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Ciprani D, Capretti G, Sorrentino M, Gramellini M, Famularo S, Casari E, Gavazzi F, Nappo G, Ridolfi C, Zerbi A. Clinical usefulness of routinely performed drain fluid cultures after pancreaticoduodenectomy. A new ally to predict patients' outcomes? Pancreatology 2024; 24:178-183. [PMID: 38171972 DOI: 10.1016/j.pan.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Previous studies showed that bacterial contamination of surgical drains was associated with higher morbidity and mortality following pancreaticoduodenectomy (PD). However, there is still no agreement on the routine use of fluid drainage cultures in the management of patients underwent PD. Therefore, we aimed to clarify the role of surgical drain bacterial contamination in predicting patients' postoperative course. METHOD Single-centre study including patients underwent PD at Humanitas Research Hospital (2010-2021). Preoperative, intraoperative and postoperative data were collected. Routinely performed fluid drain cultures on postoperative day (POD) 5 were analyzed and compared among patients throughout the cohort. RESULTS A total of 825 patients were analyzed. Bacterial contamination of surgical drains was observed in 420 (50.9 %) patients and it was found to be associated with a higher rate of B/C grade pancreatic fistula (POPF) (P < 0.001), Clavien-Dindo≥3 (P < 0.001), 30-day mortality (P = 0.011), wound infection (P < 0.001), relaparotomies (P = 0.003) and greater length of hospital stay (LOS) (P < 0.001). Also, E. coli surgical drain contamination was demonstrated to double the risk of B/C grade POPF development (OR = 1.628, 95 % IC = 1.009-2.625, P = 0.046). Finally, preoperative biliary drainage (OR = 2.474, 95 % IC = 1.855-3.298, P < 0.001), age ≥75 years old (OR = 1.492, 95 % IC = 1.077-2.067, P = 0.016) and isolated Roux-en-Y pancreaticojejunostomy (OR = 1.639, 95 % IC = 1.229-2.188, P < 0.001) were identified as risk factors for surgical drains bacterial contamination. CONCLUSION Bacterial contamination of surgical drains predicts the development of B/C grade POPF and other major complications after PD. Therefore, we suggest the routine use of fluid drain cultures following PD.
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Affiliation(s)
- Debora Ciprani
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy
| | - Giovanni Capretti
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Martina Sorrentino
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy
| | - Marco Gramellini
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy
| | - Simone Famularo
- Division of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Erminia Casari
- Laboratory Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Francesca Gavazzi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy
| | - Gennaro Nappo
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Cristina Ridolfi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Carrara S, Fantin A, Khalaf K, Rizkala T, Koleth G, Andreozzi M, Spadaccini M, Colombo M, Gruppo M, Bonifacio C, Gavazzi F, Capretti GL, Ridolfi C, Nappo G, Spaggiari P, Tommaso LD, Sollai M, Zerbi A, Maselli R, Fugazza A, Hassan C, Facciorusso A, Repici A. Exploring a novel composite method using non-contrast EUS enhanced microvascular imaging and cyst fluid analysis to differentiate pancreatic cystic lesions. Dig Liver Dis 2023; 55:1548-1553. [PMID: 37612214 DOI: 10.1016/j.dld.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/07/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND AIMS Differentiating pancreatic cystic lesions (PCLs) remains a diagnostic challenge. The use of high-definition imaging modalities which detect tumor microvasculature have been described in solid lesions. We aim to evaluate the usefulness of cystic microvasculature when used in combination with cyst fluid biochemistry to differentiate PCLs. METHODS We retrospectively analyzed 110 consecutive patients with PCLs from 2 Italian Hospitals who underwent EUS with H-Flow and EUS fine needle aspiration to obtain cystic fluid. The accuracy of fluid biomarkers was evaluated against morphological features on radiology and EUS. Gold standard for diagnosis was surgical resection. A clinical and radiological follow up was applied in those patients who were not resected because not surgical indication and no signs of malignancy were shown. RESULTS Of 110 patients, 65 were diagnosed with a mucinous cyst, 41 with a non-mucinous cyst, and 4 with an undetermined cyst. Fluid analysis alone yielded 76.7% sensitivity, 56.7% specificity, 77.8 positive predictive value (PPV), 55.3 negative predictive value (NPV) and 56% accuracy in diagnosing pancreatic cysts alone. Our composite method yielded 97.3% sensitivity, 77.1% specificity, 90.1% PPV, 93.1% NPV, 73.2% accuracy. CONCLUSIONS This new composite could be applied to the holistic approach of combining cyst morphology, vascularity, and fluid analysis alongside endoscopist expertise.
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Affiliation(s)
- Silvia Carrara
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy.
| | - Alberto Fantin
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Kareem Khalaf
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Tommy Rizkala
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
| | - Glenn Koleth
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Marta Andreozzi
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Marco Spadaccini
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Matteo Colombo
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Mario Gruppo
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | | | - Francesca Gavazzi
- Humanitas Research Hospital -IRCCS, Pancreatic Surgery Unit, Rozzano, Italy
| | | | - Cristina Ridolfi
- Humanitas Research Hospital -IRCCS, Pancreatic Surgery Unit, Rozzano, Italy
| | - Gennaro Nappo
- Humanitas Research Hospital -IRCCS, Pancreatic Surgery Unit, Rozzano, Italy
| | - Paola Spaggiari
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Luca Di Tommaso
- Humanitas Research Hospital -IRCCS, Pathology Unit, Rozzano, Italy
| | - Mauro Sollai
- Humanitas Research Hospital -IRCCS, Pathology Unit, Rozzano, Italy
| | - Alessandro Zerbi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; Humanitas Research Hospital -IRCCS, Pancreatic Surgery Unit, Rozzano, Italy
| | - Roberta Maselli
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
| | | | - Cesare Hassan
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandro Repici
- Humanitas Research Hospital -IRCCS-, Endoscopy Unit, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
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Nappo G, Donisi G, Capretti G, Ridolfi C, Pagnanelli M, Nebbia M, Bozzarelli S, Petitti T, Gavazzi F, Zerbi A. Early Recurrence after Upfront Surgery for Pancreatic Ductal Adenocarcinoma. Curr Oncol 2023; 30:3708-3720. [PMID: 37185395 PMCID: PMC10137113 DOI: 10.3390/curroncol30040282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background. Survival after surgery for pancreatic ductal adenocarcinoma (PDAC) remains poor, due to early recurrence (ER) of the disease. A global definition of ER is lacking and different cut-off values (6, 8, and 12 months) have been adopted. The aims of this study were to define the optimal cut-off for the definition of ER and predictive factors for ER. Methods. Recurrence was recorded for all consecutive patients undergoing upfront surgery for PDAC at our institute between 2010 and 2017. Receiver operating characteristic (ROC) curves were utilized, to estimate the optimal cut-off for the definition of ER as a predictive factor for poor post-progression survival (PPS). To identify predictive factors of ER, univariable and multivariable logistic regression models were used. Results. Three hundred and fifty one cases were retrospectively evaluated. The recurrence rate was 76.9%. ER rates were 29.0%, 37.6%, and 47.6%, when adopting 6, 8, and 12 months as cut-offs, respectively. A significant difference in median PPS was only shown between ER and late recurrence using 12 months as cut-off (p = 0.005). In the multivariate analysis, a pre-operative value of CA 19-9 > 70.5 UI/L (OR 3.10 (1.41–6.81); p = 0.005) and the omission of adjuvant treatment (OR 0.18 (0.08–0.41); p < 0.001) were significant predictive factors of ER. Conclusions. A twelve-months cut-off should be adopted for the definition of ER. Almost 50% of upfront-resected patients presented ER, and it significantly affected the prognosis. A high preoperative value of CA 19-9 and the omission of adjuvant treatment were the only predictive factors for ER.
