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Pancreatic Neoplasms: HELP
Articles by Mustapha Adham
Based on 35 articles published since 2010
(Why 35 articles?)
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Between 2010 and 2020, M. Adham wrote the following 35 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract: Recommendations of Verona Consensus Meeting. 2016

Adsay, Volkan / Mino-Kenudson, Mari / Furukawa, Toru / Basturk, Olca / Zamboni, Giuseppe / Marchegiani, Giovanni / Bassi, Claudio / Salvia, Roberto / Malleo, Giuseppe / Paiella, Salvatore / Wolfgang, Christopher L / Matthaei, Hanno / Offerhaus, G Johan / Adham, Mustapha / Bruno, Marco J / Reid, Michelle D / Krasinskas, Alyssa / Klöppel, Günter / Ohike, Nobuyuki / Tajiri, Takuma / Jang, Kee-Taek / Roa, Juan Carlos / Allen, Peter / Fernández-del Castillo, Carlos / Jang, Jin-Young / Klimstra, David S / Hruban, Ralph H / Anonymous6190823. ·*Department of Pathology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA †Department of Pathology, Massachusetts General Hospital, Boston, MA ‡Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan §Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY ¶Department of Pathology, University of Verona, Verona, Italy ||Department of Surgery, Massachusetts General Hospital, Boston, MA **Department of Surgery, University of Verona, Verona, Italy ††Department of Surgery, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD ‡‡Departments of Surgery, University of Bonn, Bonn, Germany §§Departments of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands ¶¶Department of Surgery, Edouard Herriot Hospital, HCL, Lyon, France ||||Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands ***Departments of Pathology, Technical University, Munich, Germany †††Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan ‡‡‡Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan §§§Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ¶¶¶Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile ||||||Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY ****Department of Surgery, Massachusetts General Hospital, Boston, MA ††††Department of Surgery, Seoul National University Hospital, Seoul, Korea ‡‡‡‡Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD. ·Ann Surg · Pubmed #25775066.

ABSTRACT: BACKGROUND: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). DESIGN: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. RESULTS: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The term "minimally invasive" should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤ 0.5, > 0.5-≤ 1, > 1 cm) is to be documented. (4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. (5) A category of "indeterminate/(suspicious) for invasion" is acceptable for rare cases. (6) The term "malignant" IPMN should be avoided. (7) The highest grade of dysplasia in the non-invasive component is to be documented separately. (8) Lesion size is to be correlated with imaging findings in cysts with rupture. (9) The main duct diameter and, if possible, its involvement are to be documented; however, it is not required to provide main versus branch duct classification in the resected tumor. (10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. (11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. (12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, and intra-biliary/cholecystic). CONCLUSIONS: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.

2 Guideline Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). 2014

Tol, Johanna A M G / Gouma, Dirk J / Bassi, Claudio / Dervenis, Christos / Montorsi, Marco / Adham, Mustapha / Andrén-Sandberg, Ake / Asbun, Horacio J / Bockhorn, Maximilian / Büchler, Markus W / Conlon, Kevin C / Fernández-Cruz, Laureano / Fingerhut, Abe / Friess, Helmut / Hartwig, Werner / Izbicki, Jakob R / Lillemoe, Keith D / Milicevic, Miroslav N / Neoptolemos, John P / Shrikhande, Shailesh V / Vollmer, Charles M / Yeo, Charles J / Charnley, Richard M / Anonymous3060801. ·Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. · Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: D.J.Gouma@amc.nl. · Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy. · Department of First Surgery, Agia Olga Hospital, Athens, Greece. · Department of General Surgery, Instituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy. · Department of HPB Surgery, Hopital Edouard Herriot, Lyon, France. · Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden. · Department of General Surgery, Mayo Clinic, Jacksonville, FL. · Department of General-, Visceral- and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany. · Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. · Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland. · Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain. · First Department of Digestive Surgery, Hippokrateon Hospital, University of Athens, Athens, Greece; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria. · Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA. · First Surgical Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia. · Department of Molecular and Clinical Cancer Medicine, Liverpool Cancer Research-UK Centre, University of Liverpool, Liverpool, UK. · Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India. · Department of Surgery, Penn Medicine, The University of Pennsylvania, Philadelphia, PA. · Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA. · Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. ·Surgery · Pubmed #25061003.

ABSTRACT: BACKGROUND: The lymph node (Ln) status of patients with resectable pancreatic ductal adenocarcinoma is an important predictor of survival. The survival benefit of extended lymphadenectomy during pancreatectomy is, however, disputed, and there is no true definition of the optimal extent of the lymphadenectomy. The aim of this study was to formulate a definition for standard lymphadenectomy during pancreatectomy. METHODS: During a consensus meeting of the International Study Group on Pancreatic Surgery, pancreatic surgeons formulated a consensus statement based on available literature and their experience. RESULTS: The nomenclature of the Japanese Pancreas Society was accepted by all participants. Extended lymphadenectomy during pancreatoduodenectomy with resection of Ln's along the left side of the superior mesenteric artery (SMA) and around the celiac trunk, splenic artery, or left gastric artery showed no survival benefit compared with a standard lymphadenectomy. No level I evidence was available on prognostic impact of positive para-aortic Ln's. Consensus was reached on selectively removing suspected Ln's outside the resection area for frozen section. No consensus was reached on continuing or terminating resection in cases where these nodes were positive. CONCLUSION: Extended lymphadenectomy cannot be recommended. Standard lymphadenectomy for pancreatoduodenectomy should strive to resect Ln stations no. 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a, and 17b. For cancers of the body and tail of the pancreas, removal of stations 10, 11, and 18 is standard. Furthermore, lymphadenectomy is important for adequate nodal staging. Both pancreatic resection in relatively fit patients or nonresectional palliative treatment were accepted as acceptable treatment in cases of positive Ln's outside the resection plane. This consensus statement could serve as a guide for surgeons and researchers in future directives and new clinical studies.

3 Guideline Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS). 2014

Hartwig, Werner / Vollmer, Charles M / Fingerhut, Abe / Yeo, Charles J / Neoptolemos, John P / Adham, Mustapha / Andrén-Sandberg, Ake / Asbun, Horacio J / Bassi, Claudio / Bockhorn, Max / Charnley, Richard / Conlon, Kevin C / Dervenis, Christos / Fernandez-Cruz, Laureano / Friess, Helmut / Gouma, Dirk J / Imrie, Clem W / Lillemoe, Keith D / Milićević, Miroslav N / Montorsi, Marco / Shrikhande, Shailesh V / Vashist, Yogesh K / Izbicki, Jakob R / Büchler, Markus W / Anonymous1650795. ·Department of Surgery, Klinikum Großhadern, University of Munich, Munich, Germany. · Department of Gastrointestinal Surgery, Penn Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. · Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France. · Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA. · Department of Molecular and Clinical Cancer Medicine, Liverpool Cancer Research-UK Centre, University of Liverpool, Liverpool, UK. · Department of HPB Surgery, Hopital Edouard Herriot, Lyon, France. · Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden. · Department of General Surgery, Mayo Clinic, Jacksonville, FL. · Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy. · Department of General-, Visceral- and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany. · Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. · Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland. · Department of First Surgery, Agia Olga Hospital, Athens, Greece. · Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain. · Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. · Academic Unit of Surgery, University of Glasgow, Glasgow, UK. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. · First Surgical Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia. · Department of General Surgery, Instituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy. · Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India. · Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. Electronic address: markus.buechler@med.uni-heidelberg.de. ·Surgery · Pubmed #24856668.

