1
|
De Pastena M, Bannone E, Fontana M, Paiella S, Esposito A, Casetti L, Landoni L, Tuveri M, Pea A, Casciani F, Zamboni G, Frigerio I, Marchegiani G, Butturini G, Malleo G, Salvia R. Thirty-day prevalence and clinical impact of fluid collections at the resection margin after distal pancreatectomy: Follow-up of a multicentric randomized controlled trial. Surgery 2024:S0039-6060(24)00191-0. [PMID: 38729888 DOI: 10.1016/j.surg.2024.03.026] [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] [Received: 10/07/2023] [Revised: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Postoperative fluid collections at the resection margin of the pancreatic stump are frequent after distal pancreatectomy, yet their clinical impact is unclear. The aim of this study was to assess the 30-day prevalence of postoperative fluid collections after distal pancreatectomy and the factors associated with a clinically relevant condition. METHODS Patients enrolled in a randomized controlled trial of parenchymal transection with either reinforced, triple-row staple, or ultrasonic dissector underwent routine magnetic resonance 30 days postoperatively. Postoperative fluid collection was defined as a cyst-like lesion of at least 1 cm at the pancreatic resection margin. Postoperative fluid collections requiring any therapy were defined as clinically relevant. RESULTS A total of 133 patients were analyzed; 69 were in the triple-row staple transection arm, and 64 were in the ultrasonic dissector transection arm. The overall 30-day prevalence of postoperative fluid collections was 68% (n = 90), without any significant difference between the two trial arms. Postoperative serum hyperamylasemia was more frequent in patients with postoperative fluid collections than those without (31% vs 7%, P = .001). Among the postoperative fluid collection population, an early postoperative pancreatic fistula (odds ratio 14.9, P = .002), post pancreatectomy acute pancreatitis (odds ratio 12.7, P = .036), and postoperative fluid collection size larger than 50 mm (odds ratio 6.6, P = .046) were independently associated with a clinically relevant postoperative fluid collection. CONCLUSION Postoperative fluid collections at the resection margin are common after distal pancreatectomy and can be predicted by early assessment of postoperative serum hyperamylasemia. A preceding pancreatectomy acute pancreatitis and/or postoperative pancreatic fistula and large collections (>50 mm) were associated with a clinically relevant postoperative fluid collection, representing targets for closer follow-up or earlier therapeutic interventions.
Collapse
Affiliation(s)
- Matteo De Pastena
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. https://twitter.com/MatteoDePastena
| | - Elisa Bannone
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. https://twitter.com/BannoneElisa
| | - Martina Fontana
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Massimiliano Tuveri
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Antonio Pea
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. https://twitter.com/Totuccio1983
| | - Fabio Casciani
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Giulia Zamboni
- Section of Radiology University of Verona Hospital Trust, Verona, Italy
| | | | - Giovanni Marchegiani
- Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy. https://twitter.com/Gio_Marchegiani
| | | | - Giuseppe Malleo
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy. https://twitter.com/gimalleo
| | - Roberto Salvia
- Unit of Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.
| |
Collapse
|
2
|
Melisi D, Zecchetto C, Merz V, Malleo G, Landoni L, Quinzii A, Casalino S, Fazzini F, Gaule M, Pesoni C, Casetti L, Esposito A, Marchegiani G, Piazzola C, D'Onofrio M, de Robertis R, Gabbrielli A, Bernardoni L, Crino SF, Pietrobono S, Luchini C, Aliberti C, Martignoni G, Milleri S, Butturini G, Scarpa A, Salvia R, Bassi C. Perioperative NALIRIFOX in patients with resectable pancreatic ductal adenocarcinoma: The open-label, multicenter, phase II nITRO trial. Eur J Cancer 2024; 196:113430. [PMID: 37995598 DOI: 10.1016/j.ejca.2023.113430] [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: 10/17/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Upfront surgery followed by postoperative treatment is a commonly adopted treatment for resectable pancreatic ductal adenocarcinoma (rPDAC). However, the risk of positive surgical margins, the poor recovery that often impairs postoperative treatments, and the risk of recurrence might limit the outcome of this strategy. This study evaluated the safety and the activity of liposomal irinotecan 50 mg/m2 + 5-fluorouracil 2400 mg/m2 + leucovorin 400 mg/m2 + oxaliplatin 60 mg/m2 (NALIRIFOX) in the perioperative treatment of patients with rPDAC. METHODS Eligible patients had a rPDAC with < 180° interface with major veins' wall. Patients received 3 cycles before and 3 cycles after resection with NALIRIFOX, days 1 and 15 of a 28-day cycle. The primary endpoint was the proportion of patients undergoing an R0 resection. RESULTS 107 patients began preoperative treatment. Nine patients discontinued the treatment because of related or unrelated adverse events. Disease-control rate was 92.9%. 87 patients underwent surgical exploration, 11 had intraoperative evidence of metastatic disease, and 1 died for surgical complications. R0 resection rate was 65.3%. 49 patients completed the three postoperative cycles. The most common grade ≥ 3 adverse events were diarrhea and neutropenia. Median overall survival (OS) of ITT patients was 32.3 months (95% CI 27.8-44.3). Median disease-free and OS from surgery of resected patients were 19.3 (95% CI 12.6-34.1) and 40.3 months (95% CI 29-NA), respectively. CONCLUSION Perioperative NALIRIFOX was manageable and active, and deserves further investigation in randomized trials comparing it with standard upfront surgery followed by adjuvant therapy.
Collapse
Affiliation(s)
- Davide Melisi
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Integrata, Verona, Italy; Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.
| | - Camilla Zecchetto
- Medical Oncology Unit, Azienda Ospedaliera Integrata, Verona, Italy; Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Giuseppe Malleo
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Luca Landoni
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Alberto Quinzii
- Medical Oncology Unit, Azienda Ospedaliera Integrata, Verona, Italy; Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Federica Fazzini
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Marina Gaule
- Medical Oncology Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Camilla Pesoni
- Medical Oncology Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Luca Casetti
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | | | - Giovanni Marchegiani
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Integrata, Verona, Italy; Hepatopancreatobiliary and Liver Transplant Surgery Unit, University of Padua, Padua, Italy
| | | | - Mirko D'Onofrio
- Radiology Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | | | | | - Laura Bernardoni
- Digestive Endoscopy Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Stefano F Crino
- Digestive Endoscopy Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Silvia Pietrobono
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Claudio Luchini
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Azienda Ospedaliera Integrata, Verona, Italy
| | | | | | - Stefano Milleri
- Centro Ricerche Cliniche, Azienda Ospedaliera Integrata, Verona, Italy
| | | | - Aldo Scarpa
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Azienda Ospedaliera Integrata, Verona, Italy
| | - Roberto Salvia
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Claudio Bassi
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| |
Collapse
|
3
|
De Pastena M, van Bodegraven EA, Mungroop TH, Vissers FL, Jones LR, Marchegiani G, Balduzzi A, Klompmaker S, Paiella S, Tavakoli Rad S, Groot Koerkamp B, van Eijck C, Busch OR, de Hingh I, Luyer M, Barnhill C, Seykora T, Maxwell T T, de Rooij T, Tuveri M, Malleo G, Esposito A, Landoni L, Casetti L, Alseidi A, Salvia R, Steyerberg EW, Abu Hilal M, Vollmer CM, Besselink MG, Bassi C. Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation. Ann Surg 2023; 277:e1099-e1105. [PMID: 35797608 DOI: 10.1097/sla.0000000000005497] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop 2 distinct preoperative and intraoperative risk scores to predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) to improve preventive and mitigation strategies, respectively. BACKGROUND POPF remains the most common complication after DP. Despite several known risk factors, an adequate risk model has not been developed yet. METHODS Two prediction risk scores were designed using data of patients undergoing DP in 2 Italian centers (2014-2016) utilizing multivariable logistic regression. The preoperative score (calculated before surgery) aims to facilitate preventive strategies and the intraoperative score (calculated at the end of surgery) aims to facilitate mitigation strategies. Internal validation was achieved using bootstrapping. These data were pooled with data from 5 centers from the United States and the Netherlands (2007-2016) to assess discrimination and calibration in an internal-external validation procedure. RESULTS Overall, 1336 patients after DP were included, of whom 291 (22%) developed POPF. The preoperative distal fistula risk score (preoperative D-FRS) included 2 variables: pancreatic neck thickness [odds ratio: 1.14; 95% confidence interval (CI): 1.11-1.17 per mm increase] and pancreatic duct diameter (OR: 1.46; 95% CI: 1.32-1.65 per mm increase). The model performed well with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.78-0.88) and 0.73 (95% CI: 0.70-0.76) upon internal-external validation. Three risk groups were identified: low risk (<10%), intermediate risk (10%-25%), and high risk (>25%) for POPF with 238 (18%), 684 (51%), and 414 (31%) patients, respectively. The intraoperative risk score (intraoperative D-FRS) added body mass index, pancreatic texture, and operative time as variables with an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.74-0.85). CONCLUSIONS The preoperative and the intraoperative D-FRS are the first validated risk scores for POPF after DP and are readily available at: http://www.pancreascalculator.com . The 3 distinct risk groups allow for personalized treatment and benchmarking.
Collapse
Affiliation(s)
- Matteo De Pastena
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Eduard A van Bodegraven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Timothy H Mungroop
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Frederique L Vissers
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Leia R Jones
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Giovanni Marchegiani
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Alberto Balduzzi
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Sjors Klompmaker
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Salvatore Paiella
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Shazad Tavakoli Rad
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Casper van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ignace de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Misha Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Caleb Barnhill
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
| | - Thomas Seykora
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Thijs de Rooij
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Massimiliano Tuveri
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Alessandro Esposito
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Adnan Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
- Department of Surgery, University of California, San Francisco, CA
| | - Roberto Salvia
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Institute Hospital Foundation, Brescia, Italy
- Department of Surgery, Southampton University, Southampton, UK
| | | | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Claudio Bassi
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| |
Collapse
|
4
|
Malleo G, Maggino L, Lionetto G, Patton A, Paiella S, Pea A, Esposito A, Casetti L, Luchini C, Scarpa A, Bassi C, Salvia R. A dynamic analysis of empirical survival outcomes after pancreatectomy for pancreatic ductal adenocarcinoma. Surgery 2023; 173:1030-1038. [PMID: 36585320 DOI: 10.1016/j.surg.2022.11.015] [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] [Received: 07/31/2022] [Revised: 10/18/2022] [Accepted: 11/15/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Survival outcomes after pancreatectomy for pancreatic ductal adenocarcinoma may be biased by right-censoring. We herein analyzed a large dataset with no censored events for up to 5 years and dynamically investigated the impact of known prognostic factors, accounting for unobserved tumor characteristics. METHODS Consecutive patients undergoing pancreatectomy from 2000 to July 2015 were included. The 1- to 5-year empirical survival rates were calculated, and factors associated with long-term survival (≥5 years) were analyzed using multivariable models. Dynamic analyses of survival and recurrence were conducted through landmarking, and the contribution of unobserved heterogeneity was estimated using frailty models. RESULTS The study population included 1,048 patients. The median follow-up was 30.4 months in the whole cohort and 97.2 months in survivors. The median survival was 30.4 months, with empirical 1- to 5-year rates of 85.5%, 59.6%, 43.2%, 32.1%, and 27.5%. A favorable pathological profile was associated with 5-year survival, albeit 25.7% of long-survivors received an R1 resection, and 28.8% had N2 disease. The median recurrence-free survival was 17.2 months. At landmark analyses, baseline prognostic lost strength over time, with no independent predictors of survival being identified in the sets of patients alive at 4 and 5 years. There was a significant amount of unobserved heterogeneity in the early postoperative period. CONCLUSION The 5-year post-pancreatectomy empirical survival was 27.5%. Dynamic analyses showed a time-varying structure of prognostic variables and a substantial impact of unobserved tumor characteristics that may drive the disease course under the selective pressure of surgical resection and adjuvant chemotherapy.