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Partelli S, Massironi S, Zerbi A, Niccoli P, Kwon W, Landoni L, Panzuto F, Tomazic A, Bongiovanni A, Kaltsas G, Sauvanet A, Bertani E, Mazzaferro V, Caplin M, Armstrong T, Weickert MO, Ramage J, Segelov E, Butturini G, Staettner S, Cives M, Frilling A, Moulton CA, He J, Boesch F, Selberheer A, Twito O, Castaldi A, De Angelis CG, Gaujoux S, Holzer K, Wilson CH, Almeamar H, Vigia E, Muffatti F, Lucà M, Lania A, Ewald J, Kim H, Salvia R, Rinzivillo M, Smid A, Gardini A, Tsoli M, Hentic O, Colombo S, Citterio D, Toumpanakis C, Ramsey E, Randeva HS, Srirajaskanthan R, Croagh D, Regi P, Gasteiger S, Invernizzi P, Ridolfi C, Giovannini M, Jang JY, Bassi C, Falconi M. Management of asymptomatic sporadic non-functioning pancreatic neuroendocrine neoplasms no larger than 2 cm: interim analysis of prospective ASPEN trial. Br J Surg 2022; 109:1186-1190. [PMID: 35986682 PMCID: PMC10364756 DOI: 10.1093/bjs/znac267] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/18/2022] [Accepted: 07/14/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Stefano Partelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Pancreas Translational and Clinical Research Centre, Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Massironi
- Division of Gastroenterology and Centre for Autoimmune Liver Diseases, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Patricia Niccoli
- Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Luca Landoni
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Francesco Panzuto
- Digestive Disease Unit, ENETS Centre of Excellence, Sant' Andrea University Hospital, Rome, Italy
| | - Ales Tomazic
- Department of Abdominal Surgery, University Medical Centre, Ljubijana, Slovenia
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumours Centre (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - Gregory Kaltsas
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alain Sauvanet
- Department of Pancreatology, Hôpital Beaujon, University of Paris, Paris, France
| | - Emilio Bertani
- Division of Gastrointestinal Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Vincenzo Mazzaferro
- Gastrointestinal and Hepato-Pancreatic Surgery and Liver Transplantation Unit, Fondazione, IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute) and Università degli Studi di Milano, Milan, Italy
| | - Martyn Caplin
- ENETS Centre of Excellence, Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
| | - Thomas Armstrong
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Southampton, UK
| | - Martin O Weickert
- ARDEN NET Centre, ENETS Centre of Excellence, University Hospitals Coventry and Warwickshire NHS Trust and Warwick Medical School, University of Warwick, Coventry, UK
| | - John Ramage
- Kings Health Partners NET Centre, Kings College Hospital London, London, UK
| | - Eva Segelov
- Department of Oncology and Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Victoria, Australia
| | | | - Stefan Staettner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria
| | - Mauro Cives
- Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Carol Anne Moulton
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medical, Baltimore, Maryland, USA
| | - Florian Boesch
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Selberheer
- Section Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University, Vienna, Austria
| | - Orit Twito
- Endocrine Institute, Meir Medical Center, Kfar-Sava, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Antonio Castaldi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudio G De Angelis
- Gastroenterology Unit, Department of Medical Sciences, City of Health and Science Hospital, Turin, Italy
| | - Sebastien Gaujoux
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Sorbonne University, Pitiè Salpétrière Hospital, Paris, France
| | - Katharina Holzer
- Department of Visceral-, Thoracic- and Vascular Surgery, Section of Endocrine Surgery, University Hospital Marburg (UKGM), Marburg, Germany
| | - Colin H Wilson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hussein Almeamar
- National NET Centre and ENETS Centre of Excellence, St Vincent's University Hospital, Dublin, Ireland
| | - Emanuel Vigia
- Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, CHULC, Lisbon, Portugal
| | - Francesca Muffatti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Pancreas Translational and Clinical Research Centre, Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Lucà
- Division of Gastroenterology and Centre for Autoimmune Liver Diseases, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Lania
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Jacques Ewald
- Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Maria Rinzivillo
- Digestive Disease Unit, ENETS Centre of Excellence, Sant' Andrea University Hospital, Rome, Italy
| | - Alojz Smid
- Department of Gastroenterology and Hepatology, University Medical Centre Ljubijana, Ljubljana, Slovenia
| | - Andrea Gardini
- General and Oncological Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Marina Tsoli
- First Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Olivia Hentic
- Department of Pancreatology, Hôpital Beaujon, University of Paris, Paris, France
| | - Samuele Colombo
- Division of Gastrointestinal Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Citterio
- Gastrointestinal and Hepato-Pancreatic Surgery and Liver Transplantation Unit, Fondazione, IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute) and Università degli Studi di Milano, Milan, Italy
| | - Christos Toumpanakis
- ENETS Centre of Excellence, Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