ABSTRACT: BACKGROUND: Complete macroscopic tumor resection is one of the most relevant predictors of long-term survival in pancreatic ductal adenocarcinoma. Because locally advanced pancreatic tumors can involve adjacent organs, "extended" pancreatectomy that includes the resection of additional organs may be needed to achieve this goal. Our aim was to develop a common consistent terminology to be used in centers reporting results of pancreatic resections for cancer. METHODS: An international panel of pancreatic surgeons working in well-known, high-volume centers reviewed the literature on extended pancreatectomies and worked together to establish a consensus on the definition and the role of extended pancreatectomy in pancreatic cancer. RESULTS: Macroscopic (R1) and microscopic (R0) complete tumor resection can be achieved in patients with locally advanced disease by extended pancreatectomy. Operative time, blood loss, need for blood transfusions, duration of stay in the intensive care unit, and hospital morbidity, and possibly also perioperative mortality are increased with extended resections. Long-term survival is similar compared with standard resections but appears to be better compared with bypass surgery or nonsurgical palliative chemotherapy or chemoradiotherapy. It was not possible to identify any clear prognostic criteria based on the specific additional organ resected. CONCLUSION: Despite increased perioperative morbidity, extended pancreatectomy is warranted in locally advanced disease to achieve long-term survival in pancreatic ductal adenocarcinoma if macroscopic clearance can be achieved. Definitions of extended pancreatectomies for locally advanced disease (and not distant metastatic disease) are established that are crucial for comparison of results of future trials across different practices and countries, in particular for those using neoadjuvant therapy.

4 Guideline Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). 2014

Bockhorn, Maximilian / Uzunoglu, Faik G / Adham, Mustapha / Imrie, Clem / Milicevic, Miroslav / Sandberg, Aken A / Asbun, Horacio J / Bassi, Claudio / Büchler, Markus / Charnley, Richard M / Conlon, Kevin / Cruz, Laureano Fernandez / Dervenis, Christos / Fingerhutt, Abe / Friess, Helmut / Gouma, Dirk J / Hartwig, Werner / Lillemoe, Keith D / Montorsi, Marco / Neoptolemos, John P / Shrikhande, Shailesh V / Takaori, Kyoichi / Traverso, William / Vashist, Yogesh K / Vollmer, Charles / Yeo, Charles J / Izbicki, Jakob R / Anonymous1640795. ·Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany. · Department of HPB Surgery, Hôpital Edouard Herriot, Lyon, France. · Academic Unit of Surgery, University of Glasgow, Glasgow, UK. · First Surgical Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia. · Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden. · Department of General Surgery, Mayo Clinic, Jacksonville, FL. · Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy. · Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. · Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. · Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland. · Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain. · First Department of Surgery, Agia Olga Hospital, Athens, Greece. · Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France. · Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany. · Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. · Department of General Surgery, Instituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy. · Department of Molecular and Clinical Cancer Medicine, Liverpool Cancer Research-UK Centre, University of Liverpool, Liverpool, UK. · Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Centre, Mumbai, India. · Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. · St. Luke's Clinic - Center For Pancreatic and Liver Diseases, Boise, ID. · Department of Gastrointestinal Surgery, Penn Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. · Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA. · Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: izbicki@uke.de. ·Surgery · Pubmed #24856119.

ABSTRACT: BACKGROUND: This position statement was developed to expedite a consensus on definition and treatment for borderline resectable pancreatic ductal adenocarcinoma (BRPC) that would have worldwide acceptability. METHODS: An international panel of pancreatic surgeons from well-established, high-volume centers collaborated on a literature review and development of consensus on issues related to borderline resectable pancreatic cancer. RESULTS: The International Study Group of Pancreatic Surgery (ISGPS) supports the National Comprehensive Cancer Network criteria for the definition of BRPC. Current evidence supports operative exploration and resection in the case of involvement of the mesentericoportal venous axis; in addition, a new classification of extrahepatic mesentericoportal venous resections is proposed by the ISGPS. Suspicion of arterial involvement should lead to exploration to confirm the imaging-based findings. Formal arterial resections are not recommended; however, in exceptional circumstances, individual therapeutic approaches may be evaluated under experimental protocols. The ISGPS endorses the recommendations for specimen examination and the definition of an R1 resection (tumor within 1 mm from the margin) used by the British Royal College of Pathologists. Standard preoperative diagnostics for BRPC may include: (1) serum levels of CA19-9, because CA19-9 levels predict survival in large retrospective series; and also (2) the modified Glasgow Prognostic Score and the neutrophil/lymphocyte ratio because of the prognostic relevance of the systemic inflammatory response. Various regimens of neoadjuvant therapy are recommended only in the setting of prospective trials at high-volume centers. CONCLUSION: Current evidence justifies portomesenteric venous resection in patients with BRPC. Basic definitions were identified, that are currently lacking but that are needed to obtain further evidence and improvement for this important patient subgroup. A consensus for each topic is given.

5 Review Palliative therapy in pancreatic cancer-palliative surgery. 2019

Perinel, Julie / Adham, Mustapha. ·Department of Digestive Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. · Lyon Sud Faculty of Medicine, Claude Bernard University Lyon 1 (UCBL1), Lyon, France. ·Transl Gastroenterol Hepatol · Pubmed #31231695.

ABSTRACT: Pancreatic cancer is a highly lethal disease with a dismal prognosis. It will probably become the second leading cause of cancer-related death within the next decade in Western countries. Over 80% of patients undergo palliative treatment for unresectable pancreatic cancer due to locally advanced disease or metastases. Those patients often develop gastric outlet obstruction (GOO), obstructive jaundice and pain during the course of their disease. Symptoms such as vomiting, anorexia, pruritus and jaundice will impact the quality of life (QOL) and could delay the administration of the chemotherapy. Palliative therapy in pancreatic cancer aims to relieve the symptoms durably and to improve the QOL. Palliative surgery was traditionally considered as a gold standard with the "double by-pass" including biliary-digestive and gastro-jejunal anastomosis. However, since the development of endoscopic stenting and minimally invasive surgery, the choice of the best modalities remains debated. While there is still a place for surgical gastrojejunostomy (GJ) in case of duodenal or GOO, endoscopic biliary stenting during endoscopic retrograde cholangiopancreatography (ERCP) is now accepted as the gold standard in case of obstructive jaundice. In pain management, endoscopic ultrasound guided or percutaneous celiac plexus neurolysis is recommended. The selection of the best technique should consider the effectiveness and the morbidity of the treatment, the performance status of the patient and the disease stage. While endoscopic stenting is associated with earlier recovery and shorter length of stay, recurrence of symptoms and reintervention are less frequent after palliative surgery. Finally, controversy exists on whether to perform prophylactic palliative surgery in the absence of symptoms when unresectable disease is discovered during surgical exploration.