Collapse
Affiliation(s)
- Giuseppe Malleo
- Unit of General and Pancreatic Surgery, University of Verona, Italy. https://twitter.com/gimalleo
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, University of Verona, Italy. https://twitter.com/LMaggino
| | | | - Alex Patton
- Unit of General and Pancreatic Surgery, University of Verona, Italy
| | - Salvatore Paiella
- Unit of General and Pancreatic Surgery, University of Verona, Italy. https://twitter.com/Totuccio1983
| | - Antonio Pea
- Unit of General and Pancreatic Surgery, University of Verona, Italy. https://twitter.com/peaantonio1
| | | | - Luca Casetti
- Unit of General and Pancreatic Surgery, University of Verona, Italy
| | - Claudio Luchini
- Section of Pathology, Department of Pathology and Diagnostics, University of Verona, Italy. https://twitter.com/CLuchini10
| | - Aldo Scarpa
- Section of Pathology, Department of Pathology and Diagnostics, University of Verona, Italy
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, University of Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, University of Verona, Italy.
| |
Collapse
|
5
|
Perri G, Marchegiani G, Reich F, Casetti L, Fontana M, Esposito A, Ruzzenente A, Salvia R, Bassi C. Intraoperative Blood Loss Estimation in Hepato-pancreato-biliary Surgery- Relevant, Not Reported, Not Standardized: Results From a Systematic Review and a Worldwide Snapshot Survey. Ann Surg 2023; 277:e849-e855. [PMID: 35837979 DOI: 10.1097/sla.0000000000005536] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide an overview of the current practice of intraoperative blood loss (BL) estimation in hepato-pancreato-biliary (HPB) surgery. BACKGROUND Intraoperative BL is a major quality marker in HPB surgery and a predictor of perioperative outcomes. However, the method for BL estimation is not standardized. METHODS A systematic review was performed of original studies published between 2006 and 2021 reporting the intraoperative BL of patients undergoing pancreatic or hepatic resections. A web-based snapshot survey was distributed globally to all members of the International Hepato-Pancreato-Biliary Association (IHPBA). RESULTS A total of 806 studies were included; 480 (60%) had BL as their primary outcome, and 105 (13%) had BL as their secondary outcome. However, 669 (83%) did not specify how BL estimation was performed, and 9 different methods were found among the remaining 136 (17%) studies.The survey was completed by 252 surgeons. Most of the responders (94%) declared that they systematically performed BL estimation and considered BL predictive of postoperative complications after pancreatic (73%) and liver (74%) resection. All methods previously identified in the literature were used by responders with different frequencies. A calculation based on suction fluid amounts, operative gauze weight, and irrigation was the most used method in the literature (7%) and among responders (51%). Most responders (83%) felt that BL estimation in HPB surgery needs improved standardization. CONCLUSIONS Standardization of intraoperative BL estimation is urgently needed in HPB surgery to ensure the consistency of reporting and reproducibility.
Collapse
Affiliation(s)
- Giampaolo Perri
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Federico Reich
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Martina Fontana
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Andrea Ruzzenente
- Department of General and Hepatobiliary Surgery, Verona University Hospital, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| |
Collapse
|
6
|
Giuliani T, De Pastena M, Paiella S, Marchegiani G, Landoni L, Festini M, Ramera M, Marinelli V, Casetti L, Esposito A, Bassi C, Salvia R. Pancreatic Enucleation Patients Share the Same Quality of Life as the General Population at Long-Term Follow-Up: A Propensity Score-Matched Analysis. Ann Surg 2023; 277:e609-e616. [PMID: 33856383 DOI: 10.1097/sla.0000000000004911] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess short- and long-term outcomes including quality of life (QoL) following pancreatic enucleation (PE). BACKGROUND PE is deemed to preserve both the endocrine and the exocrine function while ensuring radicality. However, to assess whether this reflects an actual benefit perceived by patients, QoL has to be considered. METHODS Data from all consecutive patients undergoing PE from January 2010 to December 2019 were retrospectively analyzed. Surgical outcomes were graded according to the Clavien-Dindo classification, and EORTC-C30 and the EORTC-Pan26 were administered as a cross-sectional assessment of QoL. A control group consisting of healthy individuals from the general population was obtained and matched using the propensity score matching method. RESULTS Eighty-one patients underwent PE using the open (59.3%), laparoscopic (27.2%), or robot-assisted (13.5%) approach. Sixty-five (80.2%) patients exhibited functioning/nonfunctioning pancreatic neuroendocrine tumors at final pathology.Surgical morbidity and complications of a Clavien-Dindo grade ≥3 were 48.1% and 16.0%, respectively. In-hospital mortality was 0%. Postoperative pancreatic fistula, post-pancreatectomy hemorrhage, and delayed gastric emptying rates were 21.0%, 9.9%, and 4.9%, respectively.Patients returned the questionnaires after a median of 74.2 months from the index surgery. Postoperative new onset of diabetes mellitus (NODM) was observed in 5 subjects (7.1%), with age being an independent predictor. Seven patients (10.0%) developed postoperative exocrine insufficiency. At the analysis of QoL, all function and symptom scales were comparable between the 2 groups, except for 2 of the EORTC-Pan 26 symptom scales, ("worries for the future" and "body image", P < 0.05). CONCLUSIONS Despite being associated with significant postoperative morbidity, PE provides excellent long-term outcomes. The risk of NODM is low and related to patient age, with QoL being comparable to the general population. Such information should drive surgeons to pursue PE whenever properly indicated.
Collapse
Affiliation(s)
- Tommaso Giuliani
- Department of General and Pancreatic Surgery, Verona Hospital Trust, University of Verona, Verona, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Melisi D, Zecchetto C, Merz V, Malleo G, Landoni L, Quinzii A, Casalino S, Gaule M, Pesoni C, Casetti L, Esposito A, Piazzola C, D'Onofrio M, de Robertis R, Gabbrielli A, Luchini C, Butturini G, Scarpa A, Salvia R, Bassi C. nITRO: A phase 2 study of perioperative liposomal irinotecan + 5-fluorouracil/leucovorin + oxaliplatin (NALIRIFOX) in patients with resectable pancreatic ductal adenocarcinoma (rPDAC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.701] [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: 01/25/2023] Open
Abstract
701 Background: Upfront surgery followed by adjuvant therapy is the standard treatment for patients with rPDAC. However, the risk of positive surgical margins, the poor recovery after surgery that often impairs postoperative treatment, and the high risk of relapse might limit the overall outcome of this strategy. This trial assessed the safety and the activity of liposomal irinotecan 50 mg/m2 + 5-FU 2400 mg/m2 + LV 400 mg/m2 + oxaliplatin 60 mg/m2 (NALIRIFOX) in the perioperative treatment of patients with rPDAC. Methods: nITRO is an investigator-initiated, Simon’s two-stages, single arm phase 2 study. Eligible patients had newly diagnosed rPDAC with <180° interface with major veins’ wall and a Karnofsky status ≥60. Patients received a perioperative treatment of 3 cycles before and 3 cycles after resection with NALIRIFOX, d1 and 15 of a 28 days cycle. The primary endpoint was the proportion of patients undergoing an R0 resection. Results: Between April 2018 and May 2022, 168 patients were referred by surgical units as potentially eligible for upfront resection. These patients were prescreened by CT and MRI scans within 4 weeks before treatment and 60 showed a rapid progression to a locally advanced or metastatic disease. One was not eligible because of heart failure. Among 107 patients who were enrolled and began preoperative treatment, 86 (80.4%) received all the 3 planned preoperative cycles. One patient (0.9%) obtained a radiological complete response, 22 (20.6%) a partial response, and 68 (63.6%) a stable disease, accounting for a disease control rate of 85.0%. Nine patients discontinued because of treatment related or unrelated adverse events. Seven patients had a radiological, and 2 a clinical progression. Two patients were defined as not resectable at surgical reevaluation. Most common adverse events of grade ≥3 during preoperative treatment included neutropenia (13.0%), diarrhea (9.4%) cholangitis (6.6%), mucositis (5.6%) and hypokaliemia (5.6%). One patient died for treatment-related neutropenia and sepsis. Thus, 87 (81.2%) patients underwent surgical exploration, 11 (12.6%) of them had intraoperative evidence of unresectable or metastatic disease, and 1 died for surgical complications. Among the 75 patients who underwent resection, 49 achieved an R0 resection accounting for a rate of 65.3%, largely exceeding the alternative hypothesis of 55%. Median disease-free and overall survival of resected patients were 31.3 (95% CI 17.0-45.6) and 44.9 months (95% CI 33.1-56.8), respectively. Conclusions: NALIRIFOX was manageable and active for patients with rPDAC. Perioperative NALIRIFOX allows to select those patients who may benefit from resection to the largest extent. Perioperative NALIRIFOX deserves further investigation in randomized trials comparing it with standard upfront surgery followed by adjuvant therapy. Clinical trial information: NCT03528785 .
Collapse
Affiliation(s)
- Davide Melisi
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Zecchetto
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Quinzii
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simona Casalino
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marina Gaule
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Pesoni
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Esposito
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristiana Piazzola
- Centro Ricerche Cliniche, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mirko D'Onofrio
- Radiology Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo de Robertis
- Radiology Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Armando Gabbrielli
- Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Center, Verona, Italy
| | | | - Aldo Scarpa
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| |
Collapse
|
8
|
Surci N, Bassi C, Salvia R, Marchegiani G, Casetti L, Deiro G, Bergmann C, Walenta K, Tamandl D, Schindl M, Sahora K, Mühlbacher J. Long-Term Follow-Up after Surgery for Chronic Pancreatitis: A Bicentric Retrospective Experience. Dig Surg 2023; 39:169-175. [PMID: 35917792 PMCID: PMC9909709 DOI: 10.1159/000526263] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The impact of surgery on nutritional status, pancreatic function, and symptoms of patients affected by chronic pancreatitis (CP) has not been unequivocally determined. This study aimed to evaluate clinical follow-up after surgery for CP in an Italian-Austrian population. MATERIALS AND METHODS Patients operated for CP at two high-volume centers between 2000 and 2018 were analyzed. The following parameters were compared between the pre- and postoperative period: nutritional status, endocrine and exocrine pancreatic functions, and chronic pain. RESULTS Overall, 186 patients underwent surgery for CP. Among these, 68 (40%) answered a specific follow-up questionnaire. The body mass index showed a significant increase between pre- and postoperative assessments (21.1 vs. 22.5 p = 0.003). Furthermore, a 60% decrease in the prevalence of chronic pain (81 vs. 21%, p < 0.001) was observed. On the contrary, both exocrine and endocrine pancreatic functions pointed toward a worsening after surgery, with consistent higher rates of patients presenting with diabetes mellitus, as well as patients requiring insulin therapy and oral intake of pancreatic enzymes. The analysis of body composition performed on 40 (24%) patients with a complete imaging pack revealed no significant change in the nutritional status after surgery. DISCUSSION/CONCLUSION Despite the good results observed in terms of pain relief, the surgical approach led to a consistent worsening of the global pancreatic function. No significant influence of surgery on the nutritional status of patients was detected.
Collapse
Affiliation(s)
- Niccolò Surci
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria,Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Giacomo Deiro
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Christina Bergmann
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Walenta
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Radiology, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Martin Schindl
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Mühlbacher
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria,*Jakob Mühlbacher, jakob.muehlbacherMühlbachermeduniwien.ac.at
| |
Collapse
|
9
|
Bassi C, Marchegiani G, Giuliani T, Di Gioia A, Andrianello S, Zingaretti CC, Brentegani G, De Pastena M, Fontana M, Pea A, Paiella S, Malleo G, Tuveri M, Landoni L, Esposito A, Casetti L, Butturini G, Falconi M, Salvia R. Pancreatoduodenectomy at the Verona Pancreas Institute: the Evolution of Indications, Surgical Techniques, and Outcomes: A Retrospective Analysis of 3000 Consecutive Cases. Ann Surg 2022; 276:1029-1038. [PMID: 33630454 DOI: 10.1097/sla.0000000000004753] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the present study was to critically reappraise the experience at our high-volume institution to obtain new insights for future directions. SUMMARY BACKGROUND DATA The indications, surgical techniques, and perioperative management of pancreatoduodenectomy (PD) have profoundly evolved over the last 20 years. METHODS All consecutive PDs performed during the last 20 years at the Verona Pancreas Institute were divided into four 5-year timeframes and retrospectively analyzed in terms of indications, intraoperative features, and surgical outcomes. Significant milestones were provided to understand practice changes using a before-after analysis method. RESULTS The study population consisted of 3000 patients. The median age, ASA ≥ 3 and number of nonbenchmark cases significantly increased over time ( P < 0.005). Pancreatic cancer was the leading indication, representing 60% of patients/year in the last timeframe, 40% of whom received neoadjuvant treatment. Conversely, after the development of International Guidelines, the proportion of resected cystic neoplasms progressively and thoroughly decreased. Given the increased complexity of surgery for pancreatic cancer, the evolution of technologies, surgical techniques, and postoperative management allowed the maintenance of favorable surgical outcomes over time, with a stable 20.0% of patients with a Clavien-Dindo grade ≥ 3, an 11.7% failure to rescue and a 2.3% in-hospital mortality rate. The incidence of postoperative pancreatic fistula, hemorrhage, and delayed gastric emptying was 22.4%, 13.4%, and 12.4%, respectively. CONCLUSIONS PD significantly evolved in Verona over the past 2 decades. Surgeries of greater complexity are currently performed on increasingly frailer patients, mostly for pancreatic cancer and often after neoadjuvant chemotherapy. However, the progression of all fields of pancreatic surgery, including the expanding use of postoperative pancreatic fistula mitigation strategies, has allowed satisfactory outcomes to be maintained.