| | - Emma Ramsey
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Southampton, UK
| | | | | | - Daniel Croagh
- Department of Oncology and Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Victoria, Australia
| | - Paolo Regi
- Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Silvia Gasteiger
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Pietro Invernizzi
- Division of Gastroenterology and Centre for Autoimmune Liver Diseases, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Ridolfi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Hospital-IRCCS, Rozzano, Milan, Italy
| | - Marc Giovannini
- Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Massimo Falconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Pancreas Translational and Clinical Research Centre, Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Capretti G, Nebbia M, Gavazzi F, Nappo G, Ridolfi C, Sollai M, Spaggiari P, Bozzarelli S, Carrara S, Luberto A, Zerbi A. Invasive IPMN relapse later and more often in lungs in comparison to pancreatic ductal adenocarcinoma. Pancreatology 2022; 22:782-788. [PMID: 35701318 DOI: 10.1016/j.pan.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/09/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The different oncological outcomes of invasive intraductal papillary mucinous neoplasm (I-IPMN) and pancreatic ductal adenocarcinoma (PDAC) are debated. This study aimed to compare disease recurrence patterns and histopathological characteristics in patients with resected I-IPMN and PDAC. METHODS Consecutive patients undergoing surgical resection for stage I-III I-IPMN or PDAC between 2010 and 2016 were retrospectively analyzed. Patients treated with neoadjuvant therapy or resected for Tis neoplasia were excluded. All surgical specimens were re-staged according to AJCC-8th-edition. RESULTS A total of 330 patients were included, of whom 43 had I-IPMN and 287 had PDAC. Median follow-up time was 26.7 (1.3-92.3) months and estimated median disease-free survival (DFS) was 60.3 months (47.2-73.4) for I-IPMN and 23.8 (19.3-28.2) months for PDAC (p < 0.001). During follow-up, 32.6% of I-IPMN and 67.9% of PDAC patients experienced recurrence (p < 0.001). The sites of first recurrence were the lungs (38.5% vs 13.1%, p = 0.027), liver (28.6% vs 45.0%, p = 0.180) and local (15.4% vs 36.6%, p = 0.101) for I-IPMN and PDAC, respectively. At multivariate analysis, I-IPMN histology remained an independent predictive factor for longer DFS (OR 0.528, CI 95% 0.278-1.000, p = 0.050), regardless of stage or adjuvant chemotherapy. I-IPMN and PDAC differed in rates of neuroinvasion (51.2% vs 97.2%) and positive lymph node status (N+) (46.5% vs 82.7%), especially in patients with lower T status. CONCLUSION I-IPMN showed a different recurrence pattern compared to PDAC, with a higher lung tropism, and longer DFS. This different biological behavior is associated with lower rates of neuroinvasion and nodal involvement, especially in early-stage disease.
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Affiliation(s)
- Giovanni Capretti
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy
| | - Martina Nebbia
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy.
| | - Francesca Gavazzi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Gennaro Nappo
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy
| | - Cristina Ridolfi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Mauro Sollai
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Paola Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Silvia Bozzarelli
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Antonio Luberto
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Humanitas University Department of Biomedical Sciences, Rozzano, Pieve Emanuele, Milan, Italy
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6
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Gavazzi F, Capretti G, Giordano L, Ridolfi C, Spaggiari P, Sollai M, Carrara S, Nappo G, Bozzarelli S, Zerbi A. Pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous tumor: Different prognostic factors for different overall survival. Dig Liver Dis 2022; 54:826-833. [PMID: 34219044 DOI: 10.1016/j.dld.2021.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is unclear whether invasive intraductal papillary mucinous neoplasm (IPMN) has different clinical and prognostic characteristics, beyond histological factors, when compared to pancreatic ductal adenocarcinoma (PDAC). AIMS compare prognostic features of resected PDAC and invasive IPMN METHODS: A retrospective study of patients resected for PDAC or invasive IPMN realized at Humanitas Cancer Center's Pancreatic Surgery Unit, Milan, Italy, between 2010 and 2016. Data recorded included patient demographics, onset symptoms, preoperative health status, tumor features, histology and surgical characteristics. Overall survival was estimated using Kaplan-Meier and prognostic factors for survival were assessed by multivariate Cox regression. RESULTS A total of 332 patients were included (PDAC, n = 289; invasive IPMN, n = 43). Patients with invasive IPMN had better overall survival than PDAC patients (median: 76.6 versus 25.6 months; 5-year OS rate: 65.4% vs. 14.2%; p < 0.001). PDAC histology was associated with a significantly higher risk of death than IPMN (hazard ratio 1.815, 95% CI: 1.02, 3.24; p = 0.044). Survival was also worse with PDAC in early-stage disease (IA-IB-IIA, N0). In multivariate analysis, independent predictors of worse survival included perineural invasion, preoperative ASA physical status ≥3 and pain at diagnosis. CONCLUSIONS Patients with IPMN had a better prognosis than PDAC patients, regardless of disease stage.