6 Review Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery. 2017

Besselink, Marc G / van Rijssen, L Bengt / Bassi, Claudio / Dervenis, Christos / Montorsi, Marco / Adham, Mustapha / Asbun, Horacio J / Bockhorn, Maximillian / Strobel, Oliver / Büchler, Markus W / Busch, Olivier R / Charnley, Richard M / Conlon, Kevin C / Fernández-Cruz, Laureano / Fingerhut, Abe / Friess, Helmut / Izbicki, Jakob R / Lillemoe, Keith D / Neoptolemos, John P / Sarr, Michael G / Shrikhande, Shailesh V / Sitarz, Robert / Vollmer, Charles M / Yeo, Charles J / Hartwig, Werner / Wolfgang, Christopher L / Gouma, Dirk J / Anonymous1010883. ·Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl. · Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. · Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy. · Department of First Surgery, Agia Olga Hospital, Athens, Greece. · Department of Surgery, Humanitas Research Hospital and University, Milan, Italy. · Department of HPB Surgery, Hopital Edouard Herriot, HCL, UCBL1, Lyon, France. · Department of Surgery, Mayo Clinic, Jacksonville, FL. · Department of General-, Visceral-, and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany. · Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. · Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. · Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland. · Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain. · First Department of Digestive Surgery, Hippokrateon Hospital, University of Athens, Athens, Greece; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria. · Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA. · Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. · Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN. · Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India. · Department of Surgical Oncology, Medical University in Lublin, Poland. · Department of Surgery, Penn Medicine, The University of Pennsylvania, Philadelphia, PA. · Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA. · Division of Pancreatic Surgery, Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians University, University of Munich, Germany. · Department of Surgery, Johns Hopkins Medicine, Baltimore, MD. ·Surgery · Pubmed #27692778.

ABSTRACT: BACKGROUND: Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. METHODS: The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. RESULTS: Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. CONCLUSION: This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.

7 Clinical Trial Prognostic Value of Resection Margin Involvement After Pancreaticoduodenectomy for Ductal Adenocarcinoma: Updates From a French Prospective Multicenter Study. 2017

Delpero, Jean Robert / Jeune, Florence / Bachellier, Philippe / Regenet, Nicolas / Le Treut, Yves Patrice / Paye, Francois / Carrere, Nicolas / Sauvanet, Alain / Adham, Mustapha / Autret, Aurelie / Poizat, Flora / Turrini, Olivier / Boher, Jean Marie. ·*Department of Surgery, Paoli-Calmettes Institute, Marseille, France †Department of Surgery, La Pitié-Salpêtrière - Université Pierre and Marie Curie, Paris VI, France ‡Department of Surgery, Hautepierre Hospital, University of Strasbourg, Strasbourg, France §Department of Surgery, Hotel Dieu Hospital, University of Nantes, Nantes, France ¶Department of Surgery, Hospital de la Conception, University of Aix-Marseille, Marseille, France ||Department of Surgery, Saint Antoine Hospital, University of Paris VI, Paris, France **Department of Surgery, Purpan Hospital, University of Toulouse Hospital Centre, Toulouse, France ††Department of Surgery, Beaujon Hospital, University of Paris VII, Clichy, France ‡‡Groupement Hospitalier Edouard Herriot, Université Claude Bernard Lyon 1, France §§Department of Histopathology, Paoli-Calmettes Institute, Marseille, France ¶¶Department of Biostatistics, Paoli-Calmettes Institute, Aix Marseille Univeristy, INSERM, IRD, SESSTIM, Marseille, France. ·Ann Surg · Pubmed #28953554.

ABSTRACT: OBJECTIVE: The aim of the study was to assess the relevance of resection margin status for survival after resection of pancreatic-head ductal adenocarcinoma. SUMMARY BACKGROUND DATA: The definition and prognostic value of incomplete microscopic resection (R1) remain controversial. METHODS: Prognostic factors were analyzed in 147 patients included in a prospective multicenter study on the impact of tumor clearance evaluated using a standardized pathology protocol. RESULTS: Thirty patients received neoadjuvant treatment (NAT = 20%); 41 had venous resection (VR = 28%), and 70% received adjuvant chemotherapy. In-hospital mortality was 3% (5/147). Follow-up was 83 months. Tumor clearance was 0, <1.0, <1.5, and <2.0 mm in 35 (25%), 92 (65%), 95 (67%), and 109 (77%) patients, respectively. R0-resection rates decreased from 75% to 35% when changing the definition of R1 status from R1-direct invasion (0 mm) to R1 <1.0 mm. On univariate analysis, clearance <1.0 or <1.5 mm, pT stage, pN stage, LNR ≥0.2, tumor grade 3, and lymphovascular invasion were significantly associated with 5-year survival. On multivariate analysis, pN was the most powerful independent predictor (P = 0.004). Clearance <1.0 or <1.5 mm had borderline significance for the entire cohort, but was relevant in certain subgroups (upfront pancreatectomy (n = 117; P = 0.049); without VR or NAT (n = 87; P = 0.003); N+ without VR or NAT (n = 50; P = 0.004). No N0-patient had R1-0 mm. Additional independent risk predictors were (1) R1 <1.0 mm for the SMA-margin in specific subgroups (upfront pancreatectomy, N0 patients without NAT, N+ patients without NAT or VR; (2) R1-0 mm posterior-margin for the NAT group (P = 0.004). CONCLUSION: Tumor clearance <1.0 or <1.5 mm was an independent determinants of postresection survival in certain subgroups. To avoid misinterpretation, future trials should specify the clearance margin in millimeter. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00918853.

8 Clinical Trial Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors. 2012

Adham, M / Singhirunnusorn, J. ·Department of Hepato-biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, Lyon, France. mustapha.adham@chu-lyon.fr ·Eur J Surg Oncol · Pubmed #22264964.

ABSTRACT: BACKGROUND AND OBJECTIVES: Retro pancreatic invasion is a major concern in pancreatic head carcinoma. Posterior clearance has been recognized as an independent risk factor for disease recurrence and hence patient survival. The aim of this study was to report a standardized method that ensures posterior clearance with Total Mesopancreas Excision (TMpE). METHODS: Our procedure consisted in a posterior approach with cranio-caudal dissection at the origin of the superior mesenteric artery and the celiac trunk all along their right semi-circumference. This allowed a complete clearance of retro pancreatic tissues with safe control of pancreaticoduodenal arteries at their origin. RESULTS: Fifty-two consecutive pancreatic resections with TMpE were performed. Sixteen cases were associated to vascular resection. Pathology revealed an adenocarcinoma of the pancreatic duct, distal bile duct, periampullary and neuroendocrine carcinoma. Mesopancreas was invaded by cancer in 12 cases, of these, 3 had invaded margins and 7 had a margin less than 1 mm. Mesopancreas was the only site of tumour infiltration. Applying the International Union Against Cancer criteria, an R0 resection was thus achieved in 42 patients. CONCLUSION: Our procedure is feasible and safe in experienced hand. It is a description of a standardized method for TMpE that clearly shows an advantage in improving posterior clearance and R0 resection.

