplantation and thus may make curative resection in locally advanced HPB cancers with vascular involvement feasible.
Chemotherapy, 2009
Compared with systemic therapy, hepatic arterial infusion (HAI) increases the response to fluorop... more Compared with systemic therapy, hepatic arterial infusion (HAI) increases the response to fluoropyrimidines. Thirty-one patients with non-resectable, colorectal cancer (CRC) liver metastases received irinotecan 120 mg/m(2), followed by leucovorin (LV) 20 mg/m(2) and 5-fluorouracil (5-FU) 500 mg/m(2) administered by HAI every 2 weeks, plus UFT (tegafur-uracil) 200 mg/m(2)/day with LV 30 mg/day on days 1-22, followed by a 6-day rest. The objective response rate was 65% (all 20 patients achieving a partial response). Ten patients (32%) had stable disease. The median time to progression (TTP) and overall survival (OS) were 12 and 36 months. OS was similar in patients with low versus high expression of thymidylate synthase (TS) and/or dihydropyrimidine dehydrogenase (DPD). The regimen was well tolerated. UFT with LV plus HAI irinotecan and 5-FU/LV was a feasible and effective treatment for non-resectable CRC liver metastases, increasing response, TTP and OS. TS and DPD levels in liver metastases did not predict outcome.
European Journal of Radiology, 2010
The liver and the peritoneum are two common sites for metastatic cancer spread. When there is iso... more The liver and the peritoneum are two common sites for metastatic cancer spread. When there is isolated cancer spread to either of these organs, surgical resection of the metastatic disease has led to a significant improvement in the overall and disease-free survival both in selected patients compared to systemic chemotherapy alone which was previously the standard of care. At the same time, it is not uncommon for peritoneal metastases (PM) and liver metastases (LM) to occur synchronously. In patients undergoing resection of LM from various primary sites, chiefly colorectal LM, PM may be an incidental finding during the preoperative workup or during the surgical exploration itself. Similarly, in patients with PM being treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), one or more LM may be detected on preoperative imaging. Though the presence of two sites of metastases was initially a contraindication for a curative approach at either site...
Villous adenomas of the upper gastrointestinal tract are rare [1], residing mostly in the duodenu... more Villous adenomas of the upper gastrointestinal tract are rare [1], residing mostly in the duodenum (80%) and ampulla of Vater (15%). Villous adenomas of the extrahepatic bile ducts are exceptional and only a few cases have been reported in the medical literature worldwide [2]. The adenomatous polyp to carcinoma on the large bowel sequence is well known. However, in the absence of evidence of this sequence in the biliary duct a conclusion cannot be drawn from one case report on the adenoma-carcinoma sequence. We present a case of cholangiocarcinoma of the common bile duct arising from a villous adenoma.
Journal of the Pancreas, Mar 9, 2011
Metastatic and locally advanced disease is unfortunately a common clinical occurrence in patients... more Metastatic and locally advanced disease is unfortunately a common clinical occurrence in patients affected by pancreatic cancer. The most frequent sites of metastasis are the liver and the peritoneal lining. The falciform and round ligaments are routinely resected and sent for pathology, but no metastases have ever been reported. In this study, we assess whether the falciform and round ligaments are possible sites for metastases and if routine pathology examination of these structures is justified. Retrospective, single institution study. The charts of all patients who underwent pancreatic resection from June 2005 through January 2011 were reviewed retrospectively. Data on age, gender, type of operation performed, preoperative CA 19-9 levels, vascular and perineural invasion, tumor differentiation and pathological staging were retrieved from the hospital electronic data base. Only patients with malignant lesions of the pancreas were included in the study. Presence of pancreatic meta...