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Affiliation(s)
- Francesca Gavazzi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Giovanni Capretti
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Humanitas University Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Laura Giordano
- Division of Biostatistics, Department of Oncology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Cristina Ridolfi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Paola Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Mauro Sollai
- Department of Pathology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Gennaro Nappo
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Silvia Bozzarelli
- Department of Oncology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Humanitas University Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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7
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Nappo G, Gentile D, Galvanin J, Capretti G, Ridolfi C, Petitti T, Spaggiari P, Carrara S, Gavazzi F, Repici A, Zerbi A. Trans-duodenal ampullectomy for ampullary neoplasms: early and long-term outcomes in 36 consecutive patients. Surg Endosc 2020; 34:4358-4368. [PMID: 31646438 DOI: 10.1007/s00464-019-07206-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Trans-duodenal ampullectomy (TDA) is a surgical option for the treatment of selected ampullary neoplasms. The aim of this study was to evaluate our experience with TDA for the treatment of ampullary neoplasms, focusing on indications, technical aspects, and short- and long-term outcomes. METHODS All TDAs for ampullary neoplasms performed between January 2010 and December 2018 at our institution were retrospectively evaluated. Patients had ampullary neoplasms with low-grade dysplasia or in situ carcinoma (Tis) not suitable for an endoscopic approach, ampullary carcinoma unfit for pancreaticoduodenectomy (PD), or ampullary neuroendocrine G1-tumours. RESULTS Thirty-six patients were included in the study: 9 (25.0%) with neoplasms with low-grade dysplasia, 4 (11.1%) with G1 neuroendocrine tumours and 23 (63.9%) with Tis or invasive carcinoma. Mean operative time was 252.5 min. Overall and severe (Clavien-Dindo > IIIa) morbidity rate was 44.4% and 13.9%, respectively. No 90-day mortality was observed. At follow-up, no deaths were observed and local recurrence rate was 11.1% for patients with ampullary adenomas with low-grade dysplasia. Among four patients with neuroendocrine neoplasms, only one developed recurrence (pulmonary). Tis, T1 and T2 lesions were found in 16 (69.6%), 2 (8.7%) and 5 (21.7%) patients, respectively: recurrence occurred in 3 patients with Tis lesions (one malignant), no patients with T1 neoplasms and 2 patients with T2 lesions (3 patients had a survival of > 3 years). CONCLUSIONS TDA is a feasible and effective surgical procedure for the treatment of ampullary adenomas with low-grade dysplasia when endoscopic approach is contraindicated or has failed. For lesions with evidence of malignancy, TDA seems to be an oncological safe procedure for Tis ampullary cancer and a good palliative procedure for patients unfit for PD. Moreover, TDA may be appropriate for the treatment of G1 ampullary neuroendocrine neoplasms. A large multicentre study of TDA for early ampullary cancers is needed.
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Affiliation(s)
- Gennaro Nappo
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - Damiano Gentile
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Jacopo Galvanin
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giovanni Capretti
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Cristina Ridolfi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | | | - Paola Spaggiari
- Pathology Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Cancer Center - IRCCS, Rozzano, Milan, Italy
| | - Francesca Gavazzi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Cancer Center - IRCCS, Rozzano, Milan, Italy.,Humanitas University, Rozzano, Milan, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy.,Humanitas University, Rozzano, Milan, Italy
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8
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Parollo M, Zucchelli G, Barletta V, Della Tommasina V, Canu A, Giannotti Santoro M, Ridolfi C, Branchitta G, Carluccio M, Bongiorni MG. P1358Atrial electromechanical interval in patients with arrhythmias: is everyone the same? Europace 2020. [DOI: 10.1093/europace/euaa162.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial electromechanical delay, assessed calculating the PA-TDI interval using tissue Doppler imaging, is a known and promising determinant for atrial fibrillation recurrence prediction after pulmonary vein isolation and electrical cardioversion.
Purpose
To determine the relationship between atrial electromechanical delay and the presence of atrial fibrillation.
Methods
We prospectively enrolled patients presenting at our Unit in sinus rhythm scheduled for an arrhythmogenic substrate ablation (atrial fibrillation -AF-, supraventricular tachycardia -SVT- and premature ventricular contractions -PVC-). Demographic and echocardiographic characteristics were evaluated upon admission. Atrial electromechanical delay was inferred via the PA-TDI interval, obtained by calculating the time difference between the P wave onset and the A" wave peak on TDI recordings.
Results
From October 2018 to August 2019, 200 patients (60% male, mean age 58,21 ± 14,26, mean BSA 1,9 ± 0,21 m2, mean BMI 26,42 ± 6,28 kg/m2, mean EF 60,91% ± 5,43%) were admitted to our unit to undergo AF (group 1: n = 145; 72,50%), SVT or PVC ablation (group 2: n = 55; 27,5%). Compared with the control group (group 2), patients admitted for AF ablation had a larger LA size (group 1 vs group 2: mean LA area 23,21 ± 5,07 vs 16,87 ± 4,01 cm2, p < 0,001; mean indexed LA volume 46,71 ± 20,41 ml vs 32,04 ± 14,7 ml, p < 0,001; mean LAD 41,77 ± 5,66 vs 33,84 ± 6,06, p < 0,001) and a longer PA-TDI interval (lateral 148,55 ± 28,5 vs 128,57 ± 20,9, p < 0,001; medial 125,34 ± 21,02 vs 109,11 ± 21,49, p < 0,001; average 141,43 ± 27,58 vs 119,08 ± 18,63, p < 0,001).
Conclusion
The PA-TDI interval is a non-invasive and easily achievable echocardiographic parameter, which is demonstrated to be prolonged in patients with a history of AF in contrast with patients with other arrhythmias, as expression of atrial conduction heterogeneity.
Abstract Figure. PA-TDI measurement
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Affiliation(s)
- M Parollo
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - G Zucchelli
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - V Barletta
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - V Della Tommasina
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - A Canu
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | | | - C Ridolfi
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - G Branchitta
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - M Carluccio
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
| | - M G Bongiorni
- Azienda Ospedaliero-Universitaria Pisana, U.O. Cardiologia 2, Pisa, Italy
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9
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Cortese N, Capretti G, Barbagallo M, Rigamonti A, Takis PG, Castino GF, Vignali D, Maggi G, Gavazzi F, Ridolfi C, Nappo G, Donisi G, Erreni M, Avigni R, Rahal D, Spaggiari P, Roncalli M, Cappello P, Novelli F, Monti P, Zerbi A, Allavena P, Mantovani A, Marchesi F. Metabolome of Pancreatic Juice Delineates Distinct Clinical Profiles of Pancreatic Cancer and Reveals a Link between Glucose Metabolism and PD-1 + Cells. Cancer Immunol Res 2020; 8:493-505. [PMID: 32019781 DOI: 10.1158/2326-6066.cir-19-0403] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/30/2019] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Abstract
Better understanding of pancreatic diseases, including pancreatic ductal adenocarcinoma (PDAC), is an urgent medical need, with little advances in preoperative differential diagnosis, preventing rational selection of therapeutic strategies. The clinical management of pancreatic cancer patients would benefit from the identification of variables distinctively associated with the multiplicity of pancreatic disorders. We investigated, by 1H nuclear magnetic resonance, the metabolomic fingerprint of pancreatic juice (the biofluid that collects pancreatic products) in 40 patients with different pancreatic diseases. Metabolic variables discriminated PDAC from other less aggressive pancreatic diseases and identified metabolic clusters of patients with distinct clinical behaviors. PDAC specimens were overtly glycolytic, with significant accumulation of lactate, which was probed as a disease-specific variable in pancreatic juice from a larger cohort of 106 patients. In human PDAC sections, high expression of the glucose transporter GLUT-1 correlated with tumor grade and a higher density of PD-1+ T cells, suggesting their accumulation in glycolytic tumors. In a preclinical model, PD-1+ CD8 tumor-infiltrating lymphocytes differentially infiltrated PDAC tumors obtained from cell lines with different metabolic consumption, and tumors metabolically rewired by knocking down the phosphofructokinase (Pfkm) gene displayed a decrease in PD-1+ cell infiltration. Collectively, we introduced pancreatic juice as a valuable source of metabolic variables that could contribute to differential diagnosis. The correlation of metabolic markers with immune infiltration suggests that upfront evaluation of the metabolic profile of PDAC patients could foster the introduction of immunotherapeutic approaches for pancreatic cancer.