9 Article Evaluation of the MDACC clinical classification system for pancreatic cancer patients in an European multicenter cohort. 2019

Uzunoglu, F G / Welte, M-N / Gavazzi, F / Maggino, L / Perinel, J / Salvia, R / Janot, M / Reeh, M / Perez, D / Montorsi, M / Zerbi, A / Adham, M / Uhl, W / Bassi, C / Izbicki, J R / Malleo, G / Bockhorn, M. ·Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. · Department of General Surgery, Humanitas Research Hosptital and University, Istituto Clinico Humanitas IRCCS, Milan, Italy. · Department of Surgery and Oncology, Unit of General and Pancreatic Surgery, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy. · Hospices Civils de Lyon & Lyon Sud Faculty of Medicine, UCBL1, E. Herriot Hospital, Department of Digestive Surgery, Lyon, France. · Department of Surgery, St. Josef-Hospital Bochum, Hospital of the Ruhr- University, Bochum, Germany. · Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. Electronic address: m.bockhorn@uke.de. ·Eur J Surg Oncol · Pubmed #30585172.

ABSTRACT: BACKGROUND: The MDACC group recommends to extend the current borderline classification for pancreatic cancer into three groups: type A patients with resectable/borderline tumor anatomy, type B with resectable/borderline resectable tumor anatomy and clinical findings suspicious for extrapancreatic disease and type C with borderline resectable and marginal performance status/severe pre-existing comorbidity profile or age>80. This study intents to evaluate the proposed borderline classification system in a multicenter patient cohort without neoadjuvant treatment. METHODS: Evaluation was based on a multicenter database of pancreatic cancer patients undergoing surgery from 2005 to 2016 (n = 1020). Complications were classified based on the Clavien-Dindo classification. χ RESULTS: Most patients (55.1%) were assigned as type A patients, followed by type C (35.8%) and type B patients (9.1%). Neither the complication rate, nor the mortality rate revealed a correlation to any subgroup. Type B patients had a significant worse progression free (p < 0.001) and overall survival (p = 0.005). Type B classification was identified as an independent prognostic marker for progression free survival (p = 0.005, HR 1.47). CONCLUSION: The evaluation of the proposed classification in a cohort without neoadjuvant treatment did not justify an additional medical borderline subgroup. A new subgroup based on prognostic borderline patients might be the main target group for neoadjuvant protocols in future.

10 Article Total Pancreatectomy for Presumed Intraductal Papillary Mucinous Neoplasms: A Multicentric Study of the French Surgical Association (AFC). 2018

Poiraud, Charles / El Amrani, Mehdi / Barbier, Louise / Chiche, Laurence / Mabrut, Jean Yves / Bachellier, Philippe / Pruvot, François-René / Delpero, Jean-Robert / Tuech, Jean Jacques / Adham, Mustapha / Sauvanet, Alain / Turrini, Olivier / Truant, Stéphanie. ·Department of Digestive Surgery, Hôpital Claude Huriez, Lille, France. · University of Lille, Lille, France. · Department of Digestive Surgery, Hôpital Trousseau, Tours, France. · Department of Digestive Surgery, Hôpital Beaujon, Paris, France. · Department of Digestive Surgery, Maison du Haut-Lévêque, Bordeaux, France. · Department of Digestive Surgery, Hôpital de la Croix Rousse, Lyon, France. · Department of Digestive Surgery, Hopital de Hautepierre, Strasbourg, France. · Department of Digestive Surgery, Institut Paoli Calmettes, Marseille, France. · Department of Surgery, Hôpital Charles Nicolle, Rouen, France. · Department of Digestive Surgery, Hôpital Edouard-Herriot, Lyon, France. ·Ann Surg · Pubmed #30048327.

ABSTRACT: OBJECTIVE: The aim of the current study was to assess the short and long-term outcome of total pancreatectomy (TP) for IPMN based on the largest series to date. BACKGROUND: Literature data are scarce regarding TP for IPMN, though increasingly performed in this setting. METHODS: Data of 888 IPMN patients operated between 2004 and 2013 were collected in a multicentric retrospective AFC database. Ninety-three patients (10.5%) who had TP entered this study. Patient demographics, indications, intraoperative data, 3-month morbi-mortality (Clavien), and long-term outcome were analyzed. RESULTS: Most patients had mixed type IPMN (59%) and underwent upfront (56%) or intraoperatively-decided (33%) TP. Morbidity and mortality rates were 47.3% and 4.3%, respectively, with no lethal hypoglycemia; morbidity was higher for intraoperatively-decided TP. Misdiagnoses were frequent regarding main pancreatic duct involvement (12%), invasiveness (33%), or mural nodules (50%), resulting in 12 TPs (13%) performed for asymptomatic IPMN showing only low/moderate dysplasia (LMD). On histopathological examination, there were 54 (58%) invasive IPMN (mostly pT3/T4 (76%), N+ (60%), R0 (75%)), with a significantly worse 5-year survival (21.2%) compared to noninvasive group (85.7%; P < 0.0001). In the former, 24 (58.5%) developed recurrence showing mostly distant metastasis, within 2 years in 92%. CONCLUSION: This large series of TP for IPMN reported acceptable morbi-mortality rates with no long-term death from diabetes-related complication. Morphologic assessment was imperfectly reliable with 13% of TP done for LMD only. More than half of patients were operated at an invasive carcinoma stage with poor outcome. Conversely, long-term survival was excellent after TP for noninvasive IPMN.

11 Article An onco-geriatric approach to select older patients for optimal treatments of pancreatic adenocarcinoma. 2018

Castel-Kremer, Elisabeth / De Talhouet, Solene / Charlois, Anne-Laure / Graillot, Emmanuelle / Chopin-Laly, Xavier / Adham, Mustapha / Comte, Brigitte / Lombard-Bohas, Catherine / Walter, Thomas / Boschetti, Gilles. ·Department of Geriatrics, Hospices Civils de Lyon and University Claude Bernard Lyon 1, France. Electronic address: elisabeth.castel-kremer@chu-lyon.fr. · Department of Digestive Oncology, Edouard Herriot University Hospital, Lyon, France. · Department of Gastroenterology, Lyon-Sud Hospital, Lyon, France. · Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France. · Department of Geriatrics, Hospices Civils de Lyon and University Claude Bernard Lyon 1, France. · Department of Digestive Oncology, Edouard Herriot University Hospital, Lyon, France; Department of Gastroenterology, Lyon-Sud Hospital, Lyon, France. ·J Geriatr Oncol · Pubmed #29685381.