Collapse
Affiliation(s)
- Claudio Bassi
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Tommaso Giuliani
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Anthony Di Gioia
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Stefano Andrianello
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Caterina Costanza Zingaretti
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Giacomo Brentegani
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Martina Fontana
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Antonio Pea
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Massimiliano Tuveri
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| | | | - Massimo Falconi
- Pancreatic Surgery, IRCCS San Raffaele Hospital, University ''Vita e Salute,'' Milano, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Verona Pancreas, Institute, University of Verona, Verona, Italy
| |
Collapse
|
10
|
Esposito A, Ramera M, Casetti L, De Pastena M, Fontana M, Frigerio I, Giardino A, Girelli R, Landoni L, Malleo G, Marchegiani G, Paiella S, Pea A, Regi P, Scopelliti F, Tuveri M, Bassi C, Salvia R, Butturini G. 401 consecutive minimally invasive distal pancreatectomies: lessons learned from 20 years of experience. Surg Endosc 2022; 36:7025-7037. [PMID: 35102430 PMCID: PMC9402493 DOI: 10.1007/s00464-021-08997-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aimed to discuss and report the trend, outcomes, and learning curve effect after minimally invasive distal pancreatectomy (MIDP) at two high-volume centres. METHODS Patients undergoing MIDP between January 1999 and December 2018 were retrospectively identified from prospectively maintained electronic databases. The entire cohort was divided into two groups constituting the "early" and "recent" phases. The learning curve effect was analyzed for laparoscopic (LDP) and robotic distal pancreatectomy (RDP). The follow-up was at least 2 years. RESULTS The study population included 401 consecutive patients (LDP n = 300, RDP n = 101). Twelve surgeons performed MIDP during the study period. Although patients were more carefully selected in the early phase, in terms of median age (49 vs. 55 years, p = 0.026), ASA class higher than 2 (3% vs. 9%, p = 0.018), previous abdominal surgery (10% vs. 34%, p < 0.001), and pancreatic adenocarcinoma (PDAC) (7% vs. 15%, p = 0.017), the recent phase had similar perioperative outcomes. The increase of experience in LDP was inversely associated with the operative time (240 vs 210 min, p < 0.001), morbidity rate (56.5% vs. 40.1%, p = 0.005), intra-abdominal collection (28.3% vs. 17.3%, p = 0.023), and length of stay (8 vs. 7 days, p = 0.009). Median survival in the PDAC subgroup was 53 months. CONCLUSION In the setting of high-volume centres, the surgical training of MIDP is associated with acceptable rates of morbidity. The learning curve can be largely achieved by several team members, improving outcomes over time. Whenever possible resection of PDAC guarantees adequate oncological results and survival.
Collapse
Affiliation(s)
- Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Marco Ramera
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Martina Fontana
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | | | | | | | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Antonio Pea
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Paolo Regi
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | | | - Massimiliano Tuveri
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
- Università di Verona, Verona, Italy.
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | | |
Collapse
|
11
|
Tuveri M, Bassi C, Esposito A, Casetti L, Landoni L, Malleo G, Marchegiani G, Paiella S, Fontana M, De Pastena M, Antonio P, Perri G, Balduzzi A, Polati E, Montemezzi G, Donadello K, Milan B, Simari S, De Leo D, Personi B, Marinelli V, Ohnsorge K, Adda V, Salvia R. Bioethics in an oncological surgery unit during the COVID-19 pandemic: the Verona experience. Updates Surg 2022; 74:1247-1252. [PMID: 35298787 PMCID: PMC8927519 DOI: 10.1007/s13304-022-01279-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
The spread of COVID-19 has overwhelmed medical facilities across the globe, with patients filling beds in both regular wards and in intensive care units. The repurposing of hospital facilities has resulted in a dramatic decrease in the capacity of hospitals—in terms of available beds, surgical facilities, and medical and nursing staff— to care for oncology patients. The Italian National Board of Bioethics provided precise and homogeneous guidelines for the allocation of the scarce resources available. In our experience, strictly following these general guidelines and not considering the clinical vocation of each single health care center did not allow us to resume usual activities but generated further confusion in resource allocation. To face the scarcity of available resources and guarantee our patients fair access to the health care system we created a surgical triage with four fundamental steps. We took into consideration “ well defined and widely accepted clinical prognostic factors ” as stated by the Italian Society of Anesthesia and Resuscitation. We were able to draw up a list of patients giving priority to those who theoretically should have a greater chance of overcoming their critical situation. The age criterion has also been used in the overall evaluation of different cure options in each case, but it has never been considered on its own or outside the other clinical parameters. Although not considered acceptable by many we had to forcefully adopt the criterion of comparison between patients to give priority to those most in need of immediate care.
Collapse
Affiliation(s)
- Massimiliano Tuveri
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy.
| | - Alessandro Esposito
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Giovanni Marchegiani
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Martina Fontana
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Matteo De Pastena
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Pea Antonio
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Giampaolo Perri
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Alberto Balduzzi
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Enrico Polati
- Intensive Care Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Gabriele Montemezzi
- Intensive Care Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Katia Donadello
- Intensive Care Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Beatrice Milan
- Intensive Care Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Salvatore Simari
- Intensive Care Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Domenico De Leo
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, Verona, Italy
| | - Beatrice Personi
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Veronica Marinelli
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Kathrin Ohnsorge
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Veronica Adda
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Verona Hospital Trust, University of Verona, Verona, Italy
| | | |
Collapse
|
12
|
Paiella S, De Pastena M, Esposito A, Secchettin E, Casetti L, Malleo G, Montagnini G, Bannone E, Deiro G, Bampa B, Ramera M, Landoni L, Balduzzi A, Bassi C, Salvia R. Modified Frailty Index to Assess Risk in Elderly Patients Undergoing Distal Pancreatectomy: A Retrospective Single-Center Study. World J Surg 2022; 46:891-900. [PMID: 35024923 PMCID: PMC8885554 DOI: 10.1007/s00268-021-06436-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/02/2022]
Abstract
Background To compare the postoperative course of elderly patients (≥70 years) submitted to minimally invasive (MIDP) versus open distal pancreatectomy (ODP) and to evaluate if the modified Frailty Index (mFI) predicts the surgical course of elderly patients submitted to DP. Methods Data of patients aged ≥70 who underwent DP at a single institution between March 2011 and December 2019 were retrospectively retrieved. A 2:1 propensity score matching (PSM) was used to correct for differences in baseline characteristics. Then, postoperative complications were compared between the two groups (MIDP vs. ODP). Additionally, the entire cohort of DP elderly patients was stratified according to the mFI into three groups: non-frail (mFI = 0), mildly frail (mFI = 1/2), or severely frail (mFI = 3) and then compared. Results A total of 204 patients were analyzed. After PSM, 40 MIDP and 80 ODP patients were identified. The complications considered stratified homogenously between the two groups, with no statistically significant differences. The severity of the postoperative course increased as mFI did among the three groups regarding any complication (p = 0.022), abdominal collection (p = 0.014), pulmonary complication (p = 0.001), postoperative confusion (p = 0.047), Clavien-Dindo severity ≥3 events (p = 0.036), and length of stay (p = 0.018). Conclusions Elderly patients can be safely submitted to MIDP. The mFI identifies frail elderly patients more prone to develop surgical and non-surgical complications after DP. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06436-2.
Collapse
Affiliation(s)
- Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Matteo De Pastena
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Alessandro Esposito
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy. .,Referent of the Mini-Invasive Pancreatic Laparoscopic and Robotic Surgery of the General and Pancreatic Surgery Unit, Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy.
| | - Erica Secchettin
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Greta Montagnini
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Elisa Bannone
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Giacomo Deiro
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Beatrice Bampa
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Marco Ramera
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Alberto Balduzzi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| |
Collapse
|
13
|
Marchegiani G, Perri G, Bianchi B, Esposito A, Landoni L, Casetti L, Tuveri M, Malleo G, Paiella S, Fontana M, Pea A, De Pastena M, Salvia R, Bassi C. Pancreatic surgery during COVID-19 pandemic: major activity disruption of a third-level referral center during 2020. Updates Surg 2021; 74:953-961. [PMID: 34689316 PMCID: PMC8541802 DOI: 10.1007/s13304-021-01197-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/07/2021] [Accepted: 10/18/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has severely limited the access to cancer surgery, but it is not known to what extent referral centers for pancreatic diseases were affected by its outbreak. The aim of this study is to describe the effect of COVID-19 pandemic on a third-level referral center for pancreatic surgery in Italy. METHODS The 2020 activity of The Pancreas Institute of the University of Verona was reviewed, comparing different phases of the COVID-19 pandemic outbreaks using the pre-COVID era as a control. Endpoints were the overall caseload of pancreatic resections, surgical waiting list, administration of preoperative therapy, major morbidity and mortality, residents' training; number of inpatients beds, outpatient visits/procedures/diagnostics. RESULTS In 2020, there was an overall significant reduction of pancreatic resections performed (394 vs. 506 in 2019), particularly during the first (March-May) and second (October-December) COVID-19 outbreaks, with an all-time-low of 16 resections/months in April (compared to 43 average resection/month in 2019). The rates of major morbidity (Clavien-Dindo ≥ 3) and mortality were similar to 2019 (16 vs 12%, p = 0.11 and 3 vs 2%, p = 0.29, respectively). During the first and second outbreaks resident's training, inpatient beds, outpatient visits, diagnostics, and procedures were severely impaired, while the waiting list for up-front cancer resections and the use of preoperative chemotherapy concomitantly raised. CONCLUSION The COVID-19 pandemic has severely disrupted the activity of a third-level referral center for pancreatic surgery, affecting the access to cancer surgical procedures and raising concerns regarding the solidity of the current centralization model.
Collapse
Affiliation(s)
- Giovanni Marchegiani
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy.
| | - Giampaolo Perri
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Beatrice Bianchi
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Massimiliano Tuveri
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Martina Fontana
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Antonio Pea
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Piazzale Scuro 10, 37134, Verona, Italy
| |
Collapse
|
14
|
De Pastena M, Salvia R, Paiella S, Deiro G, Bannone E, Balduzzi A, Giuliani T, Casetti L, Ramera M, Filippini C, Montagnini G, Landoni L, Esposito A. Robotic Dual-Console Distal Pancreatectomy: Could it be Considered a Safe Approach and Surgical Teaching even in Pancreatic Surgery? A Retrospective Observational Study Cohort. World J Surg 2021; 45:3191-3197. [PMID: 34304274 PMCID: PMC8408081 DOI: 10.1007/s00268-021-06216-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
Abstract
Background The study aims to assess the safety and feasibility of the robotic dual-console during a robotic distal pancreatectomy Methods The data of the consecutive patients submitted to RDP from 2012 to 2019 at the Verona University were retrieved from a prospectively maintained database. The patients submitted to RDP were divided into the dual-console platform group (DG) and compared to the standard robotic procedure group (SG). Results In the study period, 102 robotic distal pancreatectomies were performed, of whom 42 patients (41%) belonged to the DG and 60 patients (59%) to the SG. Higher operation time was recorded in the DG compared to the SG (410 vs. 265 min, p < 0.001). The overall conversion rate of the series was 7% (n 7 patients). All the conversions were observed in the SG (p = 0.021). No differences in morbidity or pancreatic fistula rate were recorded (p > 0.05). No mortality events in the 90th postoperative days were reported in this series. Conclusions The robotic dual-console approach for distal pancreatectomy is safe, feasible, and reproducible. The postoperative surgical outcomes are comparable to the standard RDP with the single-console da Vinci Surgical System®. This surgical technique can widely and safely improve the robotic surgical training program.
Collapse
Affiliation(s)
- M De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - R Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Deiro
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - E Bannone
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - A Balduzzi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - T Giuliani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - L Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - M Ramera
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - C Filippini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Montagnini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - L Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - A Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. .,University of Verona, Verona, Italy.
| |
Collapse
|
15
|
Deiro G, De Pastena M, Paiella S, Balduzzi A, Montagnini G, Andreotti E, Casetti L, Landoni L, Salvia R, Esposito A. Assessment of difficulty in laparoscopic distal pancreatectomy: A modification of the Japanese difficulty scoring system - A single-center high-volume experience. J Hepatobiliary Pancreat Sci 2021; 28:770-777. [PMID: 34114743 PMCID: PMC8518381 DOI: 10.1002/jhbp.1010] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/22/2021] [Accepted: 05/29/2021] [Indexed: 11/13/2022]
Abstract
Background The Japanese difficulty scoring system (DSS) was developed to assess the difficulty of laparoscopic distal pancreatectomy (LDP). The study aimed to validate a modified DSS (mDSS) in a European high‐volume center. Methods Patients' clinical data underwent LDP for benign and malignant pancreatic lesion between September 2013 and February 2020 were reviewed. Expert laparoscopic surgeons performed the procedures. The mDSS consisted of seven variables, such as type of operation, malignancy, neoadjuvant therapy, pancreatic resection line, tumor close to major vessels, tumor extension to peripancreatic tissue, and left‐sided portal hypertension and/or splenomegaly. According to the difficulty level and previous score, the mDSS was subdivided into three classes: low, intermediate, and high. Surrogates of case complexity (operative time, intraoperative blood loss and blood transfusion requirements, conversion rate) were used to validate the new scoring system. Results The study population included 140 LDP. Ninety‐five (68%), 35 (25%) and 10 (7%) patients belonged to low, intermediate, and high difficulty groups. The mDSS identified the complexity of the surgical case of the series for all the surrogates of complexity considered, namely conversion rate (P = .004), operative time (P = .033) and intraoperative blood loss (P = .009). No differences were recorded in the postoperative outcomes (P > .05). Conclusion The mDSS for LDP better stratified the pancreatic procedures according to their complexity. The new scoring system may allow an appropriate preoperative evaluation of surgical difficulty, facilitating LDP's training program. Future prospective studies are needed to validate the mDSS.