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Affiliation(s)
- Nina Cortese
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Giovanni Capretti
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele-Milan, Italy
| | - Marialuisa Barbagallo
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Alessandra Rigamonti
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Panteleimon G Takis
- Giotto Biotech S.R.L., Sesto Fiorentino, Florence, Italy.,Department of Metabolism, Digestion and Reproduction, National Phenome Centre, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Giovanni F Castino
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Debora Vignali
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulia Maggi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Francesca Gavazzi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Cristina Ridolfi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Gennaro Nappo
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Greta Donisi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Marco Erreni
- Unit of Advanced Optical Microscopy, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Roberta Avigni
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Daoud Rahal
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Paola Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Massimo Roncalli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele-Milan, Italy.,Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Paola Cappello
- Center for Experimental Research and Medical Studies, Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesco Novelli
- Center for Experimental Research and Medical Studies, Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Paolo Monti
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Zerbi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele-Milan, Italy
| | - Paola Allavena
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Alberto Mantovani
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele-Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Federica Marchesi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy. .,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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10
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Di Leo M, Poliani L, Rahal D, Auriemma F, Anderloni A, Ridolfi C, Spaggiari P, Capretti G, Di Tommaso L, Preatoni P, Zerbi A, Carnaghi C, Lania A, Malesci A, Repici A, Carrara S. Pancreatic Neuroendocrine Tumours: The Role of Endoscopic Ultrasound Biopsy in Diagnosis and Grading Based on the WHO 2017 Classification. Dig Dis 2019; 37:325-333. [PMID: 30897588 DOI: 10.1159/000499172] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND One of the controversial issues in the diagnosis of pancreatic neuroendocrine tumours (pNETs) is the accurate prediction of their clinical behaviour. OBJECTIVES The aim of the study was to evaluate the role of endoscopic ultrasound (EUS) biopsy in the diagnosis and grading of pNETs in a certified ENETS Center. METHODS A prospectively maintained database of EUS biopsy procedures was retrospectively reviewed to identify all consecutive patients referred to a certified ENETS Center with a suspicion of pNET between June 2014 and April 2017. The cytological and/or histological specimens were stained and the Ki-67 labeling index was evaluated. In patients undergoing surgery, the grade obtained with EUS-guided biopsy was compared with the final histological grade. The grade was evaluated according to the 2017 WHO classifications and grading. RESULTS The study population included 59 patients. EUS biopsy material reached an adequacy of 98.3% and was adequate for Ki-67 evaluation in 84.7% of cases. Twenty-nine patients (49.2%) underwent surgery. Of these, 25 patients had Ki-67 evaluated on EUS biopsy: the agreement between EUS biopsy grading and surgical specimen grading was 84%. CONCLUSION EUS biopsy is an accurate method for the diagnosis and grading of pNETs based on the WHO 2017 Ki-67 labelling scheme.
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Affiliation(s)
- Milena Di Leo
- Humanitas Clinical and Research Center, IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy, .,Humanitas University, Department of Biomedical Sciences, Milan, Italy,
| | - Laura Poliani
- Humanitas Clinical and Research Center, IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Daoud Rahal
- Department of Pathology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Francesco Auriemma
- Humanitas Clinical and Research Center, IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Andrea Anderloni
- Humanitas Clinical and Research Center, IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Cristina Ridolfi
- Humanitas Clinical and Research Center, IRCCS, Pancreatic Surgery Unit, Milan, Italy
| | - Paola Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giovanni Capretti
- Humanitas Clinical and Research Center, IRCCS, Pancreatic Surgery Unit, Milan, Italy
| | - Luca Di Tommaso
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Department of Pathology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Paoletta Preatoni
- Humanitas Clinical and Research Center, IRCCS, Division of Gastroenterology, Milan, Italy
| | - Alessandro Zerbi
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Humanitas Clinical and Research Center, IRCCS, Pancreatic Surgery Unit, Milan, Italy
| | - Carlo Carnaghi
- Humanitas Clinical and Research Center, IRCCS, Division of Oncology, Milan, Italy
| | - Andrea Lania
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Humanitas Clinical and Research Center, IRCCS, Division of Endocrinology, Milan, Italy
| | - Alberto Malesci
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,Humanitas Clinical and Research Center, IRCCS, Division of Gastroenterology, Milan, Italy
| | - Alessandro Repici
- Humanitas Clinical and Research Center, IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Silvia Carrara
- Humanitas Clinical and Research Center, IRCCS, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
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11
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Gianni L, Arcangeli V, Gianni C, Stocchi L, Menghini L, Samorani D, Ridolfi C, Emiliano T, Tassinari D. Abstract P3-11-05: Everolimus-exemestane (EE) vs palbociclib-fulvestrant (PF) or abemaciclib-fulvestrant (AF) or everolimus-fulvestrant (EF) in the treatment of metastatic HR+, HER2- metastatic breast cancer and prior aromatase inhibitors treatment. An indirect comparison with network meta-analysis. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-11-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Treatment options for patients with hormone receptor positive metastatic breast cancer (MBC) and prior treatment with aromatase inhibitors (AIs) include EE or PF. To date no direct comparison has been presented between EE and Fulvestrant plus Cyclin-dependent Kinase 4/6 (CDK4/6) inhibitors in this setting. The objective of this study was to compare the efficacy of EE to PF or AF or EF in the treatment of metastatic HR+, HER2- breast cancer pre-treated with AIs.