ABSTRACT: INTRODUCTION: Pancreatic adenocarcinoma affects mainly older patients. Surgery is indicated for localized tumors while chemotherapy alone is proposed in advanced or metastatic tumors. OBJECTIVE: To evaluate the feasibility of standard of care oncologic treatments in this population, the accuracy of the geriatric evaluation to predict the ability of patients to tolerate the recommended treatments and to identify specific geriatric prognosis factors. METHODS: We included, between 2007 and 2014, all consecutive patients over 70 years of age with a pathologically diagnosed pancreatic cancer. The patients underwent a comprehensive geriatric assessment before therapeutic decision in a multidisciplinary team meeting. We analyzed factors independently associated with all-cause mortality with Cox survival analysis. RESULTS: Seventy-three patients (median age = 77.9 years) were prospectively included. Among them, 42 patients underwent surgery whereas the 31 other patients not eligible for surgical treatment received chemotherapy (n = 22) or best supportive care alone (n = 9). Almost 62% of operated patients received adjuvant chemotherapy. In the non-surgical group, a mean of 9 cycles of palliative chemotherapy per patients were administrated. Median overall survival was 21.3 months in the surgical group and 6.1 months in the palliative group (p = 0.0001). Most of oncologic parameters were found to be independent survival predictors. Age was not associated with the survival, but a significant impact of Lawton's Instrumental Activities of Daily Living (IADL) impairment (IADL<4) (HR = 5.0, p = 0.047), Cumulative Index Rating Scale-Geriatric (CIRS-G) ≥2 (HR = 19, p = 0.035) and weight loss >10% (HR = 4.6, p = 0.03) on survival was detected. Surgery was the only factor independently predictive of survival in multivariate analysis (p < 0.001). CONCLUSION: Almost 90% of selected older pancreatic patients with cancer (64 out of 73 patients) may benefit from the same standard treatments as younger patients. IADL impairment of patients, CIRS-G ≥2, and weight loss >10% constitute survival prognostic factors which should be added to the oncological criteria in the therapeutic decision-making process.

12 Article Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study. 2018

Klompmaker, Sjors / van Hilst, Jony / Gerritsen, Sarah L / Adham, Mustapha / Teresa Albiol Quer, M / Bassi, Claudio / Berrevoet, Frederik / Boggi, Ugo / Busch, Olivier R / Cesaretti, Manuela / Dalla Valle, Raffaele / Darnis, Benjamin / De Pastena, Matteo / Del Chiaro, Marco / Grützmann, Robert / Diener, Markus K / Dumitrascu, Traian / Friess, Helmut / Ivanecz, Arpad / Karayiannakis, Anastasios / Fusai, Giuseppe K / Labori, Knut J / Lombardo, Carlo / López-Ben, Santiago / Mabrut, Jean-Yves / Niesen, Willem / Pardo, Fernando / Perinel, Julie / Popescu, Irinel / Roeyen, Geert / Sauvanet, Alain / Prasad, Raj / Sturesson, Christian / Lesurtel, Mickael / Kleeff, Jorg / Salvia, Roberto / Besselink, Marc G / Anonymous5490939. ·Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands. · Department of Digestive Surgery, E. Herriot Hospital, HCL, UCBL1, Lyon, France. · Department of Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain. · Department of Surgery, University of Verona, Verona, Italy. · Department of General and HPB Surgery, Ghent University Hospital, Ghent, Belgium. · Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. · Department of HPB Surgery, Hôpital Beaujon, Clichy Cedex, France. · Hepato-Pancreato-Biliary Unit, Parma University Hospital, Parma, Italy. · Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France. · Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden. · Department of Surgery, University Hospital Erlangen, Erlangen, Germany. · Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany. · Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania. · Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany. · Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Slovenia. · Second Department of Surgery, Democritus University of Thrace, Alexandroupolis, Greece. · HPB Surgery and Liver Transplantation Unit, Royal Free Hospital, London, UK. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. · Department of HPB and Transplant Surgery, Clínica Universidad de Navarra, Pamplona, Spain. · Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Antwerp, Belgium. · Department of HPB and Transplant Services, National Health Service, Leeds, UK. · Department of Surgery, Skåne University Hospital, Lund, Sweden. · Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany. · Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands. m.g.besselink@amc.nl. ·Ann Surg Oncol · Pubmed #29532342.

ABSTRACT: BACKGROUND: Western multicenter studies on distal pancreatectomy with celiac axis resection (DP-CAR), also known as the Appleby procedure, for locally advanced pancreatic cancer are lacking. We aimed to study overall survival, morbidity, mortality and the impact of preoperative hepatic artery embolization (PHAE). METHODS: Retrospective cohort study within the European-African Hepato-Pancreato-Biliary-Association, on DP-CAR between 1-1-2000 and 6-1-2016. Primary endpoint was overall survival. Secondary endpoints were radicality (R0-resection), 90-day mortality, major morbidity, and pancreatic fistulae (grade B/C). RESULTS: We included 68 patients from 20 hospitals in 12 countries. Postoperatively, 53% of patients had R0-resection, 25% major morbidity, 21% an ISGPS grade B/C pancreatic fistula, and 16% mortality. In total, 82% received (neo-)adjuvant chemotherapy and median overall survival in 62 patients with pancreatic ductal adenocarcinoma patients was 18 months (CI 10-37). We observed no impact of PHAE on ischemic complications. CONCLUSIONS: DP-CAR combined with chemotherapy for locally advanced pancreatic cancer is associated with acceptable overall survival. The 90-day mortality is too high and should be reduced. Future studies should investigate to what extent increasing surgical volume or better patient selection can improve outcomes.

13 Article Fukuoka-Negative Branch-Duct IPMNs: When to Worry? A Study from the French Surgical Association (AFC). 2018

Duconseil, Pauline / Adham, Mustapha / Sauvanet, Alain / Autret, Aurélie / Périnel, Julie / Chiche, Laurence / Mabrut, Jean-Yves / Tuech, Jean-Jacques / Mariette, Christophe / Turrini, Olivier. ·Department of Surgery, Hôpital Nord, Marseille, France. pauline.duconseil@gmail.com. · Department of Digestive Surgery, Hôpital Nord, Marseille, France. pauline.duconseil@gmail.com. · Department of Surgery, Hôpital Edouard-Herriot, Lyon, France. · Department of Surgery, Hôpital Beaujon, Paris, France. · Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France. · Department of Surgery, Maison du Haut-Lévêque, Bordeaux, France. · Department of Surgery, Hôpital de la Croix Rousse, Lyon, France. · Department of Surgery, Hôpital Charles Nicolle, Rouen, France. · Department of Surgery, Hôpital Claude-Huriez, Lille, France. · Department of Surgery, Institut Paoli-Calmettes, Marseille, France. ·Ann Surg Oncol · Pubmed #29392508.

ABSTRACT: BACKGROUND: This study analyzed the pathologic findings for patients with Fukuoka-negative branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) who theoretically were eligible for surveillance care with follow-up assessment, but instead underwent resection. METHODS: From January 2005 to December 2012, 820 patients underwent evaluation for IPMN. At initial staging, 319 patients had BD-IPMN, and 89 of these patients presented with Fukuoka-negative criteria. These 89 patients were included in this study. RESULTS: Of the 89 patients, 55 (62%) underwent pancreatectomy. After pathologic examination, the ultimate diagnosis was MT-IPMN for 20 (36%) of these patients (the MT group) and BD-IPMN for 35 (64%) of these patients (the BD group). The remaining 34 patients (38%) underwent enucleation. The patients in the MT group were more likely to be male (P = 0.01) and to have a higher rate of recent (< 1 year) diabetes mellitus diagnosis (P = 0.007) than the patients in the BD group. In the multivariate analysis, diabetes mellitus was independently associated with involvement of the main pancreatic duct (P = 0.05). Malignancy was diagnosed for 14 (16%) of the 89 patients. The rate of invasive IPMN was higher in the MT group than in the BD group (20% vs. 0%, P = 0.02). The 5-year overall survival rate was 100% for the BD group and 84% for the MT group (P = 0.02). For the male patients with diabetes mellitus, the rate of malignancy rose to 67%. CONCLUSIONS: For patients with a diagnosis of Fukuoka-negative BD-IPMN, resection should be considered primarily for male patients with a recent diabetes mellitus diagnosis.