Collapse
Affiliation(s)
- Giacomo Deiro
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alberto Balduzzi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Greta Montagnini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Elena Andreotti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| |
Collapse
|
16
|
Salvia R, Andrianello S, Ciprani D, Deiro G, Malleo G, Paiella S, Casetti L, Landoni L, Tuveri M, Esposito A, Marchegiani G, Bassi C. Pancreatic surgery is a safe teaching model for tutoring residents in the setting of a high-volume academic hospital: a retrospective analysis of surgical and pathological outcomes. HPB (Oxford) 2021; 23:520-527. [PMID: 32859493 DOI: 10.1016/j.hpb.2020.08.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Academic hospitals must train future surgeons, but whether residents could negatively affect the outcomes of major procedures is a matter of concern. The aim of this study is to assess if pancreatic surgery is a safe teaching model. METHODS Outcomes of 1230 major pancreatic resections performed at a high-volume pancreatic teaching hospital between 2015 and 2018 were compared according to the first surgeon type, attending vs resident. RESULTS Residents performed a selection of 132 (16%) pancreaticoduodenectomies (PD) and 46 (11%) distal pancreatectomies (DP). For PD, pancreatic fistula (25% vs 0, p < 0.001), biliary fistula (7.1% vs 3.5%, p = 0.04) and operative time (400 vs 390 min, p < 0.001) were lower for residents but post-pancreatectomy hemorrhage was higher (20.5% vs 13% p = 0.024). For DP, pancreatic fistula rate was lower for residents (31.7% vs 17.5% p = 0.046). There was no difference in terms of lymph nodes retrieval both for PDs and DPs, while the R1 resections were more frequent among PDs performed by attending surgeons (31.5% vs 15.7%, p = 0.023). CONCLUSION The active participation of residents does not negatively affect outcomes of major pancreatic resections in a high-volume center. By means of case selection and continuous tutoring, pancreatic surgery represents a safe and valid teaching model.
Collapse
Affiliation(s)
- Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
| | - Stefano Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Debora Ciprani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giacomo Deiro
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Massimiliano Tuveri
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| |
Collapse
|
17
|
Paiella S, Malleo G, Simoni N, Micera R, Guariglia S, Cavedon C, Marchegiani G, Esposito A, Landoni L, Casetti L, Tuveri M, Milella M, Secchettin E, Manzini G, Bovo C, De Pastena M, Fontana M, Salvia R, Mazzarotto R, Bassi C. A phase II trial proposal of total neoadjuvant treatment with primary chemotherapy, stereotactic body radiation therapy, and intraoperative radiation therapy in borderline resectable pancreatic adenocarcinoma. BMC Cancer 2021; 21:165. [PMID: 33593311 PMCID: PMC7885611 DOI: 10.1186/s12885-021-07877-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current management guidelines recommend that patients with borderline resectable pancreatic adenocarcinoma (BRPC) should initially receive neoadjuvant chemotherapy. The addition of advanced radiation therapy modalities, including stereotactic body radiation therapy (SBRT) and intraoperative radiation therapy (IORT), could result in a more effective neoadjuvant strategy, with higher rates of margin-free resections and improved survival outcomes. METHODS/DESIGN In this single-center, single-arm, intention-to-treat, phase II trial newly diagnosed BRPC will receive a "total neoadjuvant" therapy with FOLFIRINOX (5-fluorouracil, irinotecan and oxaliplatin) and hypofractionated SBRT (5 fractions, total dose of 30 Gy with simultaneous integrated boost of 50 Gy on tumor-vessel interface). Following surgical exploration or resection, IORT will be also delivered (10 Gy). The primary endpoint is 3-year survival. Secondary endpoints include completion of neoadjuvant treatment, resection rate, acute and late toxicities, and progression-free survival. In the subset of patients undergoing resection, per-protocol analysis of disease-free and disease-specific survival will be performed. The estimated sample size is 100 patients over a 36-month period. The trial is currently recruiting. TRIAL REGISTRATION NCT04090463 at clinicaltrials.gov.
Collapse
Affiliation(s)
- Salvatore Paiella
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Giuseppe Malleo
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Nicola Simoni
- Unit of Radiation Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Renato Micera
- Unit of Radiation Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Stefania Guariglia
- Unit of Medical Physics, University of Verona Hospital Trust, Verona, Italy
| | - Carlo Cavedon
- Unit of Medical Physics, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Alessandro Esposito
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Luca Landoni
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Luca Casetti
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Massimiliano Tuveri
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Michele Milella
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Erica Secchettin
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Gessica Manzini
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Chiara Bovo
- University of Verona Hospital Trust Management Unit, Verona, Italy
| | - Matteo De Pastena
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Martina Fontana
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Renzo Mazzarotto
- Unit of Radiation Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, University of Verona Hospital Trust, Policlinico Rossi, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| |
Collapse
|
18
|
Andrianello S, Marchegiani G, Malleo G, Masini G, Balduzzi A, Paiella S, Esposito A, Landoni L, Casetti L, Tuveri M, Salvia R, Bassi C. Pancreaticojejunostomy With Externalized Stent vs Pancreaticogastrostomy With Externalized Stent for Patients With High-Risk Pancreatic Anastomosis: A Single-Center, Phase 3, Randomized Clinical Trial. JAMA Surg 2020; 155:313-321. [PMID: 32101272 DOI: 10.1001/jamasurg.2019.6035] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance The operative scenarios with the highest postoperative pancreatic fistula (POPF) risk represent situations in which fistula prevention and mitigation strategies have the strongest potential to affect surgical outcomes after pancreaticoduodenectomy. Evidence from studies providing risk stratification is lacking. Objective To investigate whether pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG), both with externalized transanastomotic stent, is the best reconstruction method for patients at high risk of POPF after pancreaticoduodenectomy. Design, Setting, and Participants A single-center, phase 3, randomized clinical trial was conducted at the Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy, from July 12, 2017, through March 15, 2019, among adults undergoing elective pancreaticoduodenectomy and considered at high risk for pancreatic fistula after intraoperative assessment of the fistula risk score, some of whom were randomized to undergo PG or PJ. All analyses were performed on an intention-to-treat basis. Interventions Intervention consisted of PJ or PG, both with externalized transanastomotic stent and octreotide omission. Main Outcomes and Measures The primary end point was POPF. The secondary end points were Clavien-Dindo grade 3 or higher morbidity, postpancreatectomy hemorrhage, delayed gastric emptying, and average complication burden. Results A total of 604 patients were screened for eligibility; 82 were at high risk for POPF (fistula risk score, 7-10), and 72 were randomized undergo PG (n = 36; 20 men and 16 women; median age, 65 years [interquartile range, 23-82]) or PJ (n = 36; 26 men and 10 women; median age, 63 years [interquartile range, 35-79]). There was no significant difference in the incidence of POPF between patients who underwent PG and patients who underwent PJ (18 [50.0%] vs 14 [38.9%]; P = .48), but for patients who developed a POPF, the mean (SD) average complication burden was lower for those who underwent PJ than for those who underwent PG (0.25 [0.13] vs 0.39 [0.17]; P = .04). The rates of postpancreatectomy hemorrhage (14 [38.9%] in the PG group vs 9 [25.0%] in the PJ group; P = .31) and delayed gastric emptying (16 [44.4%] in the PG group vs 18 [50.0%] in the PJ group; P = .81) were similar, but patients who underwent PG presented with a significantly higher incidence of Clavien-Dindo grade 3 or higher morbidity than those who underwent PJ (17 [47.2%] vs 8 [22.2%]; P = .047). Conclusions and Relevance Among patients at the highest risk for POPF, those who underwent PG or PJ experienced similar rates of POPF. However, PG was associated with an increased incidence of Clavien-Dindo grade 3 or higher morbidity and with an increased average complication burden for the patients who developed a POPF. For patients at high risk for pancreatic fistula, PJ with the use of externalized stent and octreotide omission should be considered the most appropriate technical strategy. Trial Registration ClinicalTrials.gov Identifier: NCT03212196.
Collapse
Affiliation(s)
- Stefano Andrianello
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Gaia Masini
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Alberto Balduzzi
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Massimiliano Tuveri
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- The Pancreas Institute, Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy
| |
Collapse
|
19
|
Andrianello S, Marchegiani G, Bannone E, Vacca P, Esposito A, Casetti L, Salvia R, Bassi C. Predictors of pancreatic fistula healing time after distal pancreatectomy. J Hepatobiliary Pancreat Sci 2020; 28:1076-1088. [PMID: 33058405 DOI: 10.1002/jhbp.843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) is common after distal pancreatectomy (DP). Whilst extensive investigation into potential predictors has been carried out, there is little evidence regarding POPF healing time. METHODS This is a retrospective analysis of all consecutive DPs performed at the Department of General and Pancreatic Surgery, University of Verona Hospital Trust, from 2015 to 2019. Perioperative variables were analyzed identifying possible predictors of POPF healing time defined as days between surgery and last drain removal due to POPF. RESULTS A total of 496 patients were included. POPF rate was 28.2% and median POPF healing time was 30 days (95% CI 28-31). Independent predictors of POPF were body mass index (BMI) (OR 1.073, 95% CI 1.010-1.147, p = 0.040), operative time (OR 95% CI 1.002-1.009, P = .003), and postoperative acute pancreatitis (OR 3.793, 95% CI, 1.852-7.767, P < .001). Independent predictors of POPF healing time were female sex (HR 1.323, 95% CI 1.093-1.998, P = .042), preoperative pancreatic enzyme replacement therapy (HR 2.319, 95% CI 1.195-4.498, P = .013), ASA score 3 (HR 0.278, 95% CI 0.119-0.646, P = .003), pancreatic transection with ultrasonic dissector (HR 0.605, 95% CI 0.404-0.907, P = .015), and positive drain cultures (HR 0.635, 95% CI 0.443-0.910, P = .013). CONCLUSION POPF healing after DP is a slow process since only half of patients recover within 30 days of surgery. A longer healing time can be predicted early in the postoperative period with significant implications in therapeutic choices.
Collapse
Affiliation(s)
- Stefano Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Elisa Bannone
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Piero Vacca
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| |
Collapse
|
20
|
Simionato F, Zecchetto C, Merz V, Cavaliere A, Casalino S, Gaule M, D'Onofrio M, Malleo G, Landoni L, Esposito A, Marchegiani G, Casetti L, Tuveri M, Paiella S, Scopelliti F, Giardino A, Frigerio I, Regi P, Capelli P, Gobbo S, Gabbrielli A, Bernardoni L, Fedele V, Rossi I, Piazzola C, Giacomazzi S, Pasquato M, Gianfortone M, Milleri S, Milella M, Butturini G, Salvia R, Bassi C, Melisi D. A phase II study of liposomal irinotecan with 5-fluorouracil, leucovorin and oxaliplatin in patients with resectable pancreatic cancer: the nITRO trial. Ther Adv Med Oncol 2020; 12:1758835920947969. [PMID: 33403007 PMCID: PMC7745557 DOI: 10.1177/1758835920947969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/19/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Up-front surgery followed by postoperative chemotherapy remains the standard paradigm for the treatment of patients with resectable pancreatic cancer. However, the risk for positive surgical margins, the poor recovery after surgery that often impairs postoperative treatment, and the common metastatic relapse limit the overall clinical outcomes achieved with this strategy. Polychemotherapeutic combinations are valid options for postoperative treatment in patients with good performance status. liposomal irinotecan (Nal-IRI) is a novel nanoliposome formulation of irinotecan that accumulates in tumor-associated macrophages improving the therapeutic index of irinotecan and has been approved for the treatment of patients with metastatic pancreatic cancer after progression under gemcitabine-based therapy. Thus, it remains of the outmost urgency to investigate introduction of the most novel agents, such as nal-IRI, in perioperative approaches aimed at increasing the long-term effectiveness of surgery. Methods: The nITRO trial is a phase II, single-arm, open-label study to assess the safety and the activity of nal-IRI with fluorouracil/leucovorin (5-FU/LV) and oxaliplatin in the perioperative treatment of patients with resectable pancreatic cancer. The primary tumor must be resectable with no involvement of the major arteries and no involvement or <180° interface between tumor and vessel wall of the major veins. A total of 72 patients will be enrolled to receive a perioperative treatment of three cycles before and three cycles after surgical resection with nal-IRI 50 mg/m2, oxaliplatin 60 mg/m2, leucovorin 200 mg/m2, and 5-fluorouracil 2400 mg/m2, days 1 and 15 of a 28-day cycle. The primary objective is to improve from 40% to 55% the proportion of patients achieving R0 resection after preoperative treatment. Discussion: The nITRO trial will contribute to strengthen the clinical evidence supporting perioperative strategies in resectable pancreatic cancer patients. Moreover, this study represents a unique opportunity for translational analyses aimed to identify novel immune-related prognostic and predictive factors in this setting. Trial registration Clinicaltrial.gov: NCT03528785. Trial registration data: 1 January 2018 Protocol number: CRC 2017_01 EudraCT Number: 2017-000345-46
Collapse
Affiliation(s)
- Francesca Simionato
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Marina Gaule
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University and Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Malleo
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Landoni
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Alessandro Esposito
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | | | - Luca Casetti
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Massimiliano Tuveri
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Salvatore Paiella
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Filippo Scopelliti
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Alessandro Giardino
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Isabella Frigerio
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Paolo Regi
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Paola Capelli
- Department of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Gobbo
- Department of Pathology, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | | | - Laura Bernardoni
- Endoscopy Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Vita Fedele
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Irene Rossi
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Cristiana Piazzola
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Serena Giacomazzi
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Martina Pasquato
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Morena Gianfortone
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Milleri
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Michele Milella
- Medical Oncology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Butturini
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Roberto Salvia
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Bassi
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, AOUI Verona - Policlinico "G.B. Rossi", Piazzale L.A. Scuro, 10, Verona 37134, Italy
| |
Collapse
|
21
|
Marchegiani G, Paiella S, Malleo G, Landoni L, Tuveri M, Esposito A, Casetti L, De Pastena M, Fontana M, Salvia R, Bassi C. Management of Pancreatic Cystic Lesions. Dig Surg 2020; 37:1-9. [PMID: 30636253 PMCID: PMC7360492 DOI: 10.1159/000496509] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of undefined pancreatic cystic neoplasms (PCNs) is high in the general population, increasing with patient age. PCNs account for different biological entities with different potential for malignant transformation. The clinician must balance his or her practice between the risk of surgical overtreatment and the error of keeping a malignant lesion under surveillance. METHODS We review and discuss the clinical management of PCNs. Specifically, we analyze the main features of PCNs from the surgeon's point of view, as they present in the outpatient clinic. We also review the different consensus guidelines, address recent controversies in the literature, and present the current clinical practice at 4 different European Centers for pancreatic surgery. RESULTS The main features of PCNs were analyzed from the surgeon's point of view as they present in the outpatient clinic. All aspects of surgical management were discussed, from indications for surgery to intraoperative management and surveillance strategies. CONCLUSIONS Management of PCNs requires a selective approach with the aim of minimizing clinically relevant diagnostic mistakes. Through the evaluation of clinical and radiological features of a PCN, the surgeon can elaborate on a diagnostic hypothesis and assess malignancy risk, but the final decision should be tailored to the individual patient's need.