Methods. An indirect comparison with a network meta-analysis comparing EE with PF or AF or EF in the treatment of metastatic HR+, HER2- breast cancer pre-treated with AIs was performed. The Progression-Free-Survival (PFS) was the primary end point of all our indirect comparisons. Efficacy data were expressed as Hazard Ratio (HR) and 95% Confidence Interval (95CI), assuming an α-error of 5% as index of statistical significance.
Results. All the data of the BOLERO-2 trial, the Bachelot et al network meta-analysis (Breast Cancer Treat Rep 2014), the Paloma-3, the Monarch-2, and the prECOG trials were analyzed and indirectly compared in a network meta-analysis. 6 orders of comparison were performed: AF vs PL, PF vs EE, AF vs EE, EF vs AF, EF vs PF and EF vs EE. The pooled HR and 95%CI are reported in table1.
Table 1: difference in PFS between comparatorsComparisonsHR (95% CI)AF vs PF1.202 (0.87-1.661) p = 0.265PF vs EE1.674 (0.995-2.818) p = 0.89AF vs EE2.012 (1.09-3.714) p = 0.025EF vs AF1.085 (0.681-1.728) p = 0.731EF vs PF1.304 (0.804-2.117) p = 0.283EF vs EE2.183 (1.072-4.444) p = 0.031Everolimus-exemestane (EE), palbociclib-fulvestrant (PF), abemaciclib-fulvestrant (AF), everolimus-fulvestrant (EF).
Conclusions. Till today EE and PF represent active and approved treatments for patients with metastatic HR+, HER2- breast cancer treated with AIs. The results of Monarch-2 study with AF vs Fulvestrant and prECOG study with FE vs Fulvestrant were recently presented and were included in this metaanalysis, while the results of Ribociclib and Fulvestrant vs Fulvestrant (Monaleesa-3 study) are not currently available.
These studies generally show that combination of hormone therapies with Everolimus or CDK4/6 inhibitors are better than hormone-therapy alone, however no direct comparisons between these treatment combinations exist in literature. The results of our indirect treatment comparisons suggests that EE is similar and, in some cases, it may be even better than other treatment options. The optimal treatment strategy and sequence for patient with MBC and prior treatment with AIs should be evaluated in clinical trials. Meanwhile these data could be considered together with safety and the economic profile to help physicians in daily clinical practice.
Citation Format: Gianni L, Arcangeli V, Gianni C, Stocchi L, Menghini L, Samorani D, Ridolfi C, Emiliano T, Tassinari D. Everolimus-exemestane (EE) vs palbociclib-fulvestrant (PF) or abemaciclib-fulvestrant (AF) or everolimus-fulvestrant (EF) in the treatment of metastatic HR+, HER2- metastatic breast cancer and prior aromatase inhibitors treatment. An indirect comparison with network meta-analysis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-11-05.
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Affiliation(s)
- L Gianni
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
| | - V Arcangeli
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
| | - C Gianni
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
| | - L Stocchi
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
| | - L Menghini
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
| | - D Samorani
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
| | - C Ridolfi
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
| | - T Emiliano
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
| | - D Tassinari
- Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; Servizio di Diagnostica Senologica e Prevenzione, Infermi Hospital, AUSL Romagna, Rimini, RN, Italy; UO General Surgery, Franchini Hospital, AUSL Romagna, Santarcangelo di Romagna, RN, Italy
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12
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Bianchi E, Fantini M, Nicoletti S, Drudi F, Tamburini E, Cherubini C, Ridolfi C, Montanari F, Venturi A, Pasini G, Tassinari D. Enzalutamide (E) vs abiraterone acetate (AA) in the treatment of metastatic, castration-resistant prostate cancer. Indirect comparisons and network meta-analysis for clinical practice. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx423.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Agli LL, Cherubini C, Papi M, Santelmo C, Nicoletti S, Bianchi E, Fantini M, Ridolfi C, Stocchi L, Tamburini E, Tassinari D. Cisplatin-raltitrexed vs cisplatin-pemetrexed in the treatment of advanced pleural mesothelioma. Final results of a network meta-analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw391.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Di Caro G, Cortese N, Castino GF, Grizzi F, Gavazzi F, Ridolfi C, Capretti G, Mineri R, Todoric J, Zerbi A, Allavena P, Mantovani A, Marchesi F. Dual prognostic significance of tumour-associated macrophages in human pancreatic adenocarcinoma treated or untreated with chemotherapy. Gut 2016; 65:1710-20. [PMID: 26156960 DOI: 10.1136/gutjnl-2015-309193] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 06/21/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Tumour-associated macrophages (TAMs) play key roles in tumour progression. Recent evidence suggests that TAMs critically modulate the efficacy of anticancer therapies, raising the prospect of their targeting in human cancer. DESIGN In a large retrospective cohort study involving 110 patients with pancreatic ductal adenocarcinoma (PDAC), we assessed the density of CD68-TAM immune reactive area (%IRA) at the tumour-stroma interface and addressed their prognostic relevance in relation to postsurgical adjuvant chemotherapy (CTX). In vitro, we dissected the synergism of CTX and TAMs. RESULTS In human PDAC, TAMs predominantly exhibited an immunoregulatory profile, characterised by expression of scavenger receptors (CD206, CD163) and production of interleukin 10 (IL-10). Surprisingly, while the density of TAMs associated to worse prognosis and distant metastasis, CTX restrained their protumour prognostic significance. High density of TAMs at the tumour-stroma interface positively dictated prognostic responsiveness to CTX independently of T-cell density. Accordingly, in vitro, gemcitabine-treated macrophages became tumoricidal, activating a cytotoxic gene expression programme, inhibiting their protumoural effect and switching to an antitumour phenotype. In patients with human PDAC, neoadjuvant CTX was associated to a decreased density of CD206(+) and IL-10(+) TAMs at the tumour-stroma interface. CONCLUSIONS Overall, our data highlight TAMs as critical determinants of prognostic responsiveness to CTX and provide clinical and in vitro evidence that CTX overall directly re-educates TAMs to restrain tumour progression. These results suggest that the quantification of TAMs could be exploited to select patients more likely to respond to CTX and provide the basis for novel strategies aimed at re-educating macrophages in the context of CTX.