14 Article Unnecessary preoperative biliary drainage: impact on perioperative outcomes of resectable periampullary tumors. 2017

Cazauran, Jean-Baptiste / Perinel, Julie / Kepenekian, Vahan / El Bechwaty, Michel / Nappo, Gennaro / Pioche, Mathieu / Ponchon, Thierry / Adham, Mustapha. ·Department of Digestive Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon & Lyon Sud Faculty of Medicine UCBL1, Lyon, France. · Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon & Lyon Est Faculty of Medicine UCBL1, Lyon, France. · Department of Digestive Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon & Lyon Sud Faculty of Medicine UCBL1, Lyon, France. mustapha.adham@chu-lyon.fr. ·Langenbecks Arch Surg · Pubmed #29086013.

ABSTRACT: OBJECTIVE: Routine preoperative endoscopic biliary drainage (PEBD) is not recommended for malignant periampullary tumors (MPT) with uncomplicated obstructive cholestasis, yet many patients still receive routine PEBD. Herein were assessed perioperative outcomes of routine PEBD in resectable MPT with uncomplicated biliary obstruction. METHODS: From 2008 to 2014, we identified three groups among patients undergoing surgery for resectable MPT: "unnecessary-PEBD" (despite recommendations), "necessary-PEBD" (following recommendations), and "upfront-surgery groups." The first two groups were compared on referral patterns, drainage procedure, and post-PEBD complications; "Unnecessary-PEBD" and "upfront-surgery" groups were compared on perioperative outcomes. RESULTS: A total 140 patients underwent surgery for resectable MPT; 38 had cholestasis with clear PEBD indication ("necessary-PEBD"). A further 66 presented uncomplicated obstructive cholestasis with total bilirubin < 300 μmol/l, of whom 26 had unnecessary PEBD and 40 underwent upfront surgery. In total, 40.1% of PEBD were unnecessary and 64.1% were performed before surgical consultation. Time-to-surgery was significantly increased in the "unnecessary-PEBD" group by a mean ± SD 35.3 ± 5.5 days as compared to "upfront-surgery" group (95%CI [24.4-46.2]; p < 0.001). The "unnecessary-PEBD" group had a post-PEBD complication rate of 34.6%, and 7.7% were unresectable due to severe fibrosis following PEBD-induced acute pancreatitis. Perioperative severe complication rate was higher in the "unnecessary-PEBD" (73.1%) than in the "upfront-surgery" group (37.5%, p = 0.005), as was Clavien-Dindo grade > II post-operative complication rate (65.4 and 37.5%; p = 0.03). CONCLUSION: Routine preoperative biliary drainage is associated with an increased morbidity and persists despite recommendations against its systematic use. Early multidisciplinary team discussions with pancreatic surgeons should be implemented with an aim to reduce unnecessary stenting and improve patient outcomes.

15 Article Resectable invasive IPMN versus sporadic pancreatic adenocarcinoma of the head of the pancreas: Should these two different diseases receive the same treatment? A matched comparison study of the French Surgical Association (AFC). 2017

Duconseil, P / Périnel, J / Autret, A / Adham, M / Sauvanet, A / Chiche, L / Mabrut, J-Y / Tuech, J-J / Mariette, C / Régenet, N / Fabre, J-M / Bachellier, P / Delpéro, J-R / Paye, F / Turrini, O. ·Department of Surgery, Hôpital Nord, Marseille, France. Electronic address: pauline.duconseil@gmail.com. · Department of Surgery, Hôpital Edouard-Herriot, HCL, UCBL1, Lyon, France. · Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France. · Department of Surgery, Hôpital Beaujon, Paris, France. · Department of Surgery, Maison du Haut-Lévêque, Bordeaux, France. · Department of Surgery, Hôpital de la Croix Rousse, Lyon, France. · Department of Surgery, Hôpital Charles Nicolle, Rouen, France. · Department of Surgery, Hôpital Claude-Huriez, Lille, France. · Department of Surgery, Hôpital Hôtel Dieu, Nantes, France. · Department of Surgery, Hôpital Saint Eloi, Montpellier, France. · Department of Surgery, Hôpital de Hautepierre, Strasbourg, France. · Department of Surgery, Institut Paoli-Calmettes, Marseille, France. · Department of Surgery, Hôpital Saint Antoine, Paris, France. ·Eur J Surg Oncol · Pubmed #28687431.

ABSTRACT: PURPOSE: To compare survival and impact of adjuvant chemotherapy in patients who underwent pancreaticoduodenectomy (PD) for invasive intraductal papillary mucinous neoplasm (IIPMN) and sporadic pancreatic ductal adenocarcinoma (PDAC). METHODS: From 2005 to 2012, 240 patients underwent pancreatectomy for IIPMN and 1327 for PDAC. Exclusion criteria included neoadjuvant treatment, pancreatic resection other than PD, vascular resection, carcinoma in situ, or <11 examined lymph nodes. Thus, 82 IIPMN and 506 PDAC were eligible for the present study. Finally, The IIPMN group was matched 1:2 to compose the PDAC group according to TNM disease stage, perineural invasion, lymph node ratio, and margin status. RESULTS: There was no difference in patient's characteristics, intraoperative parameters, postoperative outcomes, and histologic parameters. Overall survival and disease-free survival times were comparable between the 2 groups. In each group, overall survival time was significantly poorer in patients who did not achieve adjuvant chemotherapy (p = 0.03 for the IIPMN group; p = 0.03 for the PDAC group). In lymph-node negative patients of the IIPMN group, adjuvant chemotherapy did not have any significant impact on overall survival time (OR = 0.57; 95% CI [0.24-1.33]). Considering the whole population (i.e. patients with IIPMN and PDAC; n = 246), patients who did not achieve adjuvant chemotherapy had poorer survival (p < 0.01). CONCLUSIONS: The courses of IIPMN and PDAC were similar after an optimized stage-to-stage comparison. Adjuvant chemotherapy was efficient in both groups. However, in lymph node negative patients, adjuvant chemotherapy seemed not to have a significant impact.