Annals of Surgical Oncology, 2001
Surgical resection is the most effective treatment for colorectal liver metastases but only a min... more Surgical resection is the most effective treatment for colorectal liver metastases but only a minority of patients are candidates for a potentially curative resection. Our experience with neoadjuvant chemotherapy followed by resection and five years survival analysis of the patients treated is presented. Between February of 1988 and September of 1996, 701 patients with unresectable colorectal liver metastases were treated with neoadjuvant chemotherapy. Four categories of nonresectable disease were defined: large size, ill location, multinodularity, and extrahepatic disease. Liver resection was performed in those patients whose disease became resectable. After resection, the patients were followed up every 3 months. A 5-year survival analysis by the different categories described was performed. Ninety-five patients (13.5%) were found to be resectable on reevaluation and underwent a potentially curative resection. There was no perioperative mortality, and the complication rate was 23%. As of December of 1999, 87 patients have completed 5 years of follow-up. The overall 5-year survival is 35% from the time of resection and 39% from the onset of chemotherapy. Respective 5-year survival rates are 60% for large tumors, 49% for ill-located lesions, 34% for multinodular disease, and 18% for liver metastases with extrahepatic disease. In this latter category, however, a 35% 5-year survival was found when all the patients with extrahepatic disease were analyzed rather than only those for whom extrahepatic disease was the main cause of nonresectability. Neoadjuvant chemotherapy enables liver resection in some patients with initially unresectable colorectal metastases. Long-term survival is similar to that reported for a priori surgical candidates.
Annals of Surgical Oncology
Annals of Surgical Oncology
HepatoBiliary Surgery and Nutrition
Clinical and Translational Gastroenterology
Journal of Clinical Oncology
HepatoBiliary Surgery and Nutrition
Background: Two-stage hepatectomy (TSH) with portal vein embolization (PVE) is associated with hi... more Background: Two-stage hepatectomy (TSH) with portal vein embolization (PVE) is associated with high morbidity and mortality and may result in liver failure due to insufficient future liver remnant. The objectives of this investigation were to evaluate the short-term outcomes of patients with colorectal cancer liver metastasis who underwent TSH with PVE, and to critically review the selection criteria for TSH-PVE. Methods: A retrospective review of all patients who were operated due to bi-lobar CRLM during the years 2007-2017 was performed. Patients who underwent TSH-PVE were compared to those who underwent right hepatectomy (RH) only. Results: Twenty-nine patient underwent TSH, 25 of whom (86.2%) completed both stages. These patients demonstrated a major complication rate of 17%, and a 90-day mortality rate of 3.4%. Most complications (80%) were related to the colonic resection, and one patient developed liver failure. Patients who suffered complications had a trend towards more baseline comorbidities and more liver lesions. Ablative techniques were utilized in 76%. When compared to 35 patients who underwent sole RH, no significant difference was demonstrated in major complication rate (20%) or mortality (0%). Conclusions: TSH is a relatively safe procedure in selected patients. Ablative techniques can reduce the occurrence of liver insufficiency and should be used liberally when possible. Factors such as number of lesions, comorbidities and the timing of colonic resection should be considered and evaluated in order to improve the outcomes of the procedure.
Vascular and Endovascular Surgery
A 67-year-old male with a history of an aortic dissection was found to have a large hepatic and c... more A 67-year-old male with a history of an aortic dissection was found to have a large hepatic and celiac artery aneurysm. Due to the extent of the dissection within the aorta, a bypass was performed from his iliac artery to the hepatic bifurcation, followed by exclusion and ligation of the aneurysms.
Hepatobiliary surgery and nutrition, 2015
The liver is the most frequently injured intraperitoneal organ, despite its relatively protected ... more The liver is the most frequently injured intraperitoneal organ, despite its relatively protected location. The liver consisting of a relatively fragile parenchyma contained within the Glisson capsule, which is thin and does not provide it with great protection. The management of hepatic trauma has undergone a paradigm shift over the past several decades with significant improvement in outcomes. Shifting from mandatory operation to selective nonoperative treatment, and, presently, to nonoperative treatment with selective operation. Operative management emphasizes packing, damage control, and utilization of interventional radiology, such as angiography and embolization. Because of the high morbidity and mortality, liver resection seems to have a minimal role in the management of hepatic injury in many reports, but in a specialized referral center, like our institute, surgical treatment becomes, in many cases, the only life-saving treatment. Innovations in liver transplant surgery, liv...
Plastic & Reconstructive Surgery, 1997
... Surgery for Bone Sarcomas of the Distal Femur: A Proposed Classification of Muscle Transfers.... more ... Surgery for Bone Sarcomas of the Distal Femur: A Proposed Classification of Muscle Transfers. Meller, Isaac MD; Ariche, Arié MD; Sagi, Amiram MD. Article Outline. Collapse Box Author Information. Tel-Aviv and Beer-Sheva, Israel. ...