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Affiliation(s)
- Giuseppe Di Caro
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Nina Cortese
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Francesca Gavazzi
- Section of Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Cristina Ridolfi
- Section of Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Giovanni Capretti
- Section of Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Rossana Mineri
- Molecular Biology Section, Clinical Investigation Laboratory, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Jelena Todoric
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, University of California San Diego, San Diego, California, USA
| | - Alessandro Zerbi
- Section of Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Paola Allavena
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Alberto Mantovani
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Federica Marchesi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Rozzano, Italy
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15
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Nicoletti S, Cherubini C, Papi M, Tamburini E, Fantini M, Nicolini M, Ridolfi C, Santelmo C, Gianni L, Lazzari Agli L, Tassinari D. Cisplatin-raltitrexed vs cisplatin-pemetrexed in the treatment of advanced pleural mesothelioma. final results of a network meta-analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Cherubini C, Bianchi E, Montanari F, Tamburini E, Fantini M, Ridolfi C, Santelmo C, Nicoletti S, Pasini G, Stocchi L, Tassinari D. Treament options in advanced castration-resistant, docetaxel-resistant prostate cancer (acrdrpc). final results of a network meta-analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw334.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Stocchi L, Famtini M, Drudi G, Barzotti E, Ridolfi C, Nicoletti S, Arcangeli V, Drudi F, Nicolini M, Polselli A, Santelmo C, Tamburini E, Gianni L, Tassinari D. Toxicity of targeted therapy in elderly patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Angiolini MR, Gavazzi F, Ridolfi C, Moro M, Morelli P, Montorsi M, Zerbi A. Role of C-Reactive Protein Assessment as Early Predictor of Surgical Site Infections Development after Pancreaticoduodenectomy. Dig Surg 2016; 33:267-75. [PMID: 27216609 DOI: 10.1159/000445006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are extremely common in pancreatic surgery and explain its considerable morbidity and mortality, even in tertiary centers. Early detection of these complications, with the help of laboratory assays, improve clinical outcome. The aim of the present study is to evaluate C-reactive protein (CRP) diagnostic accuracy as early predictor of SSIs after pancreaticoduodenectomy (PD). METHODOLOGY We considered 251 consecutive PD. We prospectively recorded preoperative clinical and anthropometric data, intraoperative details and the postoperative outcome. In the first pool of consecutive patients (n = 150), we analyzed CRP levels from postoperative day 1 to 7 and investigated the prediction of SSIs. We then validated the diagnostic accuracy on the following 101 consecutive cases. RESULTS At multivariate analysis, high BMI and preoperative biliary stenting appeared to be independently associated with SSIs and organ-space SSI development. The CRP cutoff of 17.27 mg/dl on postoperative day 3 (78% sensitivity, 79% specificity) and of 14.72 mg/dl on postoperative day 4 (87% sensitivity, 82% specificity) was in a position to predict the course of 78.2 and 80.2% of patients, respectively. CONCLUSIONS CRP on postoperative days 3 and 4 seems able to predict postoperative course, selecting patients deserving intensification of diagnostic assessment; patients not satisfying these conditions could be reasonably directed toward early discharge.
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Affiliation(s)
- Maria Rachele Angiolini
- Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
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19
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Gavazzi F, Ridolfi C, Capretti G, Angiolini MR, Morelli P, Casari E, Montorsi M, Zerbi A. Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in surgical site infections after pancreaticoduodenectomy. BMC Gastroenterol 2016; 16:43. [PMID: 27036376 PMCID: PMC4815172 DOI: 10.1186/s12876-016-0460-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/19/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The routine use of preoperative biliary drainage before pancreaticoduodenectomy (PD) remains controversial. This observational retrospective study compared stented and non-stented patients undergoing PD to assess any differences in post-operative morbidity and mortality. METHODS A total of 180 consecutive patients who underwent PD and had intra-operative bile cultures performed between January 2010 and February 2013 were retrospectively identified. All patients received peri-operative intravenous antibiotic prophylaxis, primarily cefazolin. RESULTS Overall incidence of post-operative surgical complications was 52.3 %, with no difference between stented and non-stented patients (53.4 % vs. 51.1 %; p = 0.875). However, stented patients had a significantly higher incidence of deep incisional surgical site infections (SSIs) (p = 0.038). In multivariate analysis, biliary stenting was confirmed as a risk factor for deep incisional SSIs (p = 0.044). Significant associations were also observed for cardiac disease (p = 0.010) and BMI ≥25 kg/m(2) (p = 0.045). Enterococcus spp. were the most frequent bacterial isolates in bile (74.5 %) and in drain fluid (69.1 %). In antimicrobial susceptibilty testing, all Enterococci isolates were cefazolin-resistant. CONCLUSION Given the increased risk of deep incisional SSIs, preoperative biliary stenting in patients underging PD should be used only in selected patients. In stented patients, an antibiotic with anti-enterococcal activity should be chosen for PD prophylaxis.