16 Article Treatment of metastatic pancreatic neuroendocrine tumors: relevance of ENETS 2016 guidelines. 2017

Foulfoin, Margaux / Graillot, Emmanuelle / Adham, Mustapha / Rousset, Pascal / Forestier, Julien / Hervieu, Valérie / Robinson, Philip / Scoazec, Jean-Yves / Lombard-Bohas, Catherine / Walter, Thomas. ·Hospices Civils de LyonHôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France. · University of LyonUniversité Lyon 1, Lyon, France. · Hospices Civils de LyonHôpital Edouard Herriot, Service de chirurgie, Lyon, France. · Hospices Civils de LyonHôpital Edouard Herriot, Service de radiologie, Lyon, France. · Hospices Civils de LyonHôpital Edouard Herriot, Service Central d'Anatomie et Cytologie Pathologiques, Lyon, France. · Hospices Civils de LyonDRCI, Lyon, France. · Hospices Civils de LyonHôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France thomas.walter@chu-lyon.fr. ·Endocr Relat Cancer · Pubmed #27965277.

ABSTRACT: The choice of first-line treatment for metastatic pancreatic neuroendocrine tumors (mP-NET) is mainly based on prognostic factors. ENETS-2016 guidelines stratified treatment according to 3 groups: Group 1, patients in whom all lesions could be removed; Group 2, patients with Ki67 <10%, low tumor burden, no symptoms and stable disease, for whom a watch-and-wait strategy or somatostatin analogs are proposed; Group 3, symptomatic patients or with Ki67 >10% or significant tumor burden or progressive disease, for whom a systemic chemotherapy is proposed. This retrospective study aimed to determine patient distribution, characteristics and outcome among these 3 groups. Patients with mP-NET diagnosis from 2004 to 2016 were categorized into the three groups. Prognosis was calculated using the Kaplan-Meier method. All treatments were recorded, and consistency with ENETS guidelines was explored. 104 patients were analyzed: 64% synchronous mP-NET, 80% grade 2 tumors and median overall survival (OS) of 104 (95% CI: 65-143) months. There were 15 patients in ENETS Group 1, 16 in Group 2 and 73 in Group 3. Median OS was not reached in Groups 1 and 2 and was 64 months (35-93) in Group 3. High liver tumor volume, high-grade tumor and progressive disease were associated with worse OS in multivariate analysis. The first-line treatment was in accordance with guidelines in 82%. 77% percent of deceased patients received less than 4 lines of treatment. Most patients are in Group 3 and do not receive all available treatments. Thus, trials are warranted to improve first-line chemotherapy. Alternative treatments may be considered for less aggressive disease.

17 Article Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement. 2016

Perinel, J / Nappo, G / El Bechwaty, M / Walter, T / Hervieu, V / Valette, P J / Feugier, P / Adham, M. ·Hospices Civils de Lyon, Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France. · Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France. · Hospices Civils de Lyon, Department of Digestive Oncology, Edouard Herriot Hospital, Lyon, France. · Hospices Civils de Lyon, Department of Pathology, Edouard Herriot Hospital, Lyon, France. · Hospices Civils de Lyon, Department of Digestive Radiology, Edouard Herriot Hospital, Lyon, France. · Hospices Civils de Lyon, Department of Vascular surgery, Edouard Herriot Hospital, Lyon, France. · Hospices Civils de Lyon, Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France. mustapha.adham@chu-lyon.fr. · Lyon Faculty of Medicine, Univeristy of Lyon, UCBL1, Lyon, France. mustapha.adham@chu-lyon.fr. ·Langenbecks Arch Surg · Pubmed #27476146.

ABSTRACT: Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally advanced PDA based on specific selection criteria. MATERIAL AND METHODS: All patients receiving pancreatectomy for PDA between October 2008 and July 2014 were reviewed. The patients were classified into group 1, pancreatectomy without vascular resection (66 patients); group 2, pancreatectomy with isolated venous resection (31 patients), and group 3, pancreatectomy with arterial resection for locally advanced PDA (14 patients). The primary selection criteria for arterial resection was the possibility of achieving a complete resection based on the extent of axial encasement, the absence of tumor invasion at the origin of celiac trunk (CT) and superior mesenteric artery (SMA), and a free distal arterial segment allowing reconstruction. Patient outcomes and survival were analyzed. RESULTS: Six SMA, two CT, four common hepatic artery, and two replaced right hepatic artery resections were undertaken. The preferred arterial reconstruction was splenic artery transposition. Group 3 had a higher preoperative weight loss, a longer operative time, and a higher incidence of intraoperative blood transfusion. Ninety-day mortality occurred in three patients in groups 1 and 2. There were no statistically significant differences in the incidence, grade, and type of complications in the three groups. Postoperative pancreatic fistula and postpancreatectomy hemorrhage were also comparable. In group 3, none had arterial wall invasion and nine patients had recurrence (seven metastatic and two loco-regional). Survival and disease-free survival were comparable between groups. CONCLUSION: Planned arterial resection for PDA can be performed safely with a good outcome in highly selected patients. Key elements for defining the resectability is based on the extent of the axial arterial encasement with two criteria: the origin of the CT and SMA are free from tumor invasion and the possibility of distal reconstruction.

18 Article Early Enteral Versus Total Parenteral Nutrition in Patients Undergoing Pancreaticoduodenectomy: A Randomized Multicenter Controlled Trial (Nutri-DPC). 2016

Perinel, Julie / Mariette, Christophe / Dousset, Bertrand / Sielezneff, Igor / Gainant, Alain / Mabrut, Jean-Yves / Bin-Dorel, Sylvie / Bechwaty, Michel El / Delaunay, Dominique / Bernard, Lorraine / Sauvanet, Alain / Pocard, Marc / Buc, Emmanuel / Adham, Mustapha. ·*Department of Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, UCBL1, Lyon, France†Department of Digestive and General Surgery, Hôpital C. Huriez CHRU, Lille, France‡Department of Digestive Surgery, Hôpital Cochin - St-Vincent de Paul, Paris, France§Department of Digestive Surgery, CHU Timone, Marseille, France¶Department of Digestive Surgery, CHU Dupuytren, Limoges, France||Department of Digestive Surgery and Liver Transplantation, Hôpital de la Croix Rousse, Lyon, France**Pole Information Médicale Evaluation Recherche, HCL, Lyon, France††Department of Hepato-Biliary and Pancreatic Surgery, APHP, Hôpital Beaujon, Clichy, France‡‡Department of Digestive Surgery, APHP, Hôpital Lariboisières, Paris, France§§Department of Digestive Pathology, Surgery Unit, CHU Clermont Ferrand Hôtel Dieu NHE, Clermont Ferrand, France. ·Ann Surg · Pubmed #27429039.

ABSTRACT: OBJECTIVES: The aim of this study was to compare nasojejunal early enteral nutrition (NJEEN) with total parenteral nutrition (TPN), after pancreaticoduodenectomy (PD), in terms of postoperative complications. BACKGROUND: Current nutritional guidelines recommend the use of enteral over parenteral nutrition in patients undergoing gastrointestinal surgery. However, the NJEEN remains controversial in patients undergoing PD. METHODS: Multicenter, randomized, controlled trial was conducted between 2011 and 2014. Nine centers in France analyzed 204 patients undergoing PD to NJEEN (n = 103) or TPN (n = 101). Primary outcome was the rate of postoperative complications according to Clavien-Dindo classification. Successful NJEEN was defined as insertion of a nasojejunal feeding tube, delivering at least 50% of nutritional needs on PoD 5, and no TPN for more than consecutive 48 hours. RESULTS: Postoperative complications occurred in 77.5% [95% confidence interval (95% CI) 68.1-85.1] patients in the NJEEN group versus 64.4% (95% CI 54.2-73.6) in TPN group (P = 0.040). NJEEN was associated with higher frequency of postoperative pancreatic fistula (POPF) (48.1% vs 27.7%, P = 0.012) and higher severity (grade B/C 29.4% vs 13.9%; P = 0.007). There was no significant difference in the incidence of post-pancreatectomy hemorrhage, delayed gastric emptying, infectious complications, the grade of postoperative complications, and the length of postoperative stay. A successful NJEEN was achieved in 63% patients. In TPN group, average energy intake was significantly higher (P < 0.001) and patients had an earlier recovery of oral feeding (P = 0.0009). CONCLUSIONS: In patients undergoing PD, NJEEN was associated with an increased overall postoperative complications rate. The frequency and the severity of POPF were also significantly increased after NJEEN. In terms of safety and feasibility, NJEEN should not be recommended.

19 Article Synchronous resections of hepatic oligometastatic pancreatic cancer: Disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. 2016

Tachezy, Michael / Gebauer, Florian / Janot, Monika / Uhl, Waldemar / Zerbi, Alessandro / Montorsi, Marco / Perinel, Julie / Adham, Mustapha / Dervenis, Christos / Agalianos, Christos / Malleo, Giuseppe / Maggino, Laura / Stein, Alexander / Izbicki, Jakob R / Bockhorn, Maximilian. ·Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany. · Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany. Electronic address: fgebauer@uke.de. · Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Hospital of the Ruhr-University, Bochum, Germany. · Department of General Surgery, University of Milan, Instituto Clinico Humanitas IRCCS, Milan, Italy. · Department of Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, Lyon Faculty of Medicine - UCBL1, Lyon, France. · Department of Surgery, Agia Olga Hospital, Athens, Greece. · Department of Surgery, Unit of Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Oncology, Hematology, BMT with section Pneumology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany. ·Surgery · Pubmed #27048934.

ABSTRACT: BACKGROUND: The prognosis of patients with liver metastasis is generally considered dismal, and combined resections of the primary tumor and metastasectomies are not recommended. In highly selected patients, however, resections are performed. The evidence for this indication is limited. The aim of the current study was to assess the operative and oncologic outcomes of patients with combined pancreatic and liver resections of synchronous liver metastases. METHODS: In a retrospective analysis of 6 European pancreas centers, we identified 69 patients with pancreatic ductal adenocarcinoma and synchronous liver metastasis who underwent simultaneous pancreas and liver metastasis resections. Patients receiving exploration without tumor resection served as the control group. RESULTS: Overall survival (OS) appeared to be prolonged in the group of resected patients (median 14 vs 8 months, P < .001). Subgroup analysis revealed that the survival benefit of the resected patients was driven by pancreatic ductal adenocarcinomas localized in the pancreatic head (median OS 13.6 vs 7 months, P < .001). Body/tail pancreatic ductal adenocarcinomas showed no benefit of resection (median OS 14 vs 15 months, P = .312). In the multivariate analysis, tumor resection was the only independent prognosticator for OS (hazard ratio 2.044, 95% confidence interval 1.342-3.114). CONCLUSION: The data of this retrospective and selective patient cohort suggested a clear survival benefit for patients undergoing synchronous pancreas and liver resections for pancreatic ductal adenocarcinoma, but due to the limitations of this retrospective study and very strong potential for selection bias, a strong conclusion for resection cannot be drawn. Prospective trials must validate these data and investigate the use of combined operative and systemic treatments in case of resectable metastatic pancreatic cancer. Is it time for a multicenter, prospective trial?

20 Article The Standardization of Pancreatoduodenectomy: Where Are We? 2016

Nappo, Gennaro / Perinel, Julie / El Bechwaty, Michel / Adham, Mustapha. ·From the HBP Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Universite Claude Bernard Lyon 1, Lyon, France. ·Pancreas · Pubmed #26954493.

ABSTRACT: Pancreaticoduodenectomy (PD) represents an important challenge for surgeons due to the complexity of the operation, requirement for technical skills and experience, and postoperative management involving important and life-threatening complications. Despite efforts to reduce mortality in high-volume centers, the morbidity rate is still high (approximately 40-50%). The PD standardization process of surgical aspects and preoperative and postoperative settings is essential to permit pancreatic surgeons to communicate in the same language, compare experiences and results, and to improve the short- and long-term outcomes. The aim of this article is to assess the state of the art practices for important matters of debate for PD (the role of mini invasive approach, the definition and the role of mesopancreas, the extent of lymphadenectomy, the different methods of reconstructions, the prophylactic drainage of the abdominal cavity), and to suggest possible future studies.

21 Article Diagnosis and preoperative tagging of duodenal gastrinoma by endoscopic ultrasound. 2015

Gincul, Rodica / Lepilliez, Vincent / Walter, Thomas / Rabeyrin, Maud / Ponchon, Thierry / Adham, Mustapha / Chayvialle, Jean-Alain. ·Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. · Department of Pathology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. · Department of Digestive Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. ·Endoscopy · Pubmed #26492296.

ABSTRACT: -- No abstract --

22 Article Severe Jaundice Increases Early Severe Morbidity and Decreases Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma. 2015

Sauvanet, Alain / Boher, Jean-Marie / Paye, François / Bachellier, Philippe / Sa Cuhna, Antonio / Le Treut, Yves-Patrice / Adham, Mustapha / Mabrut, Jean-Yves / Chiche, Laurence / Delpero, Jean-Robert / Anonymous3700837. ·Department of Hepato-Biliary and Pancreatic Surgery, Hôpital Beaujon, Clichy, France. Electronic address: alain.sauvanet@bjn.aphp.fr. · Department of Biostatistics and Methodology, Institut Paoli Calmettes, Marseille, France; Unité Mixte de Recherche Institut de Recherche pour le Développement, Aix-Marseille University, Marseille, France. · Department of Digestive Surgery, Hôpital Saint Antoine, Paris, France. · Department of HPB Surgery, Hôpital de Hautepierre, Strasbourg, France. · Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France. · Department of Surgery, Hôpital de la Conception, Marseille, France. · Department of Surgery, Hôpital Edouard-Herriot, Lyon, France. · Department of Surgery, Hôpital de la Croix Rousse, Lyon, France. · Department of Surgery, Maison du Haut-Levêque, Pessac, France. · Department of Surgical Oncology, Institut Paoli Calmettes, Marseille, France. ·J Am Coll Surg · Pubmed #26206638.

ABSTRACT: BACKGROUND: The influence of jaundice on outcomes after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) is debated. This study aimed to determine, in a large multicentric series, the influence of severe jaundice (serum bilirubin level ≥250 μmol/L and 300 μmol/L) on early severe morbidity and survival after PD. STUDY DESIGN: From 2004 to 2009, twelve hundred patients (median age 66 years, 57% male) with resectable PDAC underwent