Collapse
Affiliation(s)
- Giovanni Marchegiani
- *Giovanni Marchegiani, Department of Surgery, Verona University Hospital, P.le Scuro 10, IT–37134 Verona (Italy),
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Marchegiani G, Paiella S, Malleo G, Landoni L, Tuveri M, Esposito A, Casetti L, De Pastena M, Fontana M, Salvia R, Bassi C. Love (Pancreatic Surgery) in the Time of Cholera (COVID-19). Dig Surg 2020; 37:524-526. [PMID: 32554956 PMCID: PMC7360492 DOI: 10.1159/000508474] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 12/10/2022]
Affiliation(s)
- Giovanni Marchegiani
- *Giovanni Marchegiani, Department of Surgery, Verona University Hospital, P.le Scuro 10, IT–37134 Verona (Italy),
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
De Pastena M, Esposito A, Paiella S, Surci N, Montagnini G, Marchegiani G, Malleo G, Secchettin E, Casetti L, Ricci C, Landoni L, Bovo C, Bassi C, Salvia R. Cost-effectiveness and quality of life analysis of laparoscopic and robotic distal pancreatectomy: a propensity score-matched study. Surg Endosc 2020; 35:1420-1428. [PMID: 32240383 DOI: 10.1007/s00464-020-07528-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study analyzed the Quality of Life (QoL) and cost-effectiveness of laparoscopic (LDP) versus robotic distal pancreatectomy (RDP). METHOD All patients who underwent LDP or RDP from 2011 to 2017 and with a minimum postoperative follow-up of 12 months were included in the study. To minimize bias, a propensity score-matched analysis (1:2) was performed. Two different questionnaires (EORTC QLQ-C30 and EQ-5D) were completed by the patients. The mean differential cost and mean differential Quality Adjusted Life Years (QALY) were calculated and plotted on a cost-utility plane. RESULTS The study population consisted of 152 patients. After having applied the propensity score matching, the final population included 103 patients divided into RDP group (n = 37, 36%) and LDP (n = 66, 64%). No differences were found between groups regarding the baseline, intraoperative, postoperative, and pathological variables (p > 0.05). The QoL analysis showed a significant improvement in the RDP group on the postoperative social function, nausea, vomiting, and financial status (p = 0.010, p = 0.050, and p = 0.030, respectively). As expected, the crude costs analysis confirmed that RDP was more expensive than LDP (12,053 Euros vs. 5519 Euros, p < 0.001). However, the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a willingness to pay of more than 4800 Euros/QALY was accepted. CONCLUSION RDP was associated with QoL improvement in specific domains. Crude costs were higher relative to LDP. Cost-effectiveness threshold resulted to be 4800 euros/QALY. The increasing worldwide diffusion of the robotic technology, with easier access and possible cost reduction, could increase the sustainability of this procedure.
Collapse
Affiliation(s)
- Matteo De Pastena
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
| | - Alessandro Esposito
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Salvatore Paiella
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Niccolò Surci
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Greta Montagnini
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Giovanni Marchegiani
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Erica Secchettin
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Claudio Ricci
- Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Chiara Bovo
- Healthcare Department Administrator, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| |
Collapse
|
24
|
Marinelli V, Secchettin E, Andrianello S, Moretti C, Donvito S, Marchegiani G, Esposito A, Casetti L, Salvia R. Psychological distress in patients under surveillance for intraductal papillary mucinous neoplasms of the pancreas: The "Sword of Damocles" effect calls for an integrated medical and psychological approach a prospective analysis. Pancreatology 2020; 20:505-510. [PMID: 31948794 DOI: 10.1016/j.pan.2020.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/19/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Most intraductal papillary mucinous neoplasms (IPMNs) of the pancreas can be safely surveilled. Their psychological impact is not known. The aim of this study is to obtain a psychological profile of patients under surveillance and compare the results to patients undergoing surgery. METHODS Patients under surveillance for IPMNs evaluated between 2017 and 2019 at the pancreatic cysts clinic of The Pancreas Institute of Verona were compared to patients undergoing surgery for the same disease. Patients with high-risk stigmata were excluded in both groups. Patients were profiled with the Barratt Simplified Measure of Socio-Economic Status (BSMSS), the Brief Coping Orientation to Problems Experienced (Brief-COPE), the Perceived Stress Scale (PSS), the Symptom Checklist-90 and the Short Form Health Survey (SF-36). Age, sex, BSMSS and Brief-COPE were used to match patients with the propensity score as potential sources of bias. RESULTS Two hundred patients were profiled. After the matching, 74 patients under surveillance were compared to 74 patients who underwent surgery. Patients under surveillance reported significantly increased scores for symptoms such as somatization (0.71 vs. 0.54, p = 0.032), depression (0.45 vs 0.31, p = 0.047) and anxiety (0.45 vs. 0.27, p = 0.002). They also reported a reduced health perception in the domain of physical role functioning (54 vs. 68, p = 0.046). CONCLUSION Patients under surveillance for a presumed IPMN experience anxiety and stress and feel less healthy than do patients undergoing surgery. This reduction in quality of life should always be taken into account and warrants an integrated medical-psychological approach in selected cases.
Collapse
Affiliation(s)
- Veronica Marinelli
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Erica Secchettin
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Stefano Andrianello
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Moretti
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Sara Donvito
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
| | - Alessandro Esposito
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| |
Collapse
|
25
|
De Pastena M, Marchegiani G, Paiella S, Fontana M, Esposito A, Casetti L, Secchettin E, Manzini G, Bassi C, Salvia R. Use of an intraoperative wound protector to prevent surgical-site infection after pancreatoduodenectomy: randomized clinical trial. Br J Surg 2020; 107:1107-1113. [DOI: 10.1002/bjs.11527] [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: 09/11/2019] [Revised: 10/08/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Abstract
Background
Surgical-site infection (SSI) increases treatment costs, duration of hospital stay and readmission rate after pancreatic surgery. This study aimed to assess whether a wound protector could reduce the risk of superficial incisional SSI after pancreatoduodenectomy.
Methods
This RCT included patients undergoing pancreatoduodenectomy at Verona University Hospital, between 2017 and 2018. The experimental group had a dual-ring wound protector, whereas the control group had standard surgical drapes. The groups were stratified by preoperative biliary stent placement. The primary outcome was the overall rate of superficial SSI.
Results
An interim analysis was conducted after 212 patients had been enrolled; 22 patients (10·4 per cent) were excluded owing to inability to complete the pancreatoduodenectomy, or the need for postoperative reintervention. Some 94 patients (49·5 per cent) had a wound protector and 96 (50·5 per cent) had standard drapes. There were no differences between groups in demographics, or in intraoperative findings, pathological data or surgical outcomes. The overall superficial SSI rate was 7·4 per cent, which did not differ between groups (7 per cent in each group; P = 0·585). Subanalysis of patients with a preoperative biliary stent showed a similar outcome (superficial SSI rate 9 versus 8 per cent with wound protector versus surgical drapes respectively; P = 0·536). The trial was stopped prematurely on the grounds of futility.
Conclusion
Use of a wound protector did not reduce the rate of superficial SSI after pancreatoduodenectomy. Registration number: NCT03820648 (http://www.clinicaltrials.gov).
Collapse
Affiliation(s)
- M De Pastena
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - G Marchegiani
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - S Paiella
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - M Fontana
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - A Esposito
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - L Casetti
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - E Secchettin
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - G Manzini
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - C Bassi
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - R Salvia
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| |
Collapse
|
26
|
Esposito A, Casetti L, De Pastena M, Ramera M, Montagnini G, Landoni L, Bassi C, Salvia R. Robotic spleen-preserving distal pancreatectomy: the Verona experience. Updates Surg 2020; 73:923-928. [PMID: 32162271 DOI: 10.1007/s13304-020-00731-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/21/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The minimally invasive approach in spleen-preserving distal pancreatectomy has currently been emphasized in benign and pre-malignant pancreatic diseases. The study aims to demonstrate the safety and feasibility of our technique of robotic spleen-preserving distal pancreatectomy (RSPDP) by a stepwise approach. METHODS The data of consecutive patients presented for RSPDP from 2014 to 2019 at Verona University were retrieved from a prospectively maintained database. The patients were divided into two groups based on the surgical procedure performed, such as Kimura's (KG) or Warshaw's (WG) technique, and then compared. RESULTS In the study period, 32 patients underwent RSPDP. Twenty-three patients presented for the Kimura procedure (72%), while nine patients underwent the Warshaw procedure (28%). A higher body mass index was found in the KG (26 ± 4 vs. 22 ± 3, p = 0.037). Regarding the pathological data, the WG group differed in the tumor dimension, and the lymph nodes harvested (30 ± 2 vs. 17 ± 10, 9 ± 5 vs. 3 ± 4, p = 0.0028, and p = 0.005, respectively). Notably, no conversions and mortality were recorded. The overall morbidity was 25% ( eight patients) with no difference between the groups (p = 0.820). The mean length of stay was 8 days, and was similar between the groups (p = 0.350). CONCLUSIONS The present study suggests that RSPDP is a valid option for the treatment of benign or pre-malignant pancreatic diseases of the distal pancreas, with comparable morbidity with the standard treatment and no mortality. Further research is needed to standardize the technique and to assess the immunological, surgical, and financial benefits of the procedure.
Collapse
Affiliation(s)
- A Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - L Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - M De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - M Ramera
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - G Montagnini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - L Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - C Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy
| | - R Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy.
| |
Collapse
|
27
|
Esposito A, Balduzzi A, De Pastena M, Fontana M, Casetti L, Ramera M, Bassi C, Salvia R. Minimally invasive surgery for pancreatic cancer. Expert Rev Anticancer Ther 2019; 19:947-958. [DOI: 10.1080/14737140.2019.1685878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alberto Balduzzi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Martina Fontana
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Marco Ramera
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| |
Collapse
|
28
|
Maggino L, Malleo G, Marchegiani G, Viviani E, Nessi C, Ciprani D, Esposito A, Landoni L, Casetti L, Tuveri M, Paiella S, Casciani F, Sereni E, Binco A, Bonamini D, Secchettin E, Auriemma A, Merz V, Simionato F, Zecchetto C, D’Onofrio M, Melisi D, Bassi C, Salvia R. Outcomes of Primary Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma. JAMA Surg 2019; 154:932-942. [PMID: 31339530 PMCID: PMC6659151 DOI: 10.1001/jamasurg.2019.2277] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [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: 02/23/2019] [Accepted: 05/17/2019] [Indexed: 12/21/2022]
Abstract
Importance Chemotherapy is the recommended induction strategy in borderline resectable and locally advanced pancreatic ductal adenocarcinoma. However, the associated results on an intention-to-treat basis are poorly understood. Objective To investigate pragmatically the treatment compliance, conversion to surgery, and survival outcomes of patients with borderline resectable and locally advanced pancreatic ductal adenocarcinoma undergoing primary chemotherapy. Design, Setting, and Participants This prospective study took place in a national referral center for pancreatic diseases in Italy. Consecutive patients with borderline resectable and locally advanced pancreatic ductal adenocarcinoma were enrolled at the time of diagnosis (January 2013 through December 2015) and followed up to June 2018. Exposures The chemotherapy regimen, assigned based on multidisciplinary evaluation, was delivered either at a hub center or at spoke centers. By convention, primary chemotherapy was considered completed after 6 months. After restaging, surgical candidates were selected based on radiologic and biochemical response. All surgeries were carried out at the hub center. Main Outcomes and Measures Rates of receipt and completion of chemotherapy, rates of conversion to surgery, and disease-specific survival. Results Of 680 patients, 267 (39.3%) had borderline resectable and 413 (60.7%) had locally advanced pancreatic ductal adenocarcinoma. Overall, 66 patients (9.7%) were lost to follow-up. The rate of chemotherapy receipt was 92.9% (n = 570). The chemotherapeutic regimens most commonly used included FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) (260 [45.6%]) and gemcitabine plus nanoparticle albumin-bound-paclitaxel (123 [21.6%]). Nineteen patients (3.3%) receiving chemotherapy died within 6 months, mainly for disease progression. The treatment completion rate was 71.6% (408 of 570). The overall rate of resection was 15.1% (93 of 614) (borderline resectable, 60 of 249 [24.1%]; locally advanced, 33 of 365 [9%]; resection:exploration ratio, 63.3%). Independent predictors of resection were age, borderline resectable disease, chemotherapy completion, radiologic response, and biochemical response. The median survival for the whole cohort was 12.8 (95% CI, 11.7-13.9) months. Factors independently associated with survival were completion of chemotherapy, receipt of complementary radiation therapy, and resection. In patients who underwent resection, the median survival was 35.4 (95% CI, 27.0-43.7) months for initially borderline resectable and 41.8 (95% CI, 27.5-56.1) months for initially locally advanced disease. No pretreatment and posttreatment factors were associated with survival after pancreatectomy. Conclusions and Relevance This pragmatic observational cohort study with an intention-to-treat design provides real-world evidence of outcomes associated with the most current primary chemotherapy regimens used for borderline resectable and locally advanced pancreatic ductal adenocarcinoma.
Collapse
Affiliation(s)
- Laura Maggino
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Elena Viviani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Chiara Nessi
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Debora Ciprani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Massimiliano Tuveri
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Fabio Casciani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Elisabetta Sereni
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Alessandra Binco
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Deborah Bonamini
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Erica Secchettin
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Alessandra Auriemma
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Valeria Merz
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Francesca Simionato
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Camilla Zecchetto
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Mirko D’Onofrio
- Unit of Radiology, Department of Pathology and Diagnostics, University of Verona Hospital Trust, Verona, Italy
| | - Davide Melisi
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| |
Collapse
|
29
|
Paiella S, De Pastena M, Korrel M, Pan TL, Butturini G, Nessi C, De Robertis R, Landoni L, Casetti L, Giardino A, Busch O, Pea A, Esposito A, Besselink M, Bassi C, Salvia R. Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: International multicenter retrospective study. Eur J Surg Oncol 2019; 45:1668-1673. [PMID: 31005470 DOI: 10.1016/j.ejso.2019.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Warshaw (WT) and the Kimura (KT) techniques are both used for open or minimally invasive (MI) spleen preserving distal pancreatectomy (SPDP). Multicenter studies on long-term outcome of WT and KT are lacking. METHODS Multicenter retrospective study with transversal follow-up moment, including patients who underwent SPDP from 2000 to 2017 at three high-volume centers in Italy and the Netherlands. Primary endpoint was the incidence of short and long term complications. Patients without regular follow-up were interviewed about symptoms and complications. RESULTS In total, 164 patients were enrolled, 55 WT (33.5%) and 109 kT (66.5%), of which 95 (57.9%) MI. There was no 30-day mortality (0%).The only significant difference in short-term outcome was more delayed gastric emptying (DGE) after WT (9.1% vs 1.8%, p = 0.043). MI-SPDP was associated with less blood loss (median 150 vs 250 ml, respectively, p < 0.001), less DGE (0% vs 10%, p = 0.002), less abdominal abscesses (8.4% vs 18.4%, p = 0.03) and less splenic infarctions (3.2% vs. 13%, p = 0.042), than open SPDP. Long-term follow-up (median 41 months) was available for 111 patients (67.7%) of whom 18 (16.2%) had an SPDP-related long-term sequela, mostly perigastric varices (n = 11, 9%) but without differences between WT and KT. Less long-term sequelae were reported after MI as compared to open SPDP (12.5% vs 21.2%, p = 0.032). CONCLUSIONS In this international retrospective study, the WT and KT had comparable short- and long-term outcomes. If a KT does not seem feasible during SPDP, a WT is recommended, rather than performing a splenectomy. MI-SPDP was associated with less short- and long term complications as compared to an open SPDP.
Collapse
Affiliation(s)
- Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Matteo De Pastena
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Maarten Korrel
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Teresa Lucia Pan
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Giovanni Butturini
- Pancreatic Surgery Unit, Ospedale Pederzoli, Peschiera del Garda, Verona, Italy
| | - Chiara Nessi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | | | - Luca Landoni
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Alessandro Giardino
- Pancreatic Surgery Unit, Ospedale Pederzoli, Peschiera del Garda, Verona, Italy
| | - Olivier Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Antonio Pea
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Alessandro Esposito
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Marc Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy.
| |
Collapse
|
30
|
Malleo G, Maggino L, Marchegiani G, Feriani G, Esposito A, Landoni L, Casetti L, Paiella S, Baggio E, Lipari G, Capelli P, Scarpa A, Bassi C, Salvia R. Pancreatectomy with venous resection for pT3 head adenocarcinoma: Perioperative outcomes, recurrence pattern and prognostic implications of histologically confirmed vascular infiltration. Pancreatology 2017; 17:847-857. [PMID: 28843714 DOI: 10.1016/j.pan.2017.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 02/10/2017] [Revised: 07/20/2017] [Accepted: 08/18/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The outcomes of pancreatectomy with superior mesenteric vein (SMV) or portal vein (PV) resection have been mixed. This study investigated the morbidity and mortality profile after SMV-PV resection in comparison with standard pancreatectomy. Furthermore, we assessed whether tumors with histologically proven SMV-PV infiltration differ from other pT3 neoplasms in terms of recurrence pattern and survival. METHODS All patients with a pT3 head adenocarcinoma resected from 2000 to 2013 were analyzed retrospectively. In the SMV-PV resection group, information on venous wall status was obtained through pathologic reports. Standard statistical methods were used for data analysis. RESULTS The study population consisted of 651 patients, of whom 81 (12.4%) underwent synchronous SMV-PV resection. Venous resection was not associated with a higher rate of postoperative complications (60.5% versus 50.2%) and mortality (1.2% versus 1.1%) in comparison with standard pancreatectomy. Vascular infiltration was confirmed pathologically in 56/81 patients (69.1%). The median disease-specific survival of the entire population was 27 months (95% CI 24.6-29.3), with a 5-year survival rate of 20.5%. The median recurrence-free survival was 18 months (95% CI 15.0-20.9). On multivariate analysis, ASA score, preoperative pain, Ca 19-9 levels, tumor grade, R-status, lymph-vascular invasion, N-status, and adjuvant therapy resulted to be survival predictors. Similarly, Ca 19.9 levels, R-status, and N-status were predictors of recurrence. SMV-PV infiltration was not a significant prognostic factor. CONCLUSION Morbidity and mortality rates of pancreatectomy with SMV-PV resection are comparable with standard pancreatectomy. Pancreatic head adenocarcinoma with histologically confirmed SMV-PV infiltration does not segregate prognostically from other pT3 tumors.
Collapse
Affiliation(s)
- Giuseppe Malleo
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy.
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Giovanni Marchegiani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Giovanni Feriani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Alessandro Esposito
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Luca Landoni
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Luca Casetti
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Salvatore Paiella
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Elda Baggio
- Unit of Vascular Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Italy
| | - Giovanni Lipari
- Unit of Vascular Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Italy
| | - Paola Capelli
- Department of Pathology and Diagnostics, University of Verona Hospital Trust, Italy
| | - Aldo Scarpa
- Department of Pathology and Diagnostics, University of Verona Hospital Trust, Italy; ARC-NET Research Center, University of Verona Hospital Trust, Italy
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy
| |
Collapse
|
31
|
Brunner TA, Casetti L, Haueter P, Müller P, Nydegger A, Spalinger J. Nutrient intake of Swiss toddlers. Eur J Nutr 2017; 57:2489-2499. [PMID: 28812189 DOI: 10.1007/s00394-017-1521-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/12/2016] [Accepted: 08/06/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE During the first years of life, food preferences are shaped that might last throughout a person's entire life affecting his/her health in the long term. However, knowledge on early feeding habits is still limited for toddlers. Therefore, the goal of the present study was to: (1) assess toddlers' nutrient intake; (2) compare the findings to past studies as well as to national feeding recommendations and (3) identify major food sources for energy and macronutrients. METHODS A food survey using a 4-day diary was conducted. The dietary software nut.s® was used to analyse the data. RESULTS A cohort of 188 healthy toddlers (aged 1-3 years) was analysed. The energy intake of most toddlers was below the recommended daily intake (RDI) but in accordance with earlier studies. Protein intake was three- to fourfold higher than the RDI and reached the proposed upper limit of 15% of total energy intake. Fat intake was in accordance with the RDI, but the balance of saturated and unsaturated fatty acids should be improved. Carbohydrate intake met the RDI. For the micronutrients, iron and vitamin D intakes showed critical values. CONCLUSION As in other European countries, the diet of Swiss toddlers in general seems adequate but does not meet all nutritional requirements. In particular, the quality of the fats and vitamin D supplementation should be improved. For proteins and iron, additional research is needed to gain more confidence in the recommendations.
Collapse
Affiliation(s)
- Thomas A Brunner
- School of Agricultural, Forest and Food Sciences, Food Science and Management, Bern University of Applied Sciences, Länggasse 85, 3052, Zollikofen, Switzerland.
| | - Luca Casetti
- School of Agricultural, Forest and Food Sciences, Food Science and Management, Bern University of Applied Sciences, Länggasse 85, 3052, Zollikofen, Switzerland
| | - Petra Haueter
- School of Agricultural, Forest and Food Sciences, Food Science and Management, Bern University of Applied Sciences, Länggasse 85, 3052, Zollikofen, Switzerland
| | - Pascal Müller
- Paediatric Gastroenterology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Andreas Nydegger
- Paediatric Gastroenterology, Department of Paediatrics, University of Lausanne, Lausanne, Switzerland
| | | |
Collapse
|
32
|
Paiella S, De Pastena M, Pollini T, Zancan G, Ciprani D, De Marchi G, Landoni L, Esposito A, Casetti L, Malleo G, Marchegiani G, Tuveri M, Marrano E, Maggino L, Secchettin E, Bonamini D, Bassi C, Salvia R. Pancreaticoduodenectomy in patients ≥ 75 years of age: Are there any differences with other age ranges in oncological and surgical outcomes? Results from a tertiary referral center. World J Gastroenterol 2017; 23:3077-3083. [PMID: 28533664 PMCID: PMC5423044 DOI: 10.3748/wjg.v23.i17.3077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/20/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To compare surgical and oncological outcomes after pancreaticoduodenectomy (PD) in patients ≥ 75 years of age with two younger cohorts of patients.
METHODS The prospectively maintained Institutional database of pancreatic resection was queried for patients aged ≥ 75 years (late elderly, LE) submitted to PD for any disease from January 2010 to June 2015. We compared clinical, demographic and pathological features and survival outcomes of LE patients with 2 exact matched cohorts of younger patients [≥ 40 to 64 years of age (adults, A) and ≥ 65 to 74 years of age (young elderly, YE)] submitted to PD, according to selected variables.
RESULTS The final LE population, as well as the control groups, were made of 96 subjects. Up to 71% of patients was operated on for a periampullary malignancy and pancreatic cancer (PDAC) accounted for 79% of them. Intraoperative data (estimated blood loss and duration of surgery) did not differ among the groups. The overall complication rate was 65.6%, 61.5% and 58.3% for LE, YE and A patients, respectively, P = NS). Reoperation and cardiovascular complications were significantly more frequent in LE than in YE and A groups (P = 0.003 and P = 0.019, respectively). When considering either all malignancies and PDAC only, the three groups did not differ in survival. Considering all benign diseases, the estimated mean survival was 58 and 78 mo for ≥ and < 75 years of age (YE + A groups), respectively (P = 0.012).
CONCLUSION Age is not a contraindication for PD. A careful selection of LE patients allows to obtain good surgical and oncological results.
Collapse
|
33
|
Paiella S, De Pastena M, Landoni L, Esposito A, Casetti L, Miotto M, Ramera M, Salvia R, Secchettin E, Bonamini D, Manzini G, D'Onofrio M, Marchegiani G, Bassi C. Is there a role for near-infrared technology in laparoscopic resection of pancreatic neuroendocrine tumors? Results of the COLPAN "colour-and-resect the pancreas" study. Surg Endosc 2017; 31:4478-4484. [PMID: 28374260 DOI: 10.1007/s00464-017-5501-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 01/05/2017] [Accepted: 03/08/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The intraoperative identification of pancreatic neuroendocrine tumors (PanNETs) is of utmost importance to drive their laparoscopic resection. Near-infrared (NIR) surgery has emerged as a new technique for localizing tumors or neoplastic tissue. This study aimed to explore the results of the application of NIR in the laparoscopic resection of PanNETs. METHODS Per protocol we enrolled ten subjects undergoing laparoscopic pancreatic surgery for PanNET from March 2016 to October 2016. During surgery, the patients were injected with indocyanine green dye (ICG, 25 mg given in 5 boli of 5 mg each). The switch-activation of NIR was performed to identify PanNETs. An ex-post analysis of the images was realized using ImageJ Software® to calculate the fluorescence signal. RESULTS NIR imaging identified all ten PanNETs. Nine (90%) laparoscopic distal pancreatectomy with splenectomy and one (10%) laparoscopic enucleation were performed. The mean maximum tumor dimension was 2.4 cm (range 1-4 cm). Eight non-functioning PanNETs (80%) and two insulinomas (20%) were found at the final pathology. Nine out of ten (90%) PanNETs were detected after the second ICG bolus. The mean latency time was 80 s and the mean visibility time was 220 s. The peak of tumor visualization was reached 20 min after the last bolus. This finding was confirmed by the ex-post analysis of the fluorescence signal (mean signal-to-background ratio of 7.7, p = 0.001). NIR identified two additional lesions, which turned out to be normal lymph nodes at final pathology. A fluorescent signal was identified at the bed of the enucleation, and thus, a further exeresis was performed and final pathology revealed that is was residual neoplastic tissue. CONCLUSIONS This explorative study shows that NIR with ICG can have a role in laparoscopic pancreatic resection of PanNETs. Further studies are needed to assess the proper setting and role of this new and promising technology.
Collapse
Affiliation(s)
- Salvatore Paiella
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
| | - Matteo De Pastena
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Alessandro Esposito
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Marco Miotto
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Marco Ramera
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Erica Secchettin
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Deborah Bonamini
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Gessica Manzini
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Mirko D'Onofrio
- Radiology Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Marchegiani
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| |
Collapse
|
34
|
Capron C, Jondeau K, Casetti L, Jalbert V, Costa C, Verhoeyen E, Massé JM, Coppo P, Béné MC, Bourdoncle P, Cramer-Bordé E, Dusanter-Fourt I. Erratum: Viability and stress protection of chronic lymphoid leukemia cells involves overactivation of mitochondrial phosphoSTAT3Ser727. Cell Death Dis 2015. [PMCID: PMC4669783 DOI: 10.1038/cddis.2014.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
35
|
Malleo G, Salvia R, Mascetta G, Esposito A, Landoni L, Casetti L, Maggino L, Bassi C, Butturini G. Assessment of a complication risk score and study of complication profile in laparoscopic distal pancreatectomy. J Gastrointest Surg 2014; 18:2009-15. [PMID: 25238815 DOI: 10.1007/s11605-014-2651-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/29/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study assessed the patient-specific risk for major postoperative morbidity in a series of 100 laparoscopic distal pancreatectomies (LDP). METHODS A previously established complication risk score (CRS), identifying body mass index (BMI), estimated blood loss (EBL), and pancreatic specimen length as determinants of postoperative morbidity were examined against the observed outcomes. In addition, multivariate analyses were performed to investigate risk factors specific to our study population. RESULTS The postoperative morbidity rate was 49 %, major complication accounted for 12 %, and clinically relevant pancreatic fistulae (PF) were 13 %. The incidence of any complications, major complications, any PF, and clinically relevant PF did not vary appreciably when the CRS increased. The multivariate analysis indicated that male sex and an EBL ≥150 mL were independent predictors of major morbidity and clinically relevant PF. CONCLUSION In conclusion, the previously published CRS based on pre- and intraoperative factors was not able to predict the postoperative risk in our population. This is probably because risk scores may not be able to adjust for the case-mix (heterogeneity in baseline patient characteristics). According to our data, men and patients with EBL ≥150 mL are more likely to develop major postoperative complications after LDP.
Collapse
Affiliation(s)
- Giuseppe Malleo
- Unit of Surgery B, The Pancreas Institute, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona Hospital Trust, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Capron C, Jondeau K, Casetti L, Jalbert V, Costa C, Verhoeyen E, Verhoyen E, Massé JM, Coppo P, Béné MC, Bourdoncle P, Cramer-Bordé E, Dusanter-Fourt I. Viability and stress protection of chronic lymphoid leukemia cells involves overactivation of mitochondrial phosphoSTAT3Ser727. Cell Death Dis 2014; 5:e1451. [PMID: 25299776 PMCID: PMC4237234 DOI: 10.1038/cddis.2014.393] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 04/15/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 12/18/2022]
Abstract
Chronic lymphoid leukemia (CLL) is characterized by the accumulation of functionally defective
CD5-positive B lymphocytes. The clinical course of CLL is highly variable, ranging from a
long-lasting indolent disease to an unpredictable and rapidly progressing leukemia requiring
treatment. It is thus important to identify novel factors that reflect disease progression or
contribute to its assessment. Here, we report on a novel STAT3-mediated pathway that characterizes
CLL B cells-extended viability and oxidative stress control. We observed that leukemic but not
normal B cells from CLL patients exhibit constitutive activation of an atypical form of the STAT3
signaling factor, phosphorylated on serine 727 (Ser727) in the absence of detectable
canonical tyrosine 705 (Tyr705)-dependent activation in vivo. The
Ser727-phosphorylated STAT3 molecule (pSTAT3Ser727) is localized to the
mitochondria and associates with complex I of the respiratory chain. This pSer727
modification is further controlled by glutathione-dependent antioxidant pathway(s) that mediate
stromal protection of the leukemic B cells and regulate their viability. Importantly,
pSTAT3Ser727, but neither Tyr705-phosphorylated STAT3 nor total STAT3, levels correlate
with prolonged in vivo CLL B cells survival. Furthermore, STAT3 activity contributes to the
resistance to apoptosis of CLL, but not normal B cells, in vitro. These data reveal that
mitochondrial (Mt) pSTAT3Ser727 overactivity is part of the antioxidant defense pathway
of CLL B cells that regulates their viability. Mt pSTAT3Ser727 appears to be a newly
identified cell-protective signal involved in CLL cells survival. Targeting pSTAT3Ser727
could be a promising new therapeutic approach.
Collapse
Affiliation(s)
- C Capron
- 1] Institut Cochin, Inserm U1016, Paris, France [2] Service d'Hématologie-Immunologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France [4] CNRS UMR8104, Paris, France [5] Université de Versailles St Quentin en Yvelines, Guyancourt, France
| | - K Jondeau
- 1] Service d'Hématologie-Immunologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France [2] Université de Versailles St Quentin en Yvelines, Guyancourt, France
| | - L Casetti
- 1] Institut Cochin, Inserm U1016, Paris, France [2] Université Paris Descartes, Sorbonne Paris Cité, Paris, France [3] CNRS UMR8104, Paris, France
| | - V Jalbert
- Service d'Hématologie-Immunologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - C Costa
- Ecole Normale Supérieure de Lyon, Université de Lyon, UCB-Lyon1, Lyon, France
| | | | - E Verhoyen
- 1] Ecole Normale Supérieure de Lyon, Université de Lyon, UCB-Lyon1, Lyon, France [2] INSERM U1065, Lyon, France
| | - J M Massé
- 1] Institut Cochin, Inserm U1016, Paris, France [2] Université Paris Descartes, Sorbonne Paris Cité, Paris, France [3] CNRS UMR8104, Paris, France
| | - P Coppo
- Service d'Hématologie Clinique, Hôpital Saint Antoine and Université UPMC, Paris, France
| | - M C Béné
- Service d'Hématologie Biologique, Hôtel-Dieu-CHU, Nantes, France
| | - P Bourdoncle
- 1] Institut Cochin, Inserm U1016, Paris, France [2] Université Paris Descartes, Sorbonne Paris Cité, Paris, France [3] CNRS UMR8104, Paris, France
| | - E Cramer-Bordé
- 1] Institut Cochin, Inserm U1016, Paris, France [2] Service d'Hématologie-Immunologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France [3] Université Paris Descartes, Sorbonne Paris Cité, Paris, France [4] CNRS UMR8104, Paris, France [5] Université de Versailles St Quentin en Yvelines, Guyancourt, France
| | - I Dusanter-Fourt
- 1] Institut Cochin, Inserm U1016, Paris, France [2] Université Paris Descartes, Sorbonne Paris Cité, Paris, France [3] CNRS UMR8104, Paris, France
| |
Collapse
|
37
|
Abstract
The hydrophobic effect is the dominant force which drives a proteintowards its native state, but its physics has not been thoroughlyunderstood yet. We introduce an exactly solvable model of the solvation ofnon-polar molecules in water, which shows that the reduced number ofallowed configurations of water molecules when the solute is present isenough to give rise to hydrophobic behaviour. We apply our model to anon-polar homopolymer in aqueous solution, obtaining a clear evidence ofboth `cold' and `warm' collapse transitions that recall those of proteins.Finally we show how the model can be adapted to describe the solvation ofaromatic and polar molecules.
Collapse
Affiliation(s)
- P Bruscolini
- Istituto Nazionale per la Fisica della Materia (INFM) and Dipartimento di Fisica, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-10129 Torino, Italy
| | | |
Collapse
|
38
|
Butturini G, Partelli S, Crippa S, Malleo G, Rossini R, Casetti L, Melotti GL, Piccoli M, Pederzoli P, Bassi C. Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach. Surg Endosc 2011; 25:2871-8. [PMID: 21424200 DOI: 10.1007/s00464-011-1634-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 05/04/2010] [Accepted: 01/28/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic left pancreatic resections are being increasingly performed. In this study, we provide a nonrandomized comparison between laparoscopic and open left pancreatectomy (OLP) for benign and borderline tumors, focusing on both perioperative and long-term results. METHODS Demographic, pathologic, and perioperative details from patients who underwent laparoscopic and OLP between 1999 and 2006 were retrieved from our database and analyzed. Long-term results, including resume to full-time work, occurrence of incisional hernias, and incidence of exocrine and endocrine insufficiency also were evaluated. RESULTS A total of 116 patients were included in the analysis; 43 (37.1%) were managed laparoscopically and 73 (62.9%) underwent the open procedure. There were no significant differences regarding clinical and pathological data. All of the resections attempted laparoscopically were completed. The rate of splenic preservation was significantly higher in the laparoscopic group (P = 0.0001). Postoperative outcomes were similar between the two groups. Longitudinal comparison between two time periods (1999-June 2004 vs. July 2004-2006) showed that pancreatic fistula and hospital stay significantly diminished over time in the laparoscopic group (P = 0.04 and P = 0.004, respectively). Median follow-up was 53 months. The incidence of exocrine insufficiency and incisional hernias was significantly higher after open resections (both P = 0.05). After hospital discharge, median time to resume full-time work was 6 weeks in the open group and 3 weeks after laparoscopic resections (P < 0.0001). Laparoscopy also resulted as an independent factor for an early resume to full-time activities in the multivariate analysis (P < 0.0001). CONCLUSIONS Laparoscopic left pancreatectomy is a safe procedure for benign and borderline tumors, with similar perioperative outcomes compared with the open procedure. In the long term, the laparoscopic approach is likely to be superior thanks to a more rapid resume of full-time activities and to the lower incidence of incisional hernias and exocrine insufficiency. Clearly, these results have yet to be confirmed in large, randomized trials.
Collapse
Affiliation(s)
- Giovanni Butturini
- Department of Surgery, G.B. Rossi Hospital, University of Verona, P.Le L.A. Scuro 10, 37134 Verona, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Bongini L, Piazza F, Casetti L, De Los Rios P. Vibrational entropy and the structural organization of proteins. Eur Phys J E Soft Matter 2010; 33:89-96. [PMID: 20852913 DOI: 10.1140/epje/i2010-10653-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 08/16/2010] [Indexed: 05/29/2023]
Abstract
In this paper we analyze the vibrational spectra of a large ensemble of non-homologous protein structures by means of a novel tool, that we coin Hierarchical Network Model (HNM). Our coarse-grained scheme accounts for the intrinsic heterogeneity of force constants displayed by protein arrangements and also incorporates side chain degrees of freedom. Our analysis shows that vibrational entropy per unit residue correlates with the content of secondary structure. Furthermore, we assess the individual contribution to vibrational entropy of the novel features of our scheme as compared with the predictions of state-of-the-art network models. This analysis highlights the importance of properly accounting for the intrinsic hierarchy in force strengths typical of the different atomic bonds that build up and stabilize protein scaffolds. Finally, we discuss possible implications of our findings in the context of protein aggregation phenomena.
Collapse
Affiliation(s)
- L Bongini
- Departament de Fisica Fonamental, Facultat de Fisica, Universitat de Barcelona, E-08028 Barcelona, Spain.
| | | | | | | |
Collapse
|
40
|
Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M, Frulloni L, Crippa S, Zamboni G, Pederzoli P. "Paraduodenal" pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg 2010; 33:2664-9. [PMID: 19809849 DOI: 10.1007/s00268-009-0238-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cystic dystrophy of heterotopic pancreas, groove pancreatitis, pancreatic hamartoma of the duodenum, paraduodenal wall cyst, and myoadenomatosis are all terms grouped together, from a pathological viewpoint, as definitions of paraduodenal pancreatitis (PP). The objective of the present study was to investigate the clinical characteristics, therapeutic strategies, and results in 58 patients undergoing pancreatic resection for PP. METHODS From January 1990 to December 2006 data were prospectively collected on 58 patients who were diagnosed with PP who then underwent pancreaticoduodenectomy. RESULTS In this patient cohort the median age was 44.7 years; only 4 patients were women, and only 3 had non-drinker and/or non smoker habits. The overall morbidity was 18.9%, and the median hospitalization was 11 days. There were no postoperative deaths. In a median follow-up of 96.3 months, all patients noted a decrease in the pain associated with PP; 35 patients (76%) had complete disappearance of pain, whereas occasional relapsing pain occurred in the remaining 11 (24%). CONCLUSIONS Patients with PP have clinical characteristics similar to those of chronic pancreatitis. The diagnostic imaging modalities of choice are ultrasonographic endoscopy and magnetic resonance cholangiopancreaticography. Based on our surgical experience, pancreaticoduodenectomy seems to be a reasonable choice of treatment in patients with PP.
Collapse
Affiliation(s)
- L Casetti
- Dipartimento di Scienze Chirurgiche, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro, 37134 Verona, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 2007; 246:77-82. [PMID: 17592294 PMCID: PMC1899215 DOI: 10.1097/01.sla.0000258607.17194.2b] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team. SUMMARY BACKGROUND DATA Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. METHODS A consecutive series of patients affected by solid and cystic tumors were selected prospectively to undergo laparoscopic distal pancreatectomy performed by the same surgical team. Clinical characteristics as well as diagnostic preoperative assessment and intra- and postoperative data were prospectively recorded. A follow-up of at least 3 months was available for all patients. RESULTS Fifty-eight patients underwent laparoscopic resection between May 1999 and November 2005. All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. Splenic vessel preservation was possible in 84.4% of spleen-preserving procedures. There were no mortalities. The overall median hospital stay was 9 days, while it was 10.5 days for patients with postoperative pancreatic fistulae (27.5% of all cases). Follow-up was available for all patients. CONCLUSIONS Our experience in 58 consecutive patients was characterized by the lack of conversions and by acceptable rates of postoperative pancreatic fistulae and morbidity. Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible.
Collapse
Affiliation(s)
- Gianluigi Melotti
- Surgical Department, New Hospital Sant'Agostino-Estense Baggiovara Modena, Italy
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Talamini G, Zamboni G, Salvia R, Capelli P, Sartori N, Casetti L, Bovo P, Vaona B, Falconi M, Bassi C, Scarpa A, Vantini I, Pederzoli P. Intraductal papillary mucinous neoplasms and chronic pancreatitis. Pancreatology 2006; 6:626-34. [PMID: 17135772 DOI: 10.1159/000097605] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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: 01/12/2006] [Accepted: 07/20/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intraductal papillary mucinous neoplasms (IPMNs) may present with clinical and radiological pictures resembling those of chronic pancreatitis (CP). AIMS To compare the clinical and epidemiological characteristics of patients suffering from CP with those of patients suffering from IPMN. To assess whether CP is associated with an increased risk of developing IPMN. METHODS In our departments, from 1981 to 1998, we prospectively followed 473 patients suffering from CP, including 93 cases of chronic obstructive pancreatitis (COP), and 45 patients with a histologically confirmed diagnosis of IPMN. Another 6 patients had an initial diagnosis of CP and a subsequent diagnosis of IPMN. RESULTS Patients with IPMN were more often female (females 53 vs. 15%; p < 0.001), were older (mean age 63.1 vs. 42.8 years; p < 0.001), drank less alcohol (19 vs. 107 g/day; p < 0.001) and smoked fewer cigarettes (mean 8 vs. 21 cigarettes/day) than CP patients. These results were also confirmed when considering only patients with COP. The 6 patients with a subsequent diagnosis of IPMN were males (p n.s.) with a mean age of 51.4 years (p < 0.05). Only 1 patient was a drinker (p < 0.05) and 4 were smokers (p n.s.). Comparing CP and IPMN, logistic regression analysis selected sex, age, alcohol and smoking, whereas only sex and age were selected when comparing COP vs. IPMN. CONCLUSIONS In general patients with IPMN present different epidemiological characteristics than those with CP and the subgroup with COP. The clinical and pathological features suggest that in most cases IPMN is the cause of CP and not vice versa.
Collapse
Affiliation(s)
- Giorgio Talamini
- Gastroenterology and Endoscopy Unit, University of Verona, Verona, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Falconi M, Bassi C, Casetti L, Mantovani W, Mascetta G, Sartori N, Frulloni L, Pederzoli P. Long-term results of Frey's procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastrointest Surg 2006; 10:504-10. [PMID: 16627215 DOI: 10.1016/j.gassur.2005.09.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 04/12/2005] [Revised: 09/07/2005] [Accepted: 09/12/2005] [Indexed: 02/07/2023]
Abstract
Only limited prospective data are available regarding the long-term outcome of local resection of the pancreatic head in combination with longitudinal pancreaticojejunostomy in patients with chronic pancreatitis. From 1997 to 2001, 40 patients affected by chronic pancreatitis were subjected to the Frey's procedure. Preoperative selection criteria included confirmed diagnosis of chronic pancreatitis, dilation of Wirsung's duct to a diameter greater than 6 mm, and the absence of obstructive chronic pancreatitis secondary to fibrotic stenosis at the pancreatic body or tail. Preoperative pain was present in 38 cases (95%), and follow-up was performed in all patients at least once yearly up to 2003 (median 60 months, inter percentile range 20.1-79.6). Postoperative morbidity occurred in three cases (7.5%). The percentage of pain-free patients was 94.7%, 93.7%, 87.5%, and 90% at 1, 2, 3, and 4/5 years after surgical operation, respectively. After surgery, three patients developed diabetes. Both the body mass index and quality of life showed statistically significant improvements at all follow-up intervals. Whenever surgery is indicated, the short-term and long-term outcomes confirm that Frey's procedure is an appropriate means of management for patients with chronic pancreatitis in the absence of doubts of neoplasia and/or distal ductal obstruction.
Collapse
Affiliation(s)
- Massimo Falconi
- Department of Surgical, University of Verona, Verona, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Bruscolini P, Pelizzola A, Casetti L. Comment on "Novel phase behavior in a two-dimensional network-forming lattice fluid". Phys Rev Lett 2002; 88:089601. [PMID: 11863981 DOI: 10.1103/physrevlett.88.089601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2001] [Indexed: 05/23/2023]
|
45
|
Bruscolini P, Casetti L. Model for the hydration of nonpolar compounds and polymers. Phys Rev E Stat Nonlin Soft Matter Phys 2001; 64:051805. [PMID: 11735956 DOI: 10.1103/physreve.64.051805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2000] [Revised: 07/26/2001] [Indexed: 05/23/2023]
Abstract
We introduce an exactly solvable statistical-mechanical model of the hydration of nonpolar compounds, based on grouping water molecules in clusters where hydrogen bonds and isotropic interactions occur; interactions between clusters are neglected. Analytical results show that an effective strengthening of hydrogen bonds in the presence of the solute, together with a geometric reorganization of water molecules, are enough to yield hydrophobic behavior. We extend our model to describe a nonpolar homopolymer in aqueous solution, obtaining a clear evidence of both "cold" and "warm" swelling transitions. This suggests that our model could be relevant to describe some features of protein folding.
Collapse
Affiliation(s)
- P Bruscolini
- Istituto Nazionale per la Fisica della Materia and Dipartimento di Fisica, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-10129 Torino, Italy.
| | | |
Collapse
|
46
|
Talamini G, Falconi M, Bassi C, Casetti L, Fantin A, Salvia R, Pederzoli P. Previous cholecystectomy, gastrectomy, and diabetes mellitus are not crucial risk factors for pancreatic cancer in patients with chronic pancreatitis. Pancreas 2001; 23:364-7. [PMID: 11668204 DOI: 10.1097/00006676-200111000-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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] [Indexed: 01/25/2023]
Abstract
INTRODUCTION In the general population, cholecystectomy, diabetes, and chronic pancreatitis seem to be associated with an increased risk of developing pancreatic cancer. AIMS We assessed whether previous cholecystectomy, gastrectomy, or diabetes mellitus may be risk factors for pancreatic cancer in patients with chronic pancreatitis. METHODOLOGY We analyzed 853 patients with chronic pancreatitis (110 women, 743 men) with a median follow-up period of 14 years with particular reference to establishing which patients had previously undergone cholecystectomy or distal gastric resection (Billroth II anastomosis) or had diabetes or gallstone disease and the respective time scales involved. RESULTS Pancreatic cancer developed in 17 patients with chronic pancreatitis after a median period of 8 years from onset of pancreatitis symptoms (range, 3-38 years). Excluding two cholecystectomies performed 1 year before diagnosis of cancer, cholecystectomy was performed in 7/17 (41%) patients with pancreatic cancer and in 381/836 (46%) of the other patients with chronic pancreatitis. Forty-nine (10%) patients with chronic pancreatitis and no pancreatic cancer had undergone cholecystectomy during the years before the onset of chronic pancreatitis, whereas none of the patients in whom a pancreatic malignancy developed had undergone cholecystectomy before the onset of chronic pancreatitis symptoms. Gastrectomies were performed in 116 patients (14%), 47 before the onset of chronic pancreatitis. Only 2/17 patients with pancreatic cancer had undergone previous gastrectomy, though in both cases only shortly before diagnosis of the cancer. Diabetes was diagnosed in 353 patients, but only in 30 (4%) before onset of chronic pancreatitis. Only 1/17 patients (6%) with pancreatic cancer had long-standing diabetes, whereas diabetes developed in 3/17 shortly before diagnosis of pancreatic cancer. CONCLUSIONS Cholecystectomy, gastrectomy, and diabetes are not major risk factors for the development of pancreatic cancer in patients with chronic pancreatitis.
Collapse
Affiliation(s)
- G Talamini
- Gastroenterological and Surgical Department, University of Verona, 37134 Verona, Italy.
| | | | | | | | | | | | | |
Collapse
|
47
|
Talamini G, Bassi C, Butturini G, Falconi M, Casetti L, Gumbs AA, Carrara S, Fantin A, Pederzoli P. Outcome and quality of life in chronic pancreatitis. JOP 2001; 2:117-23. [PMID: 11875248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
|
48
|
Talamini G, Butturini G, Bassi C, Falconi M, Carrara S, Casetti L, Pederzoli P. [Clinical evolution of chronic pancreatitis and quality of life]. Chir Ital 2000; 52:647-53. [PMID: 11199999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Nowadays the availability of reliable, efficacious methods of assessing the outcome of chronic pancreatitis is mandatory, especially in view of the several new procedures developed to relieve the symptoms of the disease. Together with the traditional evaluation of postoperative morbidity and mortality and the assessment of exo/endocrine function in patient follow-up, we currently consider the patient's perception of his or her health status as a priority. This information is obtained by administering quality of life questionnaires along with reliable physical and psychometric evaluation.
Collapse
Affiliation(s)
- G Talamini
- Dipartimento di Scienze Chirurgiche e Gastroenterologiche Università degli Studi di Verona, Verona
| | | | | | | | | | | | | |
Collapse
|
49
|
Falconi M, Casetti L, Salvia R, Sartori N, Bettini R, Mascetta G, Bassi C, Pederzoli P. Pancreatic head mass, how can we treat it? Chronic pancreatitis: surgical treatment. JOP 2000; 1:154-61. [PMID: 11854575] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- M Falconi
- Division of Endocrine Surgery, Department of Surgical and Gastroenterological Sciences, Verona, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Bassi C, Falconi M, Caldiron E, Salvia R, Sartori N, Butturini G, Contro C, Marcucci S, Casetti L, Pederzoli P. Assessment and treatment of severe pancreatitis. Protease inhibitor. Digestion 2000; 60 Suppl 1:5-8. [PMID: 10026423 DOI: 10.1159/000051445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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] [Indexed: 02/04/2023]
Abstract
From the theoretical point of view, antiproteolytic therapy would seem to be the rationale for acute pancreatitis management. Unfortunately, clinical human trials studying the role of antiproteases in the treatment of acute pancreatitis differ in several respects in terms of their basic design. As a consequence, any form of homogeneous analysis of the reported data as a whole is impossible. Considering the data emerging from a meta-analysis of five trials a rational use of antiproteases may result in a reduction of complications requiring surgery and of patient management costs only in selected cases, meaning by that severe and necrotic forms. As regards presumptive applications, over 400 patients were prospectively tested versus placebo in a double-blind trial with the aim of preventing acute pancreatitis after ERCP. The complication incidence was significantly lower among the pretreated patients; anyway, also in this field of protease inhibitor clinical application it is necessary to identify the patients with the greatest risk to develop post-ERCP acute pancreatitis. In conclusion, antiproteases can still play a role when given prophylactically or when used in the very early phases of the disease; moreover a 'multiple drugs approach' (including, for example, suitable antibiotics) seems to represent nowadays the most modern and rational treatment of acute pancreatitis.
Collapse
Affiliation(s)
- C Bassi
- Surgical Department University of Verona, Endocrine and Pancreatic Unit, Borgo Roma University Hospital, Verona, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|