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Affiliation(s)
- Francesca Gavazzi
- Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Cristina Ridolfi
- Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Capretti
- Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Maria Rachele Angiolini
- Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Paola Morelli
- Infectious Diseases Unit, Hospital Health Direction, Humanitas Research Hospital, Rozzano, Italy
| | - Erminia Casari
- Microbiology Unit, Analysis Laboratory, Humanitas Research Hospital, Rozzano, Italy
| | - Marco Montorsi
- Chancellor of Humanitas University, Chief of Department of Surgery, Humanitas Research Hospital, Rozzano, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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20
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Tamburini E, Rudnas B, Gianni L, Drudi F, Nicoletti S, Santelmo C, Ridolfi C, Pasini G, Fabbri P, Papi M, Tassinari D. Anti-EGFR or Bevacizumab in first line treatment of RAS wild type metastatic colorectal neoplasm (RwtMCRC): meta-analysis of randomized clincal trials. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Castino GF, Cortese N, Capretti G, Serio S, Di Caro G, Mineri R, Magrini E, Grizzi F, Cappello P, Novelli F, Spaggiari P, Roncalli M, Ridolfi C, Gavazzi F, Zerbi A, Allavena P, Marchesi F. Spatial distribution of B cells predicts prognosis in human pancreatic adenocarcinoma. Oncoimmunology 2015; 5:e1085147. [PMID: 27141376 DOI: 10.1080/2162402x.2015.1085147] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/15/2015] [Indexed: 12/19/2022] Open
Abstract
B-cell responses are emerging as critical regulators of cancer progression. In this study, we investigated the role of B lymphocytes in the microenvironment of human pancreatic ductal adenocarcinoma (PDAC), in a retrospective consecutive series of 104 PDAC patients and in PDAC preclinical models. Immunohistochemical analysis revealed that B cells occupy two histologically distinct compartments in human PDAC, either scatteringly infiltrating (CD20-TILs), or organized in tertiary lymphoid tissue (CD20-TLT). Only when retained within TLT, high density of B cells predicted longer survival (median survival 16.9 mo CD20-TLThi vs. 10.7 mo CD20-TLTlo; p = 0.0085). Presence of B cells within TLT associated to a germinal center (GC) immune signature, correlated with CD8-TIL infiltration, and empowered their favorable prognostic value. Immunotherapeutic vaccination of spontaneously developing PDAC (KrasG12D-Pdx1-Cre) mice with α-enolase (ENO1) induced formation of TLT with active GCs and correlated with increased recruitment of T lymphocytes, suggesting induction of TLT as a strategy to favor mobilization of immune cells in PDAC. In contrast, in an implanted tumor model devoid of TLT, depletion of B cells with an anti-CD20 antibody reinstated an antitumor immune response. Our results highlight B cells as an essential element of the microenvironment of PDAC and identify their spatial organization as a key regulator of their antitumor function. A mindfully evaluation of B cells in human PDAC could represent a powerful prognostic tool to identify patients with distinct clinical behaviors and responses to immunotherapeutic strategies.
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Affiliation(s)
| | - Nina Cortese
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Giovanni Capretti
- Section of Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Simone Serio
- Operational Unit of Milano; Institute of Genetics and Biomedical Research, National Research Council and Humanitas Clinical and Research Center , Rozzano, Italy
| | - Giuseppe Di Caro
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Rossana Mineri
- Molecular Biology Section, Clinical Investigation Laboratory, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Elena Magrini
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Paola Cappello
- Center for Experimental Research and Medical Studies, Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino , Torino, Italy
| | - Francesco Novelli
- Center for Experimental Research and Medical Studies, Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino , Torino, Italy
| | - Paola Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Massimo Roncalli
- Department of Pathology, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Cristina Ridolfi
- Section of Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Francesca Gavazzi
- Section of Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Alessandro Zerbi
- Section of Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Paola Allavena
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center , Rozzano, Italy
| | - Federica Marchesi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milano, Italy
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22
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Affatato A, Stocchi L, Drudi F, Nicoletti S, Monterubbianesi M, Ridolfi C, Barzotti E, Santelmo C, Carloni F, Tassinari D. Early Palliative Care in Cancer Patients. Systematic Review of Literature, with Meta-Analysis of Randomized Clinical Trials. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu350.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Tamburini E, Drudi F, Nicoletti S, Santelmo C, Ridolfi C, Papi M, Stocchi L, Fantini M, Tassinari D. Maintenance Bevacizumab After Induction Chemotherapy: Systematic Review of Literature and Meta-Analysis of Randomized Clinical Trials. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Braga M, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di Carlo V. Learning curve for laparoscopic distal pancreatectomy in a high-volume hospital. Updates Surg 2012; 64:179-83. [DOI: 10.1007/s13304-012-0163-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/09/2012] [Indexed: 12/13/2022]
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25
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Rulli F, Ridolfi C, Farinon AM. Laparoscopic colorectal surgery and community hospitals. Can J Surg 2007; 50:410-411. [PMID: 18031646 PMCID: PMC2386177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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26
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Rulli F, Galatà G, Villa M, Maura A, Ridolfi C, Grande M, Farinon AM. A simple indicator of correct nasogastric suction tube placement in children and adults. Endoscopy 2007; 39 Suppl 1:E237-8. [PMID: 17674284 DOI: 10.1055/s-2007-966613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- F Rulli
- Department of Surgery, Tor Vergata University of Rome, Italy.
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27
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Presutti L, Accorsi F, Ridolfi C, Dall'Olio D. [Echo-color Doppler and echo-Doppler in the diagnosis of carotid body tumors]. Acta Otorhinolaryngol Ital 1995; 15:107-11. [PMID: 8928648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Echo-Doppler and Color Flow Doppler examinations, are able to combine the advantages offered by echography with those had with the Doppler exam. In the presence of tumours of the carotid body, these exams can furnish morphological data with regard to tumor size, its precise location and its rapport with contiguous organ as well as data regarding blood flow in the mass itself. The color Flow Doppler exam, in particular, can reveal the echographic aspect and the flow toward and away from the sonde all on the same image. This enables a precise diagnosis of a tumor of the carotid body to be reached even without angiography. The personal experience here reported involves ten cases observed during the last seven years.
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Affiliation(s)
- L Presutti
- Divisione ORL, Ospedale Maggiore, Bologna
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28
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Cantarone G, Ridolfi C, Savelli L, Alberti T, Matera N, Nasi C. [Pleural mesothelioma. Description of a case of slow development]. Minerva Med 1975; 66:1300-7. [PMID: 805383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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29
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Rizzi R, Pollazzon G, Ridolfi C. [The psychological behavior of the patient on the eve of surgery and its impact on his pre- and postoperative state]. Anesth Analg (Paris) 1975; 32:69-86. [PMID: 773215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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30
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Matera N, Ridolfi C, Alberti T, Cantarone G, Nasi C, Rimondini R. [Pheochromocytoma (description of an unusual clinical case)]. Acta Gerontol (Milano) 1971; 21:165-74. [PMID: 5003748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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31
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Rossi S, Ridolfi C, Cantarone G. [Unusual electrocardiographic aspects of hypocalcemia]. Acta Gerontol (Milano) 1970; 20:237-46. [PMID: 5514132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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32
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Pagliarini G, Pollazzon G, Ridolfi C, Rizzi R, Vacondio L. [Clinico-statistical pluricentral study of postoperative pain]. Minerva Anestesiol 1968; 34:626-31. [PMID: 5736761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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