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Ielpo B, Rosso E, d'Addetta MV, Abad M, Vellalta G, Sanchez-Velazquez P, Burdio F. Robotic Approach for Perihilar Cholangiocarcinoma IIIA Type: Step-by-Step Procedure. Ann Surg Oncol 2024; 31:3084-3085. [PMID: 38315334 DOI: 10.1245/s10434-024-14956-z] [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] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Perihilar cholangiocarcinoma is a challenging technique to be performed by minimally invasive approach being the type III among the most complex procedure. Nowadays, the robotic approach is gaining increasing interest among the surgical community, and more and more series describing robotic liver resection have been reported. However, few cases of minimally invasive Bismuth type IIIA cholangiocarcinoma have been reported. Robotic approach allows for a better dissection and suture thanks to the flexible and precise instruments movements, overcoming some of the limitations of the laparoscopic technique. Therefore, robotic technique can facilitate some of the critical steps of a technically demanding procedure, such as the extended right hepatectomy for perihilar cholangiocarcinoma Bismuth IIIA type. METHODS In this multimedia video we describe, for the first time in the literature, a full robotic surgical step-by-step technique with some tips and tricks for treating a perihilar cholangiocarcinoma Bismuth IIIA type, performing a radical extended right hemihepatectomy, including segment I combined with regional lymphadenectomy anf left bile duct reconstruction. A 55-year-old woman with obstructive jaundice (10 mg/dl) was referred to our center. The endobiliary brushing confirmed adenocarcinoma, and MRI/CT showed a focal perihilar lesion of 2 cm, including the main biliary duct bifurcation and extending up to the right duct (Bismuth Type IIIA hilar cholangiocarcinoma). After endoscopic biliary stents placement and 6 weeks after right portal vein embolization, the future liver remnant, including segments II and III, reached an enough hypertrophy volume with a ratio of 30%. A right hemihepatectomy with caudate lobe, including standard standard lymphadenectomy and left biliary duct reconstruction was performed. RESULTS The operation lasted 670 min with an estimated blood loss of 350 ml. Postoperative pathological examination revealed a moderately differentiated adenocarcinoma pT1N0 with 15 retrieved nodes and free margins. The patient experienced a type A biliary fistula and was discharged on the 21st postoperative day without abdominal drainage. CONCLUSIONS Through the tips and tricks presented in this multimedia article, we show the advantages of the robotic approach for performing correctly one of the most complex surgeries.1-7.
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Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain.
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Maria Vittoria d'Addetta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Mayra Abad
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Gemma Vellalta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
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Ielpo B, Rosso E, d'Addetta MV, Abad M, Vellalta G, Sanchez-Velazquez P, Burdio F. ASO Author Reflections: Robotic Approach for Perihilar Cholangiocarcinoma. Ann Surg Oncol 2024; 31:3106-3107. [PMID: 38334849 DOI: 10.1245/s10434-024-15006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain.
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Maria Vittoria d'Addetta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Mayra Abad
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Gemma Vellalta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
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Ielpo B, d'Addetta MV, Anselmo A, Rosso E, de Blasi V, Sanchez-Velazquez P, Vellalta G, Podda M, Burdio F. Levels of Robotic Mesopancreas Dissection According to Malignancy and Vascular Anatomy: What Surgeons Need to Know. Ann Surg Oncol 2024; 31:1916-1918. [PMID: 38071705 PMCID: PMC10838235 DOI: 10.1245/s10434-023-14686-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/13/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION The robotic approach is attracting increasing interest among the surgical community, and more and more series describing robotic pancreatoduodenectomy have been reported. Thus, surgeons performing robotic pancreatoduodenectomy should be confident with this critical step's potential scenarios. MATERIALS AND METHODS According to Yosuke et al., there are three different levels of mesopancreas dissection. We describe the main steps for a safe mesopancreas dissection by robotic approach. RESULTS This multimedia article provides, for the first time in literature, a comprehensive step-by-step overview of the mesopancreas dissection during robotic pancreatoduodenectomy (PD) and its three different levels according to tumor type. CONCLUSIONS Through the tips and indications presented in this multimedia article, we aim to familiarize surgeons with the mesopancreas dissections levels according to type of malignancy and vascular anatomy.
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Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain.
| | - Maria Vittoria d'Addetta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
- Hepato-Biliary Surgery, Borgoroma Hospital, Verona, Italy
| | - Alessandro Anselmo
- HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Vito de Blasi
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Gemma Vellalta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
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Ielpo B, d'Addetta MV, Anselmo A, Rosso E, de Blasi V, Sanchez-Velazquez P, Vellalta G, Podda M, Burdio F. ASO Visual Abstract: Levels of Robotic Mesopancreas Dissection According to Malignancy and Vascular Anatomy-What Surgeons Need to Know. Ann Surg Oncol 2024; 31:1953. [PMID: 38143266 DOI: 10.1245/s10434-023-14796-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Affiliation(s)
- Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain.
| | - Maria Vittoria d'Addetta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
- Hepato-Biliary Surgery, Borgoroma Hospital, Verona, Italy
| | - Alessandro Anselmo
- HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxebourg, Luxembourg
| | - Vito de Blasi
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxebourg, Luxembourg
| | - Patricia Sanchez-Velazquez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Gemma Vellalta
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Fernando Burdio
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital Parc Salut Mar, Pompeu Fabra University, Barcelona, Spain
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Boggi U, Kauffmann E, Napoli N, Barreto SG, Besselink MG, Fusai GK, Hackert T, Abu Hilal M, Marchegiani G, Salvia R, Shrikhande S, Truty M, Werner J, Wolfgang C, Bannone E, Capretti G, Cattelani A, Coppola A, Cucchetti A, De Sio D, Di Dato A, Di Meo G, Fiorillo C, Gianfaldoni C, Ginesini M, Hidalgo Salinas C, Lai Q, Miccoli M, Montorsi R, Pagnanelli M, Poli A, Ricci C, Sucameli F, Tamburrino D, Viti V, Addeo PF, Alfieri S, Bachellier P, Baiocchi G, Balzano G, Barbarello L, Brolese A, Busquets J, Butturini G, Caniglia F, Caputo D, Casadei R, Chunhua X, Colangelo E, Coratti A, Costa F, Crafa F, Dalla Valle R, De Carlis L, de Wilde RF, Del Chiaro M, Di Benedetto F, Di Sebastiano P, Dokmak S, Hogg M, Egorov VI, Ercolani G, Ettorre GM, Falconi M, Ferrari G, Ferrero A, Filauro M, Giardino A, Grazi GL, Gruttaduaria S, Izbicki JR, Jovine E, Katz M, Keck T, Khatkov I, Kiguchi G, Kooby D, Lang H, Lombardo C, Malleo G, Massani M, Mazzaferro V, Memeo R, Miao Y, Mishima K, Molino C, Nagakawa Y, Nakamura M, Nardo B, Panaro F, Pasquali C, Perrone V, Rangelova E, Riu L, Romagnoli R, Romito R, Rosso E, Schulick R, Siriwardena A, Spampinato M, Strobel O, Testini M, Troisi R, Uzunoglo FG, Valente R, Veneroni L, Zerbi A, Vicente E, Vistoli F, Vivarelli M, Wakabayashi G, Zanus G, Zureikat A, Zyromski NJ, Coppola R, D'Andrea V, Davide J, Dervenis C, Frigerio I, Konlon KC, Michelassi F, Montorsi M, Nealon W, Portolani N, Sousa Silva D, Bozzi G, Ferrari V, Trivella MG, Cameron J, Clavien PA, Asbun HJ. REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer. Ann Surg 2024:00000658-990000000-00795. [PMID: 38407228 DOI: 10.1097/sla.0000000000006248] [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: 02/27/2024]
Abstract
OBJECTIVE The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. METHODS The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines. RESULTS Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ). CONCLUSIONS The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Emanuele Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - S George Barreto
- College of Medicine and Public Health, Flinders University, South Australia, Australia, Division of Surgery and Perioperative Medicine, Flinders Medical Center, Beadfor Park, Australia
| | - Marc G Besselink
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | | | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Marchegiani
- Hepatopancreatobiliary and Liver Transplant Surgery, Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Shailesh Shrikhande
- Tata Memorial Hospital, Gastrointestinal and HPB Service, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Mark Truty
- Division of Hepatobiliary & Pancreas Surgery, Department of Surgery, Mayo Clinic Rochester, MN, USA
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, LMU, University of Munich, Germany
| | - Christopher Wolfgang
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Elisa Bannone
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Alice Cattelani
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum Università di Bologna; Bologna, Italy
| | - Davide De Sio
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Armando Di Dato
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J) University of Bari, Italy
| | - Claudio Fiorillo
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Cesare Gianfaldoni
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | | | - Quirino Lai
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umberto I of Rome, Rome, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Montorsi
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | | | - Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy, Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna (IRCCS AOUBO)
| | - Francesco Sucameli
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Domenico Tamburrino
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Virginia Viti
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Pietro F Addeo
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sergio Alfieri
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Philippe Bachellier
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Gianluca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia and UOC General Surgery, ASST Cremona, Italy
| | - Gianpaolo Balzano
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Linda Barbarello
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Alberto Brolese
- Department of General Surgery & HPB Unit, APSS, Trento, Italy
| | - Juli Busquets
- Division of Pancreatobiliary Surgery and Liver Transplantation, Department of Surgery, Bellvitge University Hospital, IDIBELL, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Giovanni Butturini
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Fabio Caniglia
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Damiano Caputo
- Research Unit of General Surgery, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo 200,00128 Rome, Italy
- Operative Research Unit of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Riccardo Casadei
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy, Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna (IRCCS AOUBO)
| | - Xi Chunhua
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute, Nanjing Medical University
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University
| | - Ettore Colangelo
- Department of General Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Andrea Coratti
- Department of General and Emergency Surgery, AUSL Toscana Sud Est, Misericordia Hospital of Grosseto, Italy
| | - Francesca Costa
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Francesco Crafa
- Division of General, Oncological and Robotic Surgery, San Giuseppe Moscati Hospital, Avellino Italy
| | | | - Luciano De Carlis
- Division of HPB Surgery and Transplantation, Niguarda Hospital , University of Milano-Bicocca, Milan, Italy
| | - Roeland F de Wilde
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado School of Medicine. Aurora, Colorado, USA
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Pierluigi Di Sebastiano
- Surgical Oncology, Pierangeli Clinic, Department of Innovative Technology in Medicine & Dentistry, G. D'Annunzio University Chieti-Pescara, Italy
| | - Safi Dokmak
- department of HPB surgery and liver transplantation, Beaujon hospital, Clichy, France. University Paris Cité, Paris, France
| | - Melissa Hogg
- Division of HPB Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Vyacheslav I Egorov
- Department for Surgical Oncology and HPB Surgery, Ilyinskaya Hospital, Moscow, Russia
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum Università di Bologna; Bologna, Italy
| | - Giuseppe Maria Ettorre
- Department of General Surgery and Transplantation. San Camillo Forlanini Hospital-POIT. Rome, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Marco Filauro
- Department of Surgery Galliera Hospital, Genova, Italy
| | - Alessandro Giardino
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Gian Luca Grazi
- Division of HepatoBiliaryPancreatic Surgery, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Salvatore Gruttaduaria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy (UPMC Italy), Palermo, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Jakob R Izbicki
- Department of general visceral and thoracic surgery, University Hospital Eppendorf University of Hamburg, Hamburg, Germany
| | - Elio Jovine
- Department of Surgery, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliera Universitaria di Bologna
| | - Matthew Katz
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Igor Khatkov
- Department of High Technology Surgery, Moscow Clinical Scientific Center. Moscow, Russia
| | - Gozo Kiguchi
- Department of Surgery, Hirakata Kohsai Hospital, Osaka, Japan
| | - David Kooby
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hauke Lang
- University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Carlo Lombardo
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Marco Massani
- Department of Surgery, Regional Hospital of Treviso, Treviso, Italy
| | - Vincenzo Mazzaferro
- Department of Oncology and Hemato-oncology, University of Milan HPB Surgery and Liver Transplantation Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Riccardo Memeo
- Department of HPB Surgery, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute, Nanjing Medical University
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Kohei Mishima
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
| | - Carlo Molino
- Department of General and Speciality Surgery, General and Pancreatic Surgery Team 1, AORN A. Cardarelli, Naples, Italy
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Bruno Nardo
- Division of General Surgery, Department of Surgery and Robotic, Annunziata Hub Hospital, School of Medicine Surgery and TD, University of Calabria, Cosenza, Italy
| | - Fabrizio Panaro
- Department of Surgery, Division of HBP Surgery & Transplantation. Montpellier University Hospital School of Medicine, Montpellier, France
| | - Claudio Pasquali
- Pancreatic & Digestive Endocrine Surgery Research Group - Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Vittorio Perrone
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Elena Rangelova
- Section for Upper Abdominal Surgery at the Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery at the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Long Riu
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Renato Romagnoli
- Division of General Surgery 2U - Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Raffaele Romito
- Division of General Surgery II and HPB Unit, A.O.U. Maggiore della Carità di Novara, Novara, Italy
| | - Edoardo Rosso
- Service de Chirurgie Générale, Mini-Invasive et Robotique, Centre Hôspitalier de
| | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine. Aurora, Colorado, USA
| | - Ajith Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Marcello Spampinato
- Department of General and Minimally Invasive Surgery, "Vito Fazzi" Hospital, Lecce, Italy Luxembourg, Luxembourg, Luxembourg
| | - Oliver Strobel
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J) University of Bari, Italy
| | - Roberto Troisi
- Division of HBP, Minimally Invasive and Robotic Surgery, Transplantation Service Federico II University Hospital - Naples, Italy
| | - Faik G Uzunoglo
- Department of general visceral and thoracic surgery, University Hospital Eppendorf University of Hamburg, Hamburg, Germany
| | | | - Luigi Veneroni
- Chirurgia Generale, Infermi Hospital Rimini, AUSL Romagna, Rimini, Italy
| | | | - Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Fabio Vistoli
- Division of General Surgery and Transplantation, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Vivarelli
- Division of Hepatobiliary, Pancreatic and Transplantation Surgery, Polytechnic University of Marche, Ospedali Riuniti delle Marche, Ancona, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Giacomo Zanus
- Second Division of Surgery-Treviso-Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Amer Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Roberto Coppola
- Research Unit of General Surgery, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo 200,00128 Rome, Italy
- Operative Research Unit of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Vito D'Andrea
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - José Davide
- Department of Surgery, HEBIPA - Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Isabella Frigerio
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Kevin C Konlon
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fabrizio Michelassi
- Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital at Weill Cornell, New Yourk, NY, USA
| | - Marco Montorsi
- Department of Biomedical Sciences, Humanitas University, Italy
- Division of General and Digestive Surgery, Department of General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - William Nealon
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA; Zucker School of Medicine at Hofstra, New Hyde Park, NY, USA
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Italy
| | - Donzília Sousa Silva
- Department of Surgery, HEBIPA - Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | | | | | - John Cameron
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
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Ricci C, Kauffmann EF, Pagnanelli M, Fiorillo C, Ferrari C, De Blasi V, Panaro F, Rosso E, Zerbi A, Alfieri S, Boggi U, Casadei R. Minimally invasive versus open radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma: an entropy balancing analysis. HPB (Oxford) 2024; 26:44-53. [PMID: 37775352 DOI: 10.1016/j.hpb.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/25/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The safety and efficacy of minimally invasive radical antegrade modular pancreatosplenectomy (MI-RAMPS) remain to be established in pancreatic cancer (PDAC) METHODS: Eighty-five open (O)-RAMPS were compared to 93 MI-RAMPS. The entropy balance matching approach was used to compare the two cohorts, eliminating the selection bias. Three models were created. Model 1 made O-RAMPS equal to the MI-RAMPS cohort (i.e., compared the two procedures for resectable PDAC); model 2 made MI-RAMPS equal to O-RAMPS (i.e., compared the two procedures for borderline-resectable PDAC); model 3, compared robotic and laparoscopic RAMPS. RESULTS O-RAMPS and MI-RAMPS showed "non-small" differences for BMI, comorbidity, back pain, tumor size, vascular resection, anterior or posterior RAMPS, multi-visceral resection, stump management, grading, and neoadjuvant therapy. Before reweighting, O-RAMPS had fewer clinically relevant postoperative pancreatic fistulae (CR-POPF) (20.0% vs. 40.9%; p = 0.003), while MI-RAMPS had a higher mean of lymph nodes (25.7 vs. 31.7; p = 0.011). In model 1, MI-RAMPS and O-RAMPS achieved similar results. In model 2, O-RAMPS was associated with lower comprehensive complication index scores (MD = 11.2; p = 0.038), and CR-POPF rates (OR = 0.2; p = 0.001). In model 3, robotic-RAMPS had a higher probability of negative resection margins. CONCLUSION In patients with anatomically resectable PDAC, MI-RAMPS is feasible and as safe as O-RAMPS.
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Affiliation(s)
- Claudio Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Italy; Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy.
| | | | - Michele Pagnanelli
- Section of Pancreatic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS di Roma, Largo Agostino Gemelli, 8, 00168, Rome, Italy; Università Cattolica del Sacro Cuore di Roma, Rome, Italy; CRMPG (Gemelli Pancreatic Advanced Research Center), Italy
| | - Cecilia Ferrari
- Department of Digestive Surgery and Transplantation, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Vito De Blasi
- Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg
| | - Fabrizio Panaro
- Department of Digestive Surgery and Transplantation, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Edoardo Rosso
- Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg
| | - Alessandro Zerbi
- Section of Pancreatic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS di Roma, Largo Agostino Gemelli, 8, 00168, Rome, Italy; Università Cattolica del Sacro Cuore di Roma, Rome, Italy; CRMPG (Gemelli Pancreatic Advanced Research Center), Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Italy
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Italy; Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy
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7
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Ferrari C, Leon P, Falconi M, Boggi U, Piardi T, Sulpice L, Cavaliere D, Rosso E, Chirica M, Ravazzoni F, Memeo R, Pessaux P, De Blasi V, Mascherini M, De Cian F, Navarro F, Panaro F. Multi-visceral resection for left-sided pancreatic ductal adenocarcinoma: a multicenter retrospective analysis from European countries. Langenbecks Arch Surg 2023; 408:386. [PMID: 37776339 DOI: 10.1007/s00423-023-03110-0] [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] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Due to delayed diagnosis and a lower surgical indication rate, left-sided pancreatic ductal adenocarcinoma (PDAC) is often associated with a poor prognosis in comparison to pancreatic head tumors. Multi-visceral resections (MVR) associated with distal pancreatectomy could be proposed for patients presenting with locally infiltrating disease. METHODS We retrospectively analyzed a multi-centric cohort of left-sided PDAC patients operated on from 2009 to 2020. Thirteen European high-volume HPB centers participated in this study. We analyzed patients who underwent distal pancreatectomy (DP) associated with MVR and compared them to standard DP patients. RESULTS Among 258 patients treated curatively for PDAC of the body and tail, 28 patients successfully underwent MVR. A longer operative time was observed in the MVR group (295 min +/- 74 vs. 250 min +/- 96, p= 0.248). The post-operative complication rate was comparable between the two groups (46.4% in the MVR group vs. 62.2% in the control group, p= 0.108). The incidence of positive margin (R1) was similar between the two groups (28.6% vs. 26.6%; p=0.827). After a median follow-up of 25 (9-111) months, overall survival was comparable between the two groups (p= 0.519). CONCLUSIONS Multi-visceral resection in left-sided pancreatic ductal adenocarcinoma is safe and feasible and should be considered in selected cases as it seems to provide acceptable surgical and oncological outcomes.
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Affiliation(s)
- Cecilia Ferrari
- HPB and Transplant Unit, University of Montpellier, Montpellier, France.
- Ospedale Policlinico San Martino, Genova, Italy.
| | - Piera Leon
- HPB and Transplant Unit, University of Montpellier, Montpellier, France
| | - Massimo Falconi
- Chirurgia Pancreatica, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Ugo Boggi
- Chirurgia HPB e Trapianto di Fegato, Ospedale Cisanello, Università degli Studi di Pisa, Pisa, Italy
| | | | | | | | - Edoardo Rosso
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | | | | | | | | | - Vito De Blasi
- Service de Chirurgie Générale et Mini-Invasive, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | | | - Francis Navarro
- HPB and Transplant Unit, University of Montpellier, Montpellier, France
| | - Fabrizio Panaro
- HPB and Transplant Unit, University of Montpellier, Montpellier, France
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Lof S, Claassen L, Hannink G, Al-Sarireh B, Björnsson B, Boggi U, Burdio F, Butturini G, Capretti G, Casadei R, Dokmak S, Edwin B, Esposito A, Fabre JM, Ferrari G, Fretland AA, Ftériche FS, Fusai GK, Giardino A, Groot Koerkamp B, D’Hondt M, Jah A, Kamarajah SK, Kauffmann EF, Keck T, van Laarhoven S, Manzoni A, Marino MV, Marudanayagam R, Molenaar IQ, Pessaux P, Rosso E, Salvia R, Soonawalla Z, Souche R, White S, van Workum F, Zerbi A, Rosman C, Stommel MWJ, Abu Hilal M, Besselink MG. Learning Curves of Minimally Invasive Distal Pancreatectomy in Experienced Pancreatic Centers. JAMA Surg 2023; 158:927-933. [PMID: 37378968 PMCID: PMC10308297 DOI: 10.1001/jamasurg.2023.2279] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/23/2023] [Indexed: 06/29/2023]
Abstract
Importance Understanding the learning curve of a new complex surgical technique helps to reduce potential patient harm. Current series on the learning curve of minimally invasive distal pancreatectomy (MIDP) are mostly small, single-center series, thus providing limited data. Objective To evaluate the length of pooled learning curves of MIDP in experienced centers. Design, Setting, and Participants This international, multicenter, retrospective cohort study included MIDP procedures performed from January 1, 2006, through June 30, 2019, in 26 European centers from 8 countries that each performed more than 15 distal pancreatectomies annually, with an overall experience exceeding 50 MIDP procedures. Consecutive patients who underwent elective laparoscopic or robotic distal pancreatectomy for all indications were included. Data were analyzed between September 1, 2021, and May 1, 2022. Exposures The learning curve for MIDP was estimated by pooling data from all centers. Main Outcomes and Measures The learning curve was assessed for the primary textbook outcome (TBO), which is a composite measure that reflects optimal outcome, and for surgical mastery. Generalized additive models and a 2-piece linear model with a break point were used to estimate the learning curve length of MIDP. Case mix-expected probabilities were plotted and compared with observed outcomes to assess the association of changing case mix with outcomes. The learning curve also was assessed for the secondary outcomes of operation time, intraoperative blood loss, conversion to open rate, and postoperative pancreatic fistula grade B/C. Results From a total of 2610 MIDP procedures, the learning curve analysis was conducted on 2041 procedures (mean [SD] patient age, 58 [15.3] years; among 2040 with reported sex, 1249 were female [61.2%] and 791 male [38.8%]). The 2-piece model showed an increase and eventually a break point for TBO at 85 procedures (95% CI, 13-157 procedures), with a plateau TBO rate at 70%. The learning-associated loss of TBO rate was estimated at 3.3%. For conversion, a break point was estimated at 40 procedures (95% CI, 11-68 procedures); for operation time, at 56 procedures (95% CI, 35-77 procedures); and for intraoperative blood loss, at 71 procedures (95% CI, 28-114 procedures). For postoperative pancreatic fistula, no break point could be estimated. Conclusion and Relevance In experienced international centers, the learning curve length of MIDP for TBO was considerable with 85 procedures. These findings suggest that although learning curves for conversion, operation time, and intraoperative blood loss are completed earlier, extensive experience may be needed to master the learning curve of MIDP.
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Affiliation(s)
- Sanne Lof
- Amsterdam UMC, Department of Surgery, University of Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
- Department of Surgery, Fondazione Poliambulanza–Istituto Ospedaliero, Brescia, Italy
| | - Linda Claassen
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bilal Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Italy
| | | | | | - Giovanni Capretti
- Department of Surgery, Humanitas University and IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Riccardo Casadei
- Department of Surgery, S Orsola-Malpighi Hospital, Bologna, Italy
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Bjørn Edwin
- The Intervention Center and Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Jean M. Fabre
- Department of Surgery, Saint-Éloi Hospital, Montpellier, France
| | - Giovanni Ferrari
- Department of Oncologic and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Asmund A. Fretland
- The Intervention Center and Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Fadhel S. Ftériche
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Giuseppe K. Fusai
- Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Asif Jah
- Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sivesh K. Kamarajah
- Department of Surgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | | | - Tobias Keck
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Germany
| | - Stijn van Laarhoven
- Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Alberto Manzoni
- Department of Surgery, Fondazione Poliambulanza–Istituto Ospedaliero, Brescia, Italy
| | - Marco V. Marino
- Department of Emergency and General Surgery, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Ravi Marudanayagam
- Department of Surgery, Queen Elizabeth Hospital, University Hospitals of Birmingham NHS Trust, Birmingham, United Kingdom
| | - Izaak Q. Molenaar
- Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, the Netherlands
| | - Patrick Pessaux
- Department of Viscerale and Digestive Surgery, Nouvel Hôpital Civil–IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Edoardo Rosso
- Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Zahir Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Regis Souche
- Department of Surgery, Saint-Éloi Hospital, Montpellier, France
| | - Steven White
- Department of Surgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Frans van Workum
- Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Alessandro Zerbi
- Department of Surgery, Humanitas University and IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Mohammed Abu Hilal
- Department of Surgery, Fondazione Poliambulanza–Istituto Ospedaliero, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation, Southampton, United Kingdom
| | - Marc G. Besselink
- Amsterdam UMC, Department of Surgery, University of Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
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Chierici A, Castaldi A, El Zibawi M, Rosso E, Iannelli A. How to deal with right hepatic artery coming from the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review. Hepatobiliary Pancreat Dis Int 2023; 22:121-127. [PMID: 36604294 DOI: 10.1016/j.hbpd.2022.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/09/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anatomical variations in the liver arterial supply are quite common and can affect the surgical strategy when performing a minimally invasive pancreaticoduodenectomy (MIPD). Their presence must be preemptively detected to avoid postoperative liver and biliary complications. DATA SOURCES Following the PRISMA guidelines and the Cochrane protocol we conducted a systematic review on the management of an accessory or replaced right hepatic artery (RHA) arising from the superior mesenteric artery when performing an MIPD. RESULTS Five studies involving 118 patients were included. The most common reported management of the aberrant RHA was conservative (97.0%); however, patients undergoing aberrant RHA division without reconstruction did not develop liver or biliary complications. No differences in postoperative morbidity or long-term oncological related overall survival were reported in all the included studies when comparing MIPD in patients with standard anatomy to those with aberrant RHA. CONCLUSIONS MIPD in patients with aberrant RHA is feasible without increase in morbidity and mortality. As preoperative strategy is crucial, we suggested planning an MIPD with an anomalous RHA focusing on preoperative vascular aberrancy assessment and different strategies to reduce the risk of liver ischemia.
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Affiliation(s)
- Andrea Chierici
- Service de Chirurgie Digestive, Centre Hospitalier d'Antibes Juan-les-Pins, Antibes, France.
| | - Antonio Castaldi
- Department of Digestive Surgery and Liver Transplantation, University Hospital Center of Nice, Nice, France
| | - Mohamed El Zibawi
- Department of Radiology, University Hospital Center of Nice, Nice, France
| | - Edoardo Rosso
- Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Antonio Iannelli
- Department of Digestive Surgery and Liver Transplantation, University Hospital Center of Nice, Nice, France; Faculty of Medicine, Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 'Hepatic Complications of Obesity and Alcohol', Nice, France
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Schotte H, Pascotto B, Rosso E, S Azagra J, De Blasi V. Littoral cell angioma discovered after splenectomy in a patient with non-Hodgkin lymphoma and melanoma. Case report and review. Ann Ital Chir 2023; 12:S2239253X23038951. [PMID: 36994478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Littoral cell angioma (LCA) is a rare vascular primary tumor of the spleen with no more than 440 cases described so far. Although often seen as benign, it is described to have malignant potential and to be associated with other immunologic disorders or malignancies. CASE PRESENTATION We present the case of LCA in a 75-year old man with a concomitant non-Hodgkin lymphoma and medical history of malign melanoma. The tumor was discovered incidentally after splenectomy for splenomegaly and refractory thrombocytopenia. The post-operative period was uneventful. CONCLUSION Our case is the first to report an association of LCA with both lymphoma and melanoma thus far. It emphasizes the need for a thorough total body examination for synchronous diseases and close follow-up to reveal associated malignancies or immunologic disorders. Further research is required to identify etiologic and pathogenetic mechanisms behind this tumor and a common basis between the three diseases. KEY WORDS Littoral Cell Angioma, Neoplasm, Splenectomy, Solid Spleen Tumor.
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Ielpo B, Anselmo A, Masuda Y, Xuan MYH, Burdio F, De Blasi V, Sanchez-Velazquez P, Giuliani A, Azagra JS, Viola GM, Podda M, Pellino G, Rosso E. Superior Mesenteric Artery First Approach for Minimally Invasive Pancreaticoduodenectomy: A Step-By-Step Surgical Technique Video. Ann Surg Oncol 2023; 30:1500-1503. [PMID: 36335270 DOI: 10.1245/s10434-022-12743-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In the past decade, minimally invasive pancreaticoduodenectomy has been gaining interest. However, minimally invasive pancreaticoduodenectomy remains technically challenging and is associated with a steep learning curve. Additionally, the operating surgeon should be cognizant of replicating the same oncological steps as observed in the typical open approach. In view of this, there exist various maneuvers that are designed to achieve negative margins and a safer mesopancreatic dissection. One of these techniques is the superior mesenteric artery first approach, which is garnering interest among pancreatic surgeons. MATERIAL AND METHODS According to existing literature, there are several superior mesenteric artery dissections approaches. We describes 5 different minimally invasive approaches. RESULTS This multimedia manuscript provide, for the first time in literature, a comprehensive step-by-step overview of the superior mesenteric artery first approach for minimally invasive pancreaticoduodenectomy by a team of expert surgeons from various international institutions. CONCLUSIONS Through the tips and indications presented in this article, we aim to guide the choice of this approach according to tumor location, type of minimally invasive approach and the operating surgeon's experience and increase familiarity with such a complex procedure.
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Affiliation(s)
- Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Anselmo
- HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Yeo Hao Xuan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fernando Burdio
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Vito De Blasi
- Service de Chirurgie Générale et Mini-Invasive ( Lapariscopie et Robotique), Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Patricia Sanchez-Velazquez
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Giuliani
- Unit of General and Emergency Surgery, San Carlo Hospital, Potenza, Italy
| | - Juan Santiago Azagra
- Service de Chirurgie Générale et Mini-Invasive ( Lapariscopie et Robotique), Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Rosso
- Service de Chirurgie Générale et Mini-Invasive ( Lapariscopie et Robotique), Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
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12
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Ielpo B, Anselmo A, Masuda Y, Xuan MYH, Burdio F, De Blasi V, Sanchez-Velazquez P, Giuliani A, Azagra JS, Viola GM, Podda M, Pellino G, Rosso E. ASO Author Reflections: Superior Mesenteric Artery Dissection for Minimally Invasive Pancreaticoduodenectomy: A Technique That All Surgeons Should be Familiar With. Ann Surg Oncol 2023; 30:1504-1505. [PMID: 36402897 DOI: 10.1245/s10434-022-12820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Anselmo
- Department of Surgery, HPB and Transplant Surgery Unit, Policlinico Tor Vergata, Rome, Italy
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Yeo Hao Xuan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fernando Burdio
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Vito De Blasi
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Antonio Giuliani
- Unit of General and Emergency Surgery, San Carlo Hospital, Potenza, Italy
| | - Juan Santiago Azagra
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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13
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Ielpo B, Anselmo A, Masuda Y, Xuan MYH, Burdio F, De Blasi V, Sanchez-Velazquez P, Giuliani A, Azagra JS, Viola GM, Podda M, Pellino G, Rosso E. ASO Visual Abstract: Superior Mesenteric Artery-First Approach for Minimally-Invasive Pancreaticoduodenectomy: A Step-by-Step Surgical Technique Video. Ann Surg Oncol 2023; 30:1506-1507. [PMID: 36550328 DOI: 10.1245/s10434-022-12851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Anselmo
- HPB and Transplant Surgery Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Yeo Hao Xuan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fernando Burdio
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Universitat Pompeu Fabra, Barcelona, Spain
| | - Vito De Blasi
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Antonio Giuliani
- Unit of General and Emergency Surgery, San Carlo Hospital, Potenza, Italy
| | - Juan Santiago Azagra
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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14
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Bulsei J, Chierici A, Alifano M, Castaldi A, Drai C, De Fatico S, Rosso E, Fontas E, Iannelli A. Bariatric surgery reduces the risk of pancreatic cancer in individuals with obesity before the age of 50 years: A nationwide administrative data study in France. European Journal of Surgical Oncology 2022; 49:788-793. [PMID: 36376141 DOI: 10.1016/j.ejso.2022.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Obesity is a well-established risk factor for pancreatic cancer. Bariatric surgery has demonstrated superior results in terms of weight loss and obesity-related comorbidities compared to medical and behavioral treatments. The aim of this study is to evaluate the effect of bariatric surgery on pancreatic cancer incidence in individuals with obesity. METHOD Individuals with a diagnosis of obesity were retrieved from the French national hospital discharge database. We conducted a cohort study comparing the risk to develop pancreatic cancer in individuals with obesity with and without history of bariatric surgery; the inverse probability of treatment weighting (IPTW) method was performed to assess the uncertainty around the results. Moreover, a subgroup analysis according to age at the time of bariatric surgery was performed to study its impact on the risk of pancreatic cancer. Finally, possible differences depending on the type of bariatric procedure (sleeve gastrectomy vs Roux-en-Y gastric bypass) were also explored. RESULTS 160,129 (Bariatric Surgery group) and 1,263,804 (control group) patients with 5.2 ± 1.9 and 6.0 ± 1.9 years of follow-up respectively were included. A significant reduced risk to develop pancreatic cancer during follow-up was identified for the bariatric surgery group in the overall population (HR: 0.567). However, this reduced risk was only observed in the 18-50 years group. These results were furtherly confirmed after IPTW analysis. No difference was found between different bariatric procedures. CONCLUSION Bariatric surgery has a protective effect against pancreatic cancer in the 18-50 years population. High-quality prospective studies are needed to confirm these results.
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Affiliation(s)
- Julie Bulsei
- Centre Hospitalier Universitaire de Nice, Department of Clinical Research and Innovation, Université Côte d'Azur, Nice, France
| | - Andrea Chierici
- Service de Chirurgie Digestive, Centre Hospitalier d'Antibes Juan-les-Pins, 107, av. de Nice, 06600, Antibes, France
| | - Marco Alifano
- Thoracic Surgery Department, Cochin Hospital, APHP Centre, University of Paris, France; INSERM U1138 Team «Cancer, Immune Control, and Escape», Cordeliers Research Center, University of Paris, France
| | - Antonio Castaldi
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Céline Drai
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France
| | - Serena De Fatico
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Edoardo Rosso
- Unité des Maladies de l'Appareil Digestif et Endocrine, Department of Surgery and Robotics, Centre Hospitalier de Luxembourg, L-1210 Luxembourg, Luxembourg
| | - Eric Fontas
- Centre Hospitalier Universitaire de Nice, Department of Clinical Research and Innovation, Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic complications of obesity and alcohol", France.
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15
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Anselmo A, Cascone C, Siragusa L, Sensi B, Materazzo M, Riccetti C, Bacchiocchi G, Ielpo B, Rosso E, Tisone G. Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster? Healthcare (Basel) 2022; 10:healthcare10101898. [PMID: 36292345 PMCID: PMC9602313 DOI: 10.3390/healthcare10101898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/06/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022] Open
Abstract
The development of new systemic treatment strategies has resulted in a significant increase in the response rates of colorectal liver metastases (CRLM) in the last few years. Although the radiological response is a favorable prognostic factor, complete shrinkage of CRLM, known as disappearing liver metastases (DLM), presents a therapeutic dilemma, and proper management is still debated in the literature. In fact, DLM is not necessarily equal to cure, and when resected, pathological examination reveals in more than 80% of patients a variable percentage of the tumor as residual disease or early recurrence in situ. Moreover, while a higher incidence of intrahepatic recurrence is documented in small series when surgery is avoided, its clinical significance for long-term OS is still under investigation. In light of this, a multidisciplinary approach and, in particular, radiologists’ role is needed to assist the surgeon in the management of DLM, thanks to emerging technology and strategy. Therefore, the aim of this review is to provide an overview of the DLM phenomenon and current management.
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Affiliation(s)
- Alessandro Anselmo
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Chiara Cascone
- Department of Surgery, University Campus Bio-Medico di Roma, 00128 Roma, Italy
- Correspondence: ; Tel.: +39-348-445-7000
| | - Leandro Siragusa
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Bruno Sensi
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Marco Materazzo
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Camilla Riccetti
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Giulia Bacchiocchi
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Universitat Pompeu Fabra Barcelona, 08003 Barcelona, Spain
| | - Edoardo Rosso
- Unité des Maladies de l’Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg
| | - Giuseppe Tisone
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
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16
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Ferrari C, Leon P, Falconi M, Boggi U, Al Sadairi AR, Sulpice L, Rosso E, Navarro F, Panaro F. Multivisceral resection for pancreatic ductal adenocarcinoma of the body and tail: Is it worth? A multicentre retrospective analysis from Western European countries. Int J Surg 2022. [DOI: 10.1016/j.ijsu.2022.106531] [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: 10/18/2022]
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17
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Rosso E, Chen J, Champion S, Gordon S. Outcomes of a trial of an age-friendly dining initiative: Dining Co. Health Promot J Austr 2022; 34:379-389. [PMID: 35363904 DOI: 10.1002/hpja.603] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/01/2022] [Accepted: 03/29/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES With the rise of age-friendly cities and communities, increasing attention is being paid to coproducing age-friendly guidelines with older people and community stakeholders. Little is known however about age-friendly guidelines for dining establishments. METHODS A three-stage study to develop general and contextualised requirements for an age-friendly dining experience was conducted in the City of Onkaparinga, South Australia. The first stage involved older people in co-designing aspects of an age-friendly dining experience. Subsequently, the second and third stage coproduced, trialed and evaluated age-friendly initiatives with two dining venues. RESULTS Through co-design, seven domains of an age-friendly dining experience were identified (Menu, Affordability, Dementia Awareness, Venue, Feeling Welcome, Special Offerings and Assistance), alongside an overarching desire for a 'meaningful' dining experience. Differences in health and socioeconomic status of diners underpinned the differences needed to ensure an age-friendly dining experience and highlight the importance of contextualisation for the local population. The trial demonstrated positive outcomes for both older diners and venues. DISCUSSION The environment, value and logistics of dining out are important to older people when making choices about dining in the community. The elements of an age-friendly dining experience presented in this study are a useful starting point for contextualisation to other local settings.
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Affiliation(s)
| | - Jinwen Chen
- College of Education, Psychology & Social Work, Flinders University, Sturt Road, Bedford Park, Australia
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, Sturt Road, Bedford Park, Australia
| | - Susan Gordon
- ACH Group, Henley Beach Road, Mile End, Australia.,Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, Sturt Road, Bedford Park, Australia
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18
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Morató O, Villamonte M, Sánchez-Velázquez P, Pueyo-Périz E, Grande L, Ielpo B, Rosso E, Anselmo A, Burdío F. KRAS Assessment Following ESMO Recommendations for Colorectal Liver Metastases. Is It Always Worth It? Healthcare (Basel) 2022; 10:healthcare10030472. [PMID: 35326950 PMCID: PMC8951263 DOI: 10.3390/healthcare10030472] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Genetic evaluation is essential in assessing colorectal cancer (CRC) and colorectal liver metastasis (CRLM). The aim of this study was to determine the pragmatic value of KRAS on oncological outcomes after CRLM according to the ESMO recommendations and to query whether it is necessary to request KRAS testing in each situation. Methods: A retrospective cohort of 126 patients who underwent surgery for hepatic resection for CRLM between 2009 and 2020 were reviewed. The patients were divided into three categories: wild-type KRAS, mutated KRAS and impractical KRAS according to their oncological variables. The impractical (not tested) KRAS group included patients with metachronous tumours and negative lymph nodes harvested. Disease-free survival (DFS), overall survival (OS) and hepatic recurrence-free survival (HRFS) were calculated by the Kaplan–Meier method, and a multivariable analysis was conducted using the Cox proportional hazards regression model. Results: Of the 108 patients identified, 35 cases had KRAS wild-type, 50 cases had a KRAS mutation and the remaining 23 were classified as impractical KRAS. Significantly longer medians for OS, HRFS and DFS were found in the impractical KRAS group. In the multivariable analyses, the KRAS mutational gene was the only variable that was maintained through OS, HRFS and DFS. For HRFS (HR: 13.63; 95% confidence interval (CI): 1.35–100.62; p = 0.010 for KRAS), for DFS (HR: 10.06; 95% CI: 2.40–42.17; p = 0.002 for KRAS) and for OS (HR: 4.55%; 95% CI: 1.37–15.10; p = 0.013). Conclusion: Our study considers the possibility of unnecessary KRAS testing in patients with metachronous tumours and negative lymph nodes harvested. Combining the genetic mutational profile (i.e., KRAS in specific cases) with tumour characteristics helps patient selection and achieves the best prognosis after CRLM resection.
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Affiliation(s)
- Olga Morató
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Hospital del Mar, Medical Research Institute (IMIM), University Pompeu Fabra, 08003 Barcelona, Spain; (M.V.); (P.S.-V.); (E.P.-P.); (L.G.); (B.I.); (F.B.)
- Correspondence: ; Tel.: +34-93-2483000
| | - Maria Villamonte
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Hospital del Mar, Medical Research Institute (IMIM), University Pompeu Fabra, 08003 Barcelona, Spain; (M.V.); (P.S.-V.); (E.P.-P.); (L.G.); (B.I.); (F.B.)
| | - Patricia Sánchez-Velázquez
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Hospital del Mar, Medical Research Institute (IMIM), University Pompeu Fabra, 08003 Barcelona, Spain; (M.V.); (P.S.-V.); (E.P.-P.); (L.G.); (B.I.); (F.B.)
| | - Eva Pueyo-Périz
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Hospital del Mar, Medical Research Institute (IMIM), University Pompeu Fabra, 08003 Barcelona, Spain; (M.V.); (P.S.-V.); (E.P.-P.); (L.G.); (B.I.); (F.B.)
| | - Luís Grande
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Hospital del Mar, Medical Research Institute (IMIM), University Pompeu Fabra, 08003 Barcelona, Spain; (M.V.); (P.S.-V.); (E.P.-P.); (L.G.); (B.I.); (F.B.)
| | - Benedetto Ielpo
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Hospital del Mar, Medical Research Institute (IMIM), University Pompeu Fabra, 08003 Barcelona, Spain; (M.V.); (P.S.-V.); (E.P.-P.); (L.G.); (B.I.); (F.B.)
| | - Edoardo Rosso
- Unité des Maladies de l’Appareil Digestif et Endocrine, Department of Surgery and Robotics, Centre Hospitalier de Luxembourg, L-1210 Luxembourg, Luxembourg;
| | - Alessandro Anselmo
- HPB and Transplant Unit, Department of Surgery, Policlinico Tor Vergata, 00173 Rome, Italy;
| | - Fernando Burdío
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Hospital del Mar, Medical Research Institute (IMIM), University Pompeu Fabra, 08003 Barcelona, Spain; (M.V.); (P.S.-V.); (E.P.-P.); (L.G.); (B.I.); (F.B.)
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19
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Kennedy-Behr A, Rosso E, McMullen-Roach S, Berndt A, Hauschild A, Bakewell H, Boshoff K, Antonello D, Jeizan B, Murray CM. Intergenerational Virtual Program: Promoting Meaningful Connections Across the Lifespan During the COVID-19 Pandemic. Front Public Health 2021; 9:768778. [PMID: 34988050 PMCID: PMC8720747 DOI: 10.3389/fpubh.2021.768778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Intergenerational programs have long been identified as a way of promoting health and well-being for participants. Continuing such programs during pandemic restrictions is challenging and requires a novel approach. This community case study describes the use of co-design to create a high-level intergenerational program model, adapt it to specific community needs, and deliver it virtually with the aid of modern communication technology. Interviews conducted after the program had finished indicated that despite the challenges and limitations of the virtual environment, meaningful connections were achieved across three generations. The high-level program model may serve as a basis for other programs wanting to explore this area.
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Affiliation(s)
- Ann Kennedy-Behr
- Occupational Therapy, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
- *Correspondence: Ann Kennedy-Behr
| | | | - Sarah McMullen-Roach
- Occupational Therapy, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Angela Berndt
- Occupational Therapy, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ashleigh Hauschild
- Occupational Therapy, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Hannah Bakewell
- Occupational Therapy, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Kobie Boshoff
- Occupational Therapy, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | | | - Badakhsh Jeizan
- Child Care Network and Creche Services, TAFE SA, Adelaide, SA, Australia
| | - Carolyn M. Murray
- Occupational Therapy, UniSA Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
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20
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Zimmitti G, Coppola A, Ardito F, Meniconi R, Ettorre GM, Rosso E, Manzoni A, Colasanti M, Clemente G, Murazio M, Giuliante F. Outcomes comparison of Pancreato-Gastrostomy and Isolated Jejunal Loop Pancreato-Jejunostomy following Pancreato-Duodenectomy in patients with soft pancreas and at moderate-high risk for POPF: a retrospective multicenter experience-based analysis. Updates Surg 2021; 74:223-234. [PMID: 34761349 DOI: 10.1007/s13304-021-01203-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
Following pancreatoduodenectomy (PD), the modality of pancreato-enteric continuity restoration may impact on postoperative pancreatic fistula (POPF) risk. The aim of this study is to compare, among patients with soft pancreas and at moderate/high risk for POPF, the outcomes of PD with Pancreato-Gastrostomy (PG), versus Isolated Jejunal Loop Pancreato-Jejunostomy (IJL-PJ). 193 patients with a Callery Fistula Risk Score (C-FRS) ≥ 3 operated at 3 HPB Units, two performing PG and one IJL-PJ as their preferred anastomotic technique following PD (2009-2019) were included in this study (PG = 123, IJL-PJ = 70). Primary outcomes were POPF, clinically relevant (cr-)postoperative pancreatic hemorrhage (cr-PPH), delayed gastric emptying (cr-DGE), and postoperative major complications and mortality. POPF, cr-PPH, and cr-DGE occurred in 21.8%, 17.6%, and 11.4% of patients, and did not differ significantly between PG (26%, 19.5%, and 10.6%, respectively) and IJL-PJ (17.1%, 14.3%, and 12.9%, respectively; all p > 0.05) patients. Major (Dindo ≥ 3) complication and mortality rates were 26.4% and 3.3%, respectively, and did not differ significantly between PG (29.3% and 3.8%) and IJL-PJ (21.4% and 2.9) patients (p > 0.05). A faster surgical drain and nasogastric tube removal matched a significantly shorter hospitalization among IJL-PJ patients (median LOS: 18 days versus 25 days among PG patients, p < 0.001). In conclusion, IJL-PJ and PG, when performed by surgeons specialized with the concerned anastomotic technique in patients with soft pancreas and moderate/high risk for POPF, have similar results in terms of perioperative mortality and postoperative complications both overall and specific for PD.
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Affiliation(s)
- Giuseppe Zimmitti
- Dipartimento Di Chirurgia Generale, Istituto Ospedaliero Fondazione Poliambulanza, via Bissolati n.57, Brescia, Italy
| | - Alessandro Coppola
- Dipartimento Di Chirurgia Generale Ed Epato-Biliare, Policlinico Universitario Agostino Gemelli, via della Pineta Sacchetti n.217, Roma, Italy
| | - Francesco Ardito
- Dipartimento Di Chirurgia Generale Ed Epato-Biliare, Policlinico Universitario Agostino Gemelli, via della Pineta Sacchetti n.217, Roma, Italy
| | - Roberto Meniconi
- Dipartimento Di Chirurgia Generale E Trapianti, Ospedale S. Camillo-Forlanini Spallanzani, via G. Folchi n.6a, Roma, Italy
| | - Giuseppe Maria Ettorre
- Dipartimento Di Chirurgia Generale E Trapianti, Ospedale S. Camillo-Forlanini Spallanzani, via G. Folchi n.6a, Roma, Italy
| | - Edoardo Rosso
- Dipartimento Di Chirurgia Generale, Istituto Ospedaliero Fondazione Poliambulanza, via Bissolati n.57, Brescia, Italy
| | - Alberto Manzoni
- Dipartimento Di Chirurgia Generale, Istituto Ospedaliero Fondazione Poliambulanza, via Bissolati n.57, Brescia, Italy
| | - Marco Colasanti
- Dipartimento Di Chirurgia Generale E Trapianti, Ospedale S. Camillo-Forlanini Spallanzani, via G. Folchi n.6a, Roma, Italy
| | - Gennaro Clemente
- Dipartimento Di Chirurgia Generale Ed Epato-Biliare, Policlinico Universitario Agostino Gemelli, via della Pineta Sacchetti n.217, Roma, Italy
| | - Marino Murazio
- Dipartimento Di Chirurgia Generale Ed Epato-Biliare, Policlinico Universitario Agostino Gemelli, via della Pineta Sacchetti n.217, Roma, Italy
| | - Felice Giuliante
- Dipartimento Di Chirurgia Generale Ed Epato-Biliare, Policlinico Universitario Agostino Gemelli, via della Pineta Sacchetti n.217, Roma, Italy.
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21
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van Hilst J, Korrel M, Lof S, de Rooij T, Vissers F, Al-Sarireh B, Alseidi A, Bateman AC, Björnsson B, Boggi U, Bratlie SO, Busch O, Butturini G, Casadei R, Dijk F, Dokmak S, Edwin B, van Eijck C, Esposito A, Fabre JM, Falconi M, Ferrari G, Fuks D, Groot Koerkamp B, Hackert T, Keck T, Khatkov I, de Kleine R, Kokkola A, Kooby DA, Lips D, Luyer M, Marudanayagam R, Menon K, Molenaar Q, de Pastena M, Pietrabissa A, Rajak R, Rosso E, Sanchez Velazquez P, Saint Marc O, Shah M, Soonawalla Z, Tomazic A, Verbeke C, Verheij J, White S, Wilmink HW, Zerbi A, Dijkgraaf MG, Besselink MG, Abu Hilal M. Minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma (DIPLOMA): study protocol for a randomized controlled trial. Trials 2021; 22:608. [PMID: 34503548 PMCID: PMC8427847 DOI: 10.1186/s13063-021-05506-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023] Open
Abstract
Background Recently, the first randomized trials comparing minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for non-malignant and malignant disease showed a 2-day reduction in time to functional recovery after MIDP. However, for pancreatic ductal adenocarcinoma (PDAC), concerns have been raised regarding the oncologic safety (i.e., radical resection, lymph node retrieval, and survival) of MIDP, as compared to ODP. Therefore, a randomized controlled trial comparing MIDP and ODP in PDAC regarding oncological safety is warranted. We hypothesize that the microscopically radical resection (R0) rate is non-inferior for MIDP, as compared to ODP. Methods/design DIPLOMA is an international randomized controlled, patient- and pathologist-blinded, non-inferiority trial performed in 38 pancreatic centers in Europe and the USA. A total of 258 patients with an indication for elective distal pancreatectomy with splenectomy because of proven or highly suspected PDAC of the pancreatic body or tail will be randomly allocated to MIDP (laparoscopic or robot-assisted) or ODP in a 1:1 ratio. The primary outcome is the microscopically radical resection margin (R0, distance tumor to pancreatic transection and posterior margin ≥ 1 mm), which is assessed using a standardized histopathology assessment protocol. The sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-β), expected R0 rate in the open group of 58%, expected R0 resection rate in the minimally invasive group of 67%, and a non-inferiority margin of 7%. Secondary outcomes include time to functional recovery, operative outcomes (e.g., blood loss, operative time, and conversion to open surgery), other histopathology findings (e.g., lymph node retrieval, perineural- and lymphovascular invasion), postoperative outcomes (e.g., clinically relevant complications, hospital stay, and administration of adjuvant treatment), time and site of disease recurrence, survival, quality of life, and costs. Follow-up will be performed at the outpatient clinic after 6, 12, 18, 24, and 36 months postoperatively. Discussion The DIPLOMA trial is designed to investigate the non-inferiority of MIDP versus ODP regarding the microscopically radical resection rate of PDAC in an international setting. Trial registration ISRCTN registry ISRCTN44897265. Prospectively registered on 16 April 2018.
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Affiliation(s)
- Jony van Hilst
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, VUMC, ZH-7F18, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Maarten Korrel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, VUMC, ZH-7F18, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Sanne Lof
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, VUMC, ZH-7F18, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Thijs de Rooij
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, VUMC, ZH-7F18, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Frederique Vissers
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, VUMC, ZH-7F18, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | | | - Adnan Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Adrian C Bateman
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ugo Boggi
- Department of Surgery, Universitá di Pisa, Pisa, Italy
| | - Svein Olav Bratlie
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olivier Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, VUMC, ZH-7F18, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | | | - Riccardo Casadei
- Division of Pancreatic Surgery IRCCS, Azienda Ospedaliero Universitaria Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Frederike Dijk
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Safi Dokmak
- Department of HPB surgery and liver transplantation, Beaujon Hospital, Clichy, France
| | - Bjorn Edwin
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - Casper van Eijck
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery - Pancreas Institute, University Hospital of Verona, Verona, Italy
| | | | - Massimo Falconi
- Department of Surgery, San Raffaele Hospital IRCCS, Università Vita-Salute, Milan, Italy
| | - Giovanni Ferrari
- Department of Surgery, Niguarda Ca'Granda Hospital, Milan, Italy
| | - David Fuks
- Department of Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Keck
- Department of Surgery, UKSH campus Lübeck, Lübeck, Germany
| | - Igor Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation
| | - Ruben de Kleine
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Arto Kokkola
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David A Kooby
- Department of Surgery, Emory University Hospital, Atlanta, USA
| | - Daan Lips
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Misha Luyer
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Ravi Marudanayagam
- Department of HPB Surgery, University Hospital Birmingham, Birmingham, UK
| | - Krishna Menon
- Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Matteo de Pastena
- Department of General and Pancreatic Surgery - Pancreas Institute, University Hospital of Verona, Verona, Italy
| | | | - Rushda Rajak
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA
| | - Edoardo Rosso
- Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | | | - Olivier Saint Marc
- Department of Surgery, Centre Hospitalier Regional D'Orleans, Orleans, France
| | - Mihir Shah
- Department of Surgery, Emory University Hospital, Atlanta, USA
| | - Zahir Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Ales Tomazic
- Department of Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Joanne Verheij
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Steven White
- Department of Surgery, The Freeman Hospital Newcastle Upon Tyne, Newcastle, UK
| | - Hanneke W Wilmink
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Alessandro Zerbi
- Department of Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI) and Humanitas University, Pieve Emanuele, MI, Italy
| | - Marcel G Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, VUMC, ZH-7F18, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
| | - Mohammad Abu Hilal
- Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. .,Department of General Surgery, Fondazione Poliambulanza Instituto Ospedaliero, Brescia, Italy.
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22
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Lof S, van der Heijde N, Abuawwad M, Al-Sarireh B, Boggi U, Butturini G, Capretti G, Coratti A, Casadei R, D'Hondt M, Esposito A, Ferrari G, Fusai G, Giardino A, Groot Koerkamp B, Hackert T, Kamarajah S, Kauffmann EF, Keck T, Marudanayagam R, Nickel F, Manzoni A, Pessaux P, Pietrabissa A, Rosso E, Salvia R, Soonawalla Z, White S, Zerbi A, Besselink MG, Abu Hilal M. Robotic versus laparoscopic distal pancreatectomy: multicentre analysis. Br J Surg 2021; 108:188-195. [PMID: 33711145 DOI: 10.1093/bjs/znaa039] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP. METHODS A multicentre international propensity score-matched study included patients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (Clavien-Dindo grade IIIa or above). RESULTS A total of 1551 patients (407 RDP and 1144 LDP) were included in the study. Some 402 patients who had RDP were matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r. 225-350) versus 240 (195-300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7-12) versus 7 (6-10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004). CONCLUSION The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.
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Affiliation(s)
- S Lof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - N van der Heijde
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Abuawwad
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - B Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - U Boggi
- Division of General and Transplant surgery, University of Pisa, Pisa, Italy
| | - G Butturini
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - G Capretti
- Pancreatic Surgery, Humanitas University, Milan, Italy
| | - A Coratti
- Department of Surgical Oncology and Robotics, Careggi University Hospital, Florence, Italy
| | - R Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk, Belgium
| | - A Esposito
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - G Ferrari
- Department of Oncological and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G Fusai
- Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, UK
| | - A Giardino
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - B Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - S Kamarajah
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - E F Kauffmann
- Division of General and Transplant surgery, University of Pisa, Pisa, Italy
| | - T Keck
- Clinic for Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - R Marudanayagam
- Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - A Manzoni
- Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - P Pessaux
- Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil - IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - A Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - E Rosso
- Department of Surgery, Elsan Pôle Santé Sud, Le Mans, France
| | - R Salvia
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Z Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - S White
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A Zerbi
- Pancreatic Surgery, Humanitas University, Milan, Italy
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Abu Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
- Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
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23
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Lof S, Vissers FL, Klompmaker S, Berti S, Boggi U, Coratti A, Dokmak S, Fara R, Festen S, D'Hondt M, Khatkov I, Lips D, Luyer M, Manzoni A, Rosso E, Saint-Marc O, Besselink MG, Abu Hilal M. Risk of conversion to open surgery during robotic and laparoscopic pancreatoduodenectomy and effect on outcomes: international propensity score-matched comparison study. Br J Surg 2021; 108:80-87. [PMID: 33640946 DOI: 10.1093/bjs/znaa026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/23/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Minimally invasive pancreatoduodenectomy (MIPD) is increasingly being performed because of perceived patient benefits. Whether conversion of MIPD to open pancreatoduodenectomy worsens outcome, and which risk factors are associated with conversion, is unclear. METHODS This was a post hoc analysis of a European multicentre retrospective cohort study of patients undergoing MIPD (2012-2017) in ten medium-volume (10-19 MIPDs annually) and four high-volume (at least 20 MIPDs annually) centres. Propensity score matching (1 : 1) was used to compare outcomes of converted and non-converted MIPD procedures. Multivariable logistic regression analysis was performed to identify risk factors for conversion, with results presented as odds ratios (ORs) with 95 per cent confidence intervals (c.i). RESULTS Overall, 65 of 709 MIPDs were converted (9.2 per cent) and the overall 30-day mortality rate was 3.8 per cent. Risk factors for conversion were tumour size larger than 40 mm (OR 2.7, 95 per cent c.i.1.0 to 6.8; P = 0.041), pancreatobiliary tumours (OR 2.2, 1.0 to 4.8; P = 0.039), age at least 75 years (OR 2.0, 1.0 to 4.1; P = 0.043), and laparoscopic pancreatoduodenectomy (OR 5.2, 2.5 to 10.7; P < 0.001). Medium-volume centres had a higher risk of conversion than high-volume centres (15.2 versus 4.1 per cent, P < 0.001; OR 4.1, 2.3 to 7.4, P < 0.001). After propensity score matching (56 converted MIPDs and 56 completed MIPDs) including risk factors, rates of complications with a Clavien-Dindo grade of III or higher (32 versus 34 per cent; P = 0.841) and 30-day mortality (12 versus 6 per cent; P = 0.274) did not differ between converted and non-converted MIPDs. CONCLUSION Risk factors for conversion during MIPD include age, large tumour size, tumour location, laparoscopic approach, and surgery in medium-volume centres. Although conversion during MIPD itself was not associated with worse outcomes, the outcome in these patients was poor in general which should be taken into account during patient selection for MIPD.
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Affiliation(s)
- S Lof
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK.,Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - F L Vissers
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - S Klompmaker
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - S Berti
- Department of Surgery, Sant'Andrea Hospital La Spezia, La Spezia, Italy
| | - U Boggi
- Department of Surgery, Universitá di Pisa, Pisa, Italy
| | - A Coratti
- Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy
| | - S Dokmak
- Department of Surgery, Hospital of Beaujon, Clichy, France
| | - R Fara
- Department of Surgery, Hôpital Européen Marseille, Marseille, France
| | - S Festen
- Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - I Khatkov
- Department of Surgery, Moscow Clinical Scientific Centre, Moscow, Russia
| | - D Lips
- Department of Gastro-intestinal and Oncological Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M Luyer
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - A Manzoni
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - E Rosso
- Department of Surgery, Pôle Santé Sud, Le Mans, France
| | - O Saint-Marc
- Department of Surgery, Centre Hospitalier Regional d'Orleans, Orleans, France
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Abu Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK.,Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
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24
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Azagra JS, Rosso E, Pascotto B, de Blasi V, Henrard A, González González L. Real robotic total mesopancreas excision (TMpE) assisted by hanging manoeuver (HM): Standardised technique. Int J Med Robot 2021; 17:e2259. [PMID: 33825351 DOI: 10.1002/rcs.2259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/28/2021] [Revised: 03/06/2021] [Accepted: 04/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is one of the most demanding interventions for digestive surgeons. R0 resection is a key point for the overall survival and disease-free survival. Total mesopancreas excision (TMpE) has been described by laparotomy but laparoscopy did not provide good results probably because of the technical difficulties of the approach. We propose a standardised total robotic approach. METHODS In this step-by-step technical description, we propose as example, a case of a 53-year-old man with a pancreatic head adenocarcinoma with doubts about the invasion of the mesopancreas surrounding superior mesenteric artery. The mesopancreas hanging manoeuver allows us to perform a TMpE. RESULTS The surgery performed was a robotic artery first pancreaticoduodenectomy with TMpE. The pathological result was pancreatic ductal adenocarcinoma pT2, N1 (1/23), M0, V0, L0, Pn0, R0. CONCLUSIONS Robotic approach is safe, effective and reproductible. Through a standardised technique, it may overcome some of the technical difficulties of laparoscopic PD.
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Affiliation(s)
- Juan Santiago Azagra
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Edoardo Rosso
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Beniamino Pascotto
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Vito de Blasi
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Alexandre Henrard
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Lucia González González
- Department of General and Minimally Invasive Surgery (Laparoscopy and Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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25
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Giuliante F, Ardito F, Aldrighetti L, Ferrero A, Pinna AD, De Carlis L, Cillo U, Jovine E, Portolani N, Gruttadauria S, Mazzaferro V, Massani M, Rosso E, Ettorre GM, Ratti F, Guglielmi A, Cescon M, Colasanti M, Di Sandro S, Gringeri E, Russolillo N, Ruzzenente A, Sposito C, Zanello M, Zimmitti G. Liver resection for perihilar cholangiocarcinoma: Impact of biliary drainage failure on postoperative outcome. Results of an Italian multicenter study. Surgery 2021; 170:383-389. [PMID: 33622570 DOI: 10.1016/j.surg.2021.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative biliary drainage may be essential to reduce the risk of postoperative liver failure after hepatectomy for perihilar cholangiocarcinoma. However, infectious complications related to preoperative biliary drainage may increase the risk of postoperative mortality. The strategy and optimal drainage method continues to be controversial. METHODS This is a retrospective multicenter study including patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2000 and 2016 at 14 Italian referral hepatobiliary centers. The primary end point was to evaluate independent predictors for postoperative outcome in patients undergoing liver resection for perihilar cholangiocarcinoma after preoperative biliary drainage. RESULTS Of the 639 enrolled patients, 441 (69.0%) underwent preoperative biliary drainage. Postoperative mortality was 8.9% (12.5% after right-side hepatectomy versus 5.7% after left-side hepatectomy; P = .003). Of the patients, 40.5% underwent preoperative biliary drainage at the first admitting hospital, before evaluation at referral centers. Use of percutaneous preoperative biliary drainage was significantly more frequent at referral centers than at community hospitals where endoscopic preoperative biliary drainage was the most frequent type. The overall failure rate after preoperative biliary drainage was 43.3%, significantly higher at community hospitals than that at referral centers (52.7% v 36.9%; P = .002). Failure of the first preoperative biliary drainage was one of the strongest predictors for postoperative complications after right-side and left-side hepatectomies and for mortality after right-side hepatectomy. Type of preoperative biliary drainage (percutaneous versus endoscopic) was not associated with significantly different risk of mortality. CONCLUSION Failure of preoperative biliary drainage was significantly more frequent at community hospitals and it was an independent predictor for postoperative outcome. Centers' experience in preoperative biliary drainage management is crucial to reduce the risk of failure that is closely associated with postoperative morbidity and mortality.
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Affiliation(s)
- Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy.
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Antonio D Pinna
- Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Elio Jovine
- Department of General Surgery, Sant'Orsola-Malpighi, IRCCS, University of Bologna, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Vincenzo Mazzaferro
- General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano (National Cancer Institute), University of Milan, Milan, Italy
| | - Marco Massani
- Department of Surgery, Regional Hospital of Treviso, Italy
| | - Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alfredo Guglielmi
- General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | | | | | - Matteo Cescon
- Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Stefano Di Sandro
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Enrico Gringeri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Andrea Ruzzenente
- General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Carlo Sposito
- General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano (National Cancer Institute), University of Milan, Milan, Italy
| | - Matteo Zanello
- Department of General Surgery, Sant'Orsola-Malpighi, IRCCS, University of Bologna, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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26
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Rosso E, Petrucciani N, El Zibawi M, Iannelli A. Pancreaticoduodenectomy with vascular divestment for locally advanced pancreatic neuroendocrine tumour. ANZ J Surg 2021; 91:E551-E553. [PMID: 33417734 DOI: 10.1111/ans.16569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Edoardo Rosso
- Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Mohamed El Zibawi
- Department of Radiology, University Hospital Centre Nice, Nice, France
| | - Antonio Iannelli
- Department of Digestive Surgery and Liver Transplantation, University Hospital Centre Nice, Nice, France.,Université Côte d'Azur, Medicine, Nice, France.,Inserm, U1065, Team 8 'Hepatic complications of obesity and alcohol'
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27
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Zimmitti G, Panettieri E, Ardito F, Mele C, Maria V, Rosso E, Nuzzo G, Giuliante F. Aggressive recurrences determine oncologic outcomes after resection of liver metastases from primary right colon cancer: Results of a case-control study. Eur J Surg Oncol 2020; 47:834-841. [PMID: 33032866 DOI: 10.1016/j.ejso.2020.09.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Despite recent studies suggest that, among patients operated on for colorectal liver metastases (CLM), the primary tumor location may impact on postoperative survivals, results are still contrasting. OBJECTIVE evaluating survivals (overall (OS) and (DFS)) following liver resection of CLM from Right colon Cancer (RcC-CLM) versus Left colon Cancer (LcC-CLM), among patients undergoing preoperative chemotherapy (pCHT), identifying survival predictors, and investigating impact of recurrent disease pattern and management on survival. METHODS Among 727 patients operated for CLM(1989-2016), after excluding patients with primary transverse colon/rectum tumor and patients not receving pCHT, 297 patients were identified. Among them, 81 with RcC-CLM were matched 1:1 with LcC-CLM, according to CLM number and diameter, disease-free interval between primary tumor and CLM diagnosis, primary tumor N-status, and the presence of extrahepatic disease. RESULTS Overall, 66.7% of patients had multiple CLM, 21% had CLM>5 cm, 82.7% had DFI<12 months, 67.9% had N+ primary tumor, and 11.1% had extrahepatic disease at time of hepatectomy. RcC-CLM patients were similar to LcC-CLM in terms of demographic, clinical, perioperative, and pathologic characteristics. Patients operated for RcC-CLM, compared to LcC-CLM, had significantly shorter 5y-DFS(18% versus 39%) and 5y-OS(38% vs 65%). At multivariate analysis, being operated for RcC-CLM, compared to LcC-CLM, was the strongest predictor of recurrence (Hazard Ratio:2.265,p < .001) and death (HR:2.234,p = .001). Among 107 patients experiencing recurrent disease, curative recurrence resection was associated with higher 5y-OS(64% vs 17%; p < .001). However, recurrence resection was less frequently feasible among RcC-CLM(26%) patients, compared to LcC-CLM(44%,p = .05). CONCLUSIONS resection of RcC-CLM, compared to LcC-CLM, is associated with worse survivals, probably related to a different pattern of recurrence precluding recurrence resection among RcC-CLM patients.
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Affiliation(s)
- Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Foundation Policlinico Universitario A. Gemelli, Catholic University, L.go A. Gemelli, 8 Rome, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Foundation Policlinico Universitario A. Gemelli, Catholic University, L.go A. Gemelli, 8 Rome, Italy
| | - Caterina Mele
- Hepatobiliary Surgery Unit, Foundation Policlinico Universitario A. Gemelli, Catholic University, L.go A. Gemelli, 8 Rome, Italy
| | - Vellone Maria
- Hepatobiliary Surgery Unit, Foundation Policlinico Universitario A. Gemelli, Catholic University, L.go A. Gemelli, 8 Rome, Italy
| | - Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Gennaro Nuzzo
- Hepatobiliary Surgery Unit, Foundation Policlinico Universitario A. Gemelli, Catholic University, L.go A. Gemelli, 8 Rome, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Foundation Policlinico Universitario A. Gemelli, Catholic University, L.go A. Gemelli, 8 Rome, Italy.
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Zimmitti G, Langella S, Sega V, Manzoni A, Bogoni S, Russolillo N, Ferrero A, Rosso E. Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications. ANZ J Surg 2020; 91:348-354. [PMID: 33021058 DOI: 10.1111/ans.16282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/23/2020] [Revised: 07/28/2020] [Accepted: 08/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent reports suggest that, following pancreatic resection, serum amylase elevation (SAE) may be a surrogate indicator of post-operative acute pancreatitis (PAP) and predict post-operative pancreatic fistula (POPF). However, POPF may not account for the majority of complications when pancreatoenteric continuity is restored by pancreatogastrostomy. We aimed to evaluate, among patients undergoing pancreatoduodenectomy with pancreatogastrostomy, the correlation between SAE, radiological changes consistent with PAP and types of post-operative complications overall and specific for pancreatic surgery. METHODS Perioperative data from 102 patients who underwent pancreatoduodenectomy with pancreatogastrostomy at two Italian hospitals (January 2015-January 2017) were retrospectively analysed. SAE was defined as serum amylase more than three times the normal concentration at post-operative day 1. Post-operative abdominal computed tomography scan was routinely performed and retrospectively and blindly re-assessed for findings consistent with PAP. RESULTS Among 102 study patients, overall and major complications and mortality occurred in 68% and 24% and 3% of cases, respectively. POPF and post-pancreatectomy haemorrhage (PPH) occurred in 12% and 21%, respectively. In 75% of patients developing PPH, it occurred in the absence of POPF. SAE occurred in 36 patients who, compared to 66 non-SAE patients, more frequently showed computed tomography scan findings consistent with pancreatic stump inflammation (P = 0.002), confirming association between SAE and PAP. SAE was independently associated with the occurrence of major complications, POPF and PPH (hazard ratio (HR) 3.27, P = 0.032; HR 3.94, P = 0.012; HR 12.26, P = 0.002). CONCLUSION SAE can be considered a valid surrogate of PAP and is strongly associated with a higher rate of post-operative major complications, both overall and specific for pancreatic resection.
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Affiliation(s)
- Giuseppe Zimmitti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Turin, Italy
| | - Valentina Sega
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Selene Bogoni
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Turin, Italy
| | - Edoardo Rosso
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
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Zimmitti G, La Mendola R, Manzoni A, Sega V, Malerba V, Treppiedi E, Codignola C, Monfardini L, Garatti M, Rosso E. Investigation of intraoperative factors associated with postoperative pancreatic fistula following laparoscopic left pancreatectomy with stapled closure: a video review-based analysis : Video-review for predictors of pancreatic leak. Surg Endosc 2020; 35:941-954. [PMID: 32914358 DOI: 10.1007/s00464-020-07912-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/04/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) following distal pancreatectomy (DP) remains the most frequent complication, potential precursor of more serious events, and mechanisms behind POPF development are not clear. Primary aim of the current study is to investigate correlations between patients' characteristics, including technical intraoperative data assessed by retrospective video review of laparoscopic DP (L-PD), and development of clinically relevant (CR-)POPF and major complication. METHODS Patients undergoing L-DP whose surgery video was available for review were included in this study. Retrospective video review, performed by two surgeons blinded for postoperative outcomes, was focused on pancreatic neck transection and identification of pancreatic capsule disruption (PCD)/staple line bleeding (SLB). Correlation between clinical, demographic, and intraoperative factors and CR-POPF/major complications and assessment of factors associated with PCD and SLB were investigated. RESULTS Of 41 L-DP performed at our institution (June 2015-June 2020) using a triple-row stapler (EndoGIA™ Reloads with Tri-Staple™), surgery video was available for 38 patients [men/women, 13/25; median age (range) 62 (25-84) years; median BMI (range) 24 (17-42)]. PCD and SLB occurred in 15(39%) and 19(50%) patients and were concomitant in 9(24%). CR-POPF and major complications occurred in 8(21%) and 12(31%) patients, respectively. PCD, SLB, and PCD + SLB rates were significantly higher among patients with CR-POPF, compared to patients without (all p < 0.05). Among patients with PCD, pancreatic thickness at pancreatic transection site was higher (19 mm), compared to non-PCD patients (13 mm, p < 0.001). A directly proportional relation between PCD, CR-POPF, and major complication rate and pancreatic thickness was confirmed by ROC analysis (AUC = 0.949, 0.798, and 0.740, respectively). CONCLUSION PCD and SLB close to the staple line detected by retrospective video-review are intraoperatively detectable indicators of severe pancreatic traumatism and a potential precursors of CR-POPF following L-PD. Given the strict correlation between PCD and pancreatic thickness, alternative techniques to stapled closure for pancreatic transection may be recommended for patients with a thick pancreas and modification in postoperative care may be considered in patients with PCD/SLB.
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Affiliation(s)
- Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy.
| | - Roberta La Mendola
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Valentina Sega
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Valentina Malerba
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Elio Treppiedi
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Claudio Codignola
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Lorenzo Monfardini
- Department of Radiology, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via L. Bissolati 57, 25124, Brescia, Italy
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Petrucciani N, Debs T, Rosso E, Addeo P, Antolino L, Magistri P, Gugenheim J, Ben Amor I, Aurello P, D'Angelo F, Nigri G, Di Benedetto F, Iannelli A, Ramacciato G. Left-sided portal hypertension after pancreatoduodenectomy with resection of the portal/superior mesenteric vein confluence. Results of a systematic review. Surgery 2020; 168:434-439. [PMID: 32600882 DOI: 10.1016/j.surg.2020.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/08/2020] [Accepted: 04/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatoduodenectomy with synchronous resection of the portal vein/superior mesenteric vein confluence may result in the development of left-sided portal hypertension. Left-sided portal hypertension presents with splenomegaly and varices and may cause severe gastrointestinal bleeding. The aim of the study is to review the incidence, treatment, and preventive strategies of left-sided portal hypertension. METHODS A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to identify all studies published up to September 30, 2019 reporting data on patients with left-sided portal hypertension after pancreatoduodenectomy with venous resection. RESULTS Eight articles including 829 patients were retrieved. Left-sided portal hypertension occurred in 7.7% of patients who had splenic vein preservation and 29.4% of those having splenic vein ligation. Fourteen cases of gastrointestinal bleeding owing to left-sided portal hypertension were reported at a mean interval of 28 months from pancreatoduodenectomy. Related mortality at 1 month was 7.1%. Treatment of left-sided portal hypertension consisted of splenectomy in 3 cases (21%) and colectomy in 1 (7%) case, whereas radiologic, endoscopic procedures or conservative treatments were effective in the other cases (71%). CONCLUSION Left-sided portal hypertension represents a potentially severe complication of pancreatoduodenectomy with venous resection occurring at greater incidence when the splenic vein is ligated and not reimplanted. Left-sided portal hypertension-related gastrointestinal bleeding although rare can be managed depending on the situation by endoscopic, radiologic procedures or operative intervention with low related mortality.
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Affiliation(s)
- Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy.
| | - Tarek Debs
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Edoardo Rosso
- Départment de Chirurgie Générale, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Laura Antolino
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy
| | - Jean Gugenheim
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Imed Ben Amor
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France
| | - Paolo Aurello
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Francesco D'Angelo
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, France; INSERM U1065, Mediterranean Center for Molecular Medicine, Team 8 Hepatic Complications of Obesity, Nice, France
| | - Giovanni Ramacciato
- Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy
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Rosso E, Manzoni A, Zimmitti G, Sega V, Treppiedi E, Giaccari S, Codignola C, Garatti M. Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Venous Tangential Resection: Focus on Periadventitial Dissection of the Superior Mesenteric Artery for Obtaining Negative Margin and a Safe Vascular Resection. Ann Surg Oncol 2020; 27:2902-2903. [PMID: 32323087 DOI: 10.1245/s10434-020-08271-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Due to its technical complexity, laparoscopic (L-) radical antegrade modular pancreatosplenectomy (RAMPS) for left-sided pancreatic ductal adenocarcinoma (PDAC) has been described in a few series.1-4 In addition, splenomesenteric junction tumor involvement is considered a formal contraindication to L-RAMPS. METHODS The video shows posterior L-RAMPS with a left approach to the superior mesenteric artery (SMA) for a left-sided PDAC with suspected involvement of the splenomesenteric junction. RESULTS The patient was a 61-year-old woman affected by a cT3N0M0 pancreatic body PDAC. Following dissection of the superior mesenteric vein (SMV), proper/common hepatic artery, and gastroduodenal artery, the pancreatic neck is encircled and the celiac trunk (CT) skeletonized. The treitz ligament is opened, and the SMA is identified and dissected on its left anterior margin. Pancreatic mobilization en bloc with the Gerota fascia and left adrenal gland is followed by splenic artery transection and suprapancreatic lymphadenectomy completion. The mesopancreas is dissected from the right margin of the SMA and CT and the pancreas is transected. The portal vein and SMV are cross-clamped and a venous tangential resection/closure is performed. Cryostate histological examination of the venous and pancreatic stumps showed absence of tumor cells. Final pathology revealed a pT2N0(0+/42)R0G2 PDAC of the pancreatic body. CONCLUSION During L-RAMPS, periadvential SMA dissection through the left-anterior approach, specular to the right posterior SMA approach described for laparoscopic pancreatoduodenectomy,5,6 has a primary role in maximizing the vascular surgical margin and, allowing for complete mobilization of the specimen before vein resection, may make a splenomesenteric junction tangential resection/closure easier and safer in case of tumor involvement of the splenomesenteric venous axis.
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Affiliation(s)
- Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Valentina Sega
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Elio Treppiedi
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Sara Giaccari
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Claudio Codignola
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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Zimmitti G, Manzoni A, Garatti M, Rosso E. ASO Author Reflections: Pushing the Limits of Resection for Left Pancreatic Cancer: from Conventional Distal Pancreatosplenectomy, to Laparoscopic Radical Antegrade Modular Pancreatosplenectomy, Until Vein Resection for Vascular Tumor Involvement. Ann Surg Oncol 2020; 27:2904-2905. [PMID: 32166594 DOI: 10.1245/s10434-020-08343-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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Rosso E, Iannelli A. ASO Author Reflections: Mini-invasive Pancreaticoduodenectomy-Moving from Feasible to Radical. Ann Surg Oncol 2020; 27:1615-1616. [PMID: 32152771 DOI: 10.1245/s10434-020-08292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Edoardo Rosso
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy.
| | - Antonio Iannelli
- Université Côte d'Azur, Nice, France.,Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Nice Cedex 3, France.,Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France
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Zimmitti G, Panettieri E, Ardito F, Rosso E, Mele C, Nuzzo G, Giuliante F. Type of response to conversion chemotherapy strongly impacts survival after hepatectomy for initially unresectable colorectal liver metastases. ANZ J Surg 2020; 90:558-563. [DOI: 10.1111/ans.15632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Giuseppe Zimmitti
- Department of General SurgeryIstituto Ospedaliero Fondazione Poliambulanza Brescia Italy
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Foundation ‘Policlinico Universitario A. Gemelli’Catholic University Rome Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Foundation ‘Policlinico Universitario A. Gemelli’Catholic University Rome Italy
| | - Edoardo Rosso
- Department of General SurgeryIstituto Ospedaliero Fondazione Poliambulanza Brescia Italy
| | - Caterina Mele
- Hepatobiliary Surgery Unit, Foundation ‘Policlinico Universitario A. Gemelli’Catholic University Rome Italy
| | - Gennaro Nuzzo
- Hepatobiliary Surgery Unit, Foundation ‘Policlinico Universitario A. Gemelli’Catholic University Rome Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Foundation ‘Policlinico Universitario A. Gemelli’Catholic University Rome Italy
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Rosso E, Zimmitti G, Iannelli A, Garatti M. The ‘TRIANGLE Operation’ by Laparoscopy: Radical Pancreaticoduodenectomy with Major Vascular Resection for Borderline Resectable Pancreatic Head Cancer. Ann Surg Oncol 2019; 27:1613-1614. [DOI: 10.1245/s10434-019-08101-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Indexed: 02/06/2023]
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Panaro F, Kellil T, Vendrell J, Sega V, Souche R, Piardi T, Leon P, Cassinotto C, Assenat E, Rosso E, Navarro F. Microvascular invasion is a major prognostic factor after pancreatico-duodenectomy for adenocarcinoma. J Surg Oncol 2019; 120:483-493. [PMID: 31197842 DOI: 10.1002/jso.25580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/23/2019] [Revised: 04/03/2019] [Accepted: 05/18/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Microvascular invasion (MVI) has been proved to be poor prognostic factor in many cancers. To date, only one study published highlights the relationship between this factor and the natural history of pancreatic cancer. The aim of this study was to assess the impact of MVI, on disease-free survival (DFS) and overall survival (OS), after pancreatico-duodenectomy (PD) for pancreatic head adenocarcinoma. Secondarily, we aim to demonstrate that MVI is the most important factor to predict OS after surgery compared with resection margin (RM) and lymph node (LN) status. MATERIALS AND METHODS Between January 2015 and December 2017, 158 PD were performed in two hepato-bilio-pancreatic (HBP) centers. Among these, only 79 patients fulfilled the inclusion criteria of the study. Clinical-pathological data and outcomes were retrospectively analyzed from a prospectively maintained database. RESULTS Of the 79 patients in the cohort, MVI was identified in 35 (44.3%). In univariate analysis, MVI (P = .012 and P < .0001), RM (P = .023 and P = .021), and LN status (P < .0001 and P = .0001) were significantly associated with DFS and OS. A less than 1 mm margin clearance did not influence relapse (P = .72) or long-term survival (P = .48). LN ratio > 0.226 had a negative impact on OS (P = .044). In multivariate analysis, MVI and RM persisted as independent prognostic factors of DFS (P = .0075 and P = .0098, respectively) and OS (P < .0001 and P = .0194, respectively). Using the likelihood ratio test, MVI was identified as the best fit to predict OS after PD for ductal adenocarcinomas compared with the margin status model (R0 vs R1) (P = .0014). CONCLUSION The MVI represents another major prognostic factor determining long-term outcomes.
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Affiliation(s)
- Fabrizio Panaro
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Saint Eloi Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
| | - Tarek Kellil
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Saint Eloi Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
| | - Julie Vendrell
- Department of Pathology and Onco-Biology/Solid Tumors Biology Lab, Arnaud de Villeneuve Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
| | - Valentina Sega
- Division of Surgical Oncology, Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Regis Souche
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Saint Eloi Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
| | - Tullio Piardi
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Reims University Hospital-School of Medicine, Reims, France
| | - Piera Leon
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Saint Eloi Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
| | - Christophe Cassinotto
- Department of Radiology, Saint Eloi Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
| | - Eric Assenat
- Division of Medical Oncology, Department of Medicine, Saint Eloi Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
| | - Edoardo Rosso
- Department of Pathology and Onco-Biology/Solid Tumors Biology Lab, Arnaud de Villeneuve Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
| | - Francis Navarro
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Saint Eloi Hospital, School of Medicine, Montpellier University Hospital, Montpellier, France
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Treppiedi E, Cocchi L, Zimmitti G, Manzoni A, Seletti V, Bizzotto A, Spada C, Garatti M, Rosso E. Ileocolic invagination in adults: A totally minimally invasive endoscopic and laparoscopic staged approach. J Minim Access Surg 2019; 16:87-89. [PMID: 30777993 PMCID: PMC6945337 DOI: 10.4103/jmas.jmas_279_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Adult intussusception of the bowel is a rare clinical entity, and its management remains debated. The timing of treatment is not yet standardised, and no guidelines exist. We report a case of an 83-year-old woman presenting to the emergency department of our hospital with a history of increasing abdominal pain in the right iliac fossa. A contrast-enhanced computed tomography scan showed the presence of a large ileocolic intussusception with evidence of the terminal ileus invaginated within the right colon and the ileocolic vessels dragged and trapped into the intussusception. A colonoscopy confirmed the ileocolic invagination with a large right colonic lesion as leading point, and a partial pneumatic (carbon dioxide) and hydrostatic reduction was achieved. Subsequent laparoscopic right colectomy was performed according to oncological principles. A totally minimally invasive approach of this rare condition has been achieved but the literature lacks about the correct management of this entity.
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Affiliation(s)
- Elio Treppiedi
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Lorenzo Cocchi
- Department of General Surgery, University of Genoa, San Martino Hospital, Genova, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Valeria Seletti
- Department of Radiology, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alessandra Bizzotto
- Department of Digestive Endoscopy Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Cristiano Spada
- Department of Digestive Endoscopy Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Edoardo Rosso
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
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T. Kellil, Panaro F, Vendrell J, Rosso E, Navarro F, Ramos J. The three prognostic factors associated with poor outcomes after pancreatico-duodenectomy for carcinoma of the head of the pancreas: a retrospective multi-centers study during the last 5-years. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.261] [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: 10/27/2022] Open
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Treppiedi E, La Mendola R, Rosso E. Bowel preparation in elective colorectal surgery: back to the future? Updates Surg 2018; 71:595-596. [PMID: 29974353 DOI: 10.1007/s13304-018-0561-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Elio Treppiedi
- Department of General Surgery, Fondazione Poliambulanza, Istituto Ospedaliero, 25124, Brescia, Italy
| | | | - Edoardo Rosso
- Department of General Surgery, Fondazione Poliambulanza, Istituto Ospedaliero, 25124, Brescia, Italy
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Baiocchi GL, Rosso E, Celotti A, Zimmiti G, Manzoni A, Garatti M, Tiberio G, Portolani N. Laparoscopic pancreatic resections in two medium-sized medical centres. Updates Surg 2018; 70:41-45. [PMID: 29492761 DOI: 10.1007/s13304-018-0520-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 02/22/2018] [Indexed: 11/28/2022]
Abstract
To analyze the clinical outcomes of patients undergoing minimally invasive surgery for pancreatic neoplasms, in two medium-volume centers in Northern Italy, a retrospective chart review was performed in the operative registries, searching for patients who had undergone pancreatic surgery via laparoscopy, irrespective of the final pathological nature of the resected neoplasm. For each case, a standard data extraction form was completed and the following data was extracted: age and sex, type of resection, estimated blood loss, length of the operation, number of harvested nodes, post-operative pancreatic fistula, major post-operative complications, mortality and final pathological diagnosis. The systematic literature research was also undertaken and the reported results were analyzed. A total of 55 cases were recorded, including 39 distal pancreatectomies and 16 pancreaticoduodenectomies. The most frequent indications leading to surgery were ductal adenocarcinoma (26 pts) and cystic neoplasm (22 pts). No post-operative death occurred in this series; pancreatic fistula occurred in 64% of distal pancreatectomies and 22% of pancreaticoduodenectomies. The mean operating times were 178' and 572', respectively. Both distal pancreatectomy and pancreaticoduodenectomy proved to be feasible and were safely performed by laparoscopy, in two centers with medium-volume pancreatic caseload.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Edoardo Rosso
- UOC Chirurgia Generale, Fondazione Poliambulanza, Brescia, Italy
| | - Andrea Celotti
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy. .,III Chirurgia-Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Giuseppe Zimmiti
- UOC Chirurgia Generale, Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Manzoni
- UOC Chirurgia Generale, Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- UOC Chirurgia Generale, Fondazione Poliambulanza, Brescia, Italy
| | - Guido Tiberio
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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Zimmitti G, Manzoni A, Ramera M, Villanacci A, Sega V, Treppiedi E, Guerini F, Garatti M, Codignola C, Rosso E. Management of portal annular pancreas during laparoscopic pancreaticoduodenectomy. J Minim Access Surg 2018; 14:354-356. [PMID: 29582803 PMCID: PMC6130175 DOI: 10.4103/jmas.jmas_235_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Portal annular pancreas (PAP) is a pancreatic congenital anomaly consisting of pancreatic parenchyma encircling the portal vein and/or the superior mesenteric vein. It has been reported that the risk of developing a post-operative pancreatic fistula is higher following pancreaticoduodenectomy in patients with PAP, probably because of the possibility of leaving undrained a portion of pancreatic parenchyma during the reconstructive phase. Few manuscripts have reported a surgical technique of pancreaticoduodenectomy in case of PAP, herein we report the first case of a patient with PAP undergoing laparoscopic pancreaticoduodenectomy.
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Affiliation(s)
- Giuseppe Zimmitti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Ramera
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Alberta Villanacci
- Department of Radiology and Diagnostic Imaging, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Valentina Sega
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Elio Treppiedi
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Francesca Guerini
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Claudio Codignola
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Edoardo Rosso
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
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Treppiedi E, Zimmitti G, Manzoni A, Sega V, Guerini F, Mutti S, Lombardi M, Bonaventure T, Rosso E. Extra peritoneal giant pelvic hibernoma: a case report. J Surg Case Rep 2017; 2017:rjx250. [PMID: 29255590 PMCID: PMC5730937 DOI: 10.1093/jscr/rjx250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/25/2017] [Indexed: 11/13/2022] Open
Abstract
Abdominal hibernoma is a rare slow-growing tumor originating from brown adipose tissue. Due to its rarity, only a few case reports have been published so far. Pelvic localization is anedoctal and preoperative differential diagnosis with other malignancies may be challenging. We present the case of a woman who, due to a lower abdominal pain, underwent an abdominal ultrasonography with diagnosis of a 15 cm hyperechogenous pelvic mass. A subsequent MRI showed a 16 × 5.8 × 7.8 cm3 lesion anterior to the left iliacus muscle, with an intra- and extrapelvic component longitudinally extending from the left anterior superior iliac spine until the lesser trochanter. Surgical resection was performed and final histopathology was consistent with hibernoma. This report emphasizes the necessity to include hibernoma among differential diagnosis when a retroperitoneal abdominal mass is diagnosed and the difficulty to perform preoperatively this diagnosis due to the extreme rarity of these neoplasms.
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Affiliation(s)
- Elio Treppiedi
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Alberto Manzoni
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Valentina Sega
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Francesca Guerini
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Stefano Mutti
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Mariano Lombardi
- Department of Pathological Anatomy, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Tamu Bonaventure
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
| | - Edoardo Rosso
- Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia 25124, Italy
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Raynard B, Hébuterne X, Goldwasser F, Ait Hssain A, Dubray Longeras P, Barthélémy P, Rosso E, Phoutthasang V, Bories C, Digue L, Laharie D, Desport JC, Falkowski S, Lacau Saint Guily J, Gyan E. [Crossed perceptions about malnutrition in patients and their doctors in oncology]. Bull Cancer 2017; 104:921-928. [PMID: 29128080 DOI: 10.1016/j.bulcan.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/15/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
Malnutrition is common in oncology. However, it is often detected too late and nutritional support is sub-optimal. The patient's opinion, although often sought in therapeutic decisions in oncology, does not appear to be frequently taken into account in dietetic management. In NutriCancer2012 study, we interviewed patients, relatives and doctors about their perceptions of the impact of malnutrition and its quality of care. Of the 2209 patients questioned, majority said they were concerned about nutrition with 75% considering it essential to take appropriate nutritional care but only 19% self-reported link between malnutrition and fatigue. Physicians underestimated impact of malnutrition on patient's "quality of life". Doctors referred to the lack of human resources and knowledge in nutrition, and more than 80% wished the creation of nutrition teams. Sensitization of the general public and patients (and relatives) as soon as the cancer diagnosis could lead to better malnutrition's screening. Better nutrition training for physicians and creation of nutrition team could optimize management and improve efficacy during cancer treatments.
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Affiliation(s)
- Bruno Raynard
- Centre Gustave-Roussy, unité transversale de diététique et de nutrition, département des soins de support, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
| | - Xavier Hébuterne
- Hôpital de l'Archet, service de gastro-entérologie et nutrition, fédération d'hépato-gastro-entérologie et de nutrition clinique, 151, route Saint-Antoine-de-Ginestière, 06202 Nice, France
| | - François Goldwasser
- AP-HP, hôpital Cochin, service de cancérologie, 123, boulevard Port-Royal, 75014 Paris, France
| | - Ali Ait Hssain
- Centre hospitalier universitaire Gabriel-Montpied, service d'anesthésie-réanimation, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Pascale Dubray Longeras
- Centre Jean-Perrin, service d'oncologie médicale, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - Philippe Barthélémy
- Hôpitaux universitaires de Strasbourg, pôle d'hématologie et d'oncologie médicale, 1, avenue Molière, 67200 Strasbourg, France
| | - Edoardo Rosso
- Hôpitaux universitaires de Strasbourg, chirurgie générale, hépatique et endocrinienne, 1, avenue Molière, 67200 Strasbourg, France
| | - Valérie Phoutthasang
- Hôpital Carémeau, service d'hépato-gastro-entérologie, unité transversale de nutrition clinique, place du Pr R.-Debré, 30029 Nîmes, France
| | - Camille Bories
- Hôpital Carémeau, service d'hépato-gastro-entérologie, unité transversale de nutrition clinique, place du Pr R.-Debré, 30029 Nîmes, France
| | - Laurence Digue
- CHU Saint-André, service d'oncologie médicale, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - David Laharie
- CHU de Bordeaux, GH Sud, hôpital Haut-Lévêque, service d'hépato-gastro-entérologie et oncologie digestive, avenue de Magellan, 33604 Pessac, France
| | - Jean-Claude Desport
- CHU Limoges, hôpital Dupuytren, unité de nutrition, centre de spécialité de l'obésité, centre expert de nutrition parentérale à domicile, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Sabrina Falkowski
- CHU de Limoges, hôpital Dupuytren, service d'oncologie médicale, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Jean Lacau Saint Guily
- AP-HP, hôpital Tenon, service d'ORL et chirurgie cervico-faciale, 4, rue de la Chine, 75020 Paris, France
| | - Emmanuel Gyan
- CHRU de Tours, hôpital Bretonneau, service de cancérologie, 2, boulevard Tonnellé, 37044 Tours, France
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Addeo P, Langella S, Arru L, De Blasi V, Rosso E, Bachellier P. Robotic middle pancreatectomy with the double pursestring invaginated pancreaticogastrostomy (with video). J Visc Surg 2016; 153:475-476. [PMID: 27374474 DOI: 10.1016/j.jviscsurg.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P Addeo
- Hepato-pancreato-biliary surgery and liver transplantation, pôle des pathologies digestives, hépatiques et de la transplantation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
| | - S Langella
- Hepato-pancreato-biliary surgery and liver transplantation, pôle des pathologies digestives, hépatiques et de la transplantation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - L Arru
- Hepato-pancreato-biliary surgery and liver transplantation, pôle des pathologies digestives, hépatiques et de la transplantation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - V De Blasi
- Hepato-pancreato-biliary surgery and liver transplantation, pôle des pathologies digestives, hépatiques et de la transplantation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - E Rosso
- Hepato-pancreato-biliary surgery and liver transplantation, pôle des pathologies digestives, hépatiques et de la transplantation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - P Bachellier
- Hepato-pancreato-biliary surgery and liver transplantation, pôle des pathologies digestives, hépatiques et de la transplantation, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
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Aroldi F, Bertocchi P, Savelli G, Rosso E, Zaniboni A. Pancreatic cancer: New hopes after first line treatment. World J Gastrointest Oncol 2016; 8:682-7. [PMID: 27672426 PMCID: PMC5027023 DOI: 10.4251/wjgo.v8.i9.682] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/07/2016] [Accepted: 07/14/2016] [Indexed: 02/05/2023] Open
Abstract
Pancreatic cancer is the fourth leading cause of cancer-related death worldwide. Extensive research has yielded advances in first-line treatment strategies, but there is no standardized second-line therapy. In this review, we examine the literature trying to establish a possible therapeutic algorithm.
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Zimmitti G, Manzoni A, Addeo P, Garatti M, Zaniboni A, Codignola C, Bachellier P, Rosso E. 10. Feasibility, safety, and oncologic validity of superior mesenteric artery first approach during open and laparoscopic pancreaticoduodenectomy. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.016] [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: 11/30/2022] Open
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Souche R, Addeo P, Oussoultzoglou E, Herrero A, Rosso E, Navarro F, Fabre JM, Bachellier P. First and repeat liver resection for primary and recurrent intrahepatic cholangiocarcinoma. Am J Surg 2016; 212:221-9. [DOI: 10.1016/j.amjsurg.2015.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 12/21/2022]
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Bertocchi P, Abeni C, Meriggi F, Rota L, Rizzi A, Di Biasi B, Aroldi F, Ogliosi C, Savelli G, Rosso E, Zaniboni A. Gemcitabine Plus Nab-Paclitaxel as Second-Line and Beyond Treatment for Metastatic Pancreatic Cancer: a Single Institution Retrospective Analysis. Rev Recent Clin Trials 2016; 10:142-5. [PMID: 25881637 DOI: 10.2174/1574887110666150417115303] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 02/08/2023]
Abstract
Metastatic pancreatic cancer still represent one of the most deadly disease for which there are few therapeutic options, especially in second line and beyond setting. Nabpaclitaxel plus gemcitabine activity was demonstrated in first line setting, but there are no clear evidence suggesting its use after that. We report a retrospective data analysis of 23 patients who received nab-paclitaxel plus gemcitabine after first line treatment at our Oncology Department. We observed a significant clinical benefit (43,5%) with a median overall survival of 5 months. In addition, manageable side effects were reported. Our data, despite the small sample, seem to indicate that nab- paclitaxel plus gemcitabine is an active and well tolerated regimen even in pretreated patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Alberto Zaniboni
- Medical Oncology, Fondazione Poliambulanza, Via Bissolati 57,25124,Brescia, Italy.
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Rosso E, McGrath R. Promoting physical activity among children and youth in disadvantaged South Australian CALD communities through alternative community sport opportunities. Health Promot J Austr 2016; 27:105-110. [PMID: 26922053 DOI: 10.1071/he15092] [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] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/06/2015] [Indexed: 11/23/2022] Open
Abstract
Issue addressed: Recently arrived migrants and refugees from a culturally and linguistically diverse background (CALD) may be particularly vulnerable to social exclusion. Participation in sport is endorsed as a vehicle to ease the resettlement process; however, in Australia, this is often thought as a simple matter of integration into existing sport structures (e.g. clubs). This approach fails to place actual community needs at the centre of sport engagement efforts.Methods: A consultation framework was established with South Australian CALD community leaders and organisations to scope needs for community-based alternatives to participation in traditional sport (e.g. clubs), co-design a suitable community sport program and pilot it in five communities. Interviews and questionnaire surveys were conducted with participants, community representatives, stakeholders and volunteers.Results: Regular, free soccer activities engaged 263 young people from a great variety of nationalities, including over 50% refugees, in secondary state school and community-based sites.Conclusion: Alternative community sport programs can provide a basic but valuable forum to promote physical activity and associated well being in CALD and refugee communities.So what?: Alternative approaches can extend the health benefits of sport participation to disadvantaged children and youth who are excluded from traditional sport participation opportunities.
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Affiliation(s)
- Edoardo Rosso
- Division of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Richard McGrath
- School of Health Sciences, University of South Australia, City East Campus, Frome Road, GPO Box 2471, Adelaide, SA 5001, Australia
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Aroldi F, Bertocchi P, Rosso E, Prochilo T, Zaniboni A. Pancreatic Cancer: Promises and Failures of Target Therapies. Rev Recent Clin Trials 2016; 11:33-38. [PMID: 26419284 DOI: 10.2174/1574887110666150930122720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 06/05/2023]
Abstract
Currently, few efficient therapies are available to battle pancreatic cancer. Mechanisms underlying this cancer are not well known and researchers are trying to identify new therapeutic targets. Here, we present a review of new treatments and their results in recent years.
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Affiliation(s)
| | | | | | | | - Alberto Zaniboni
- UO di Oncologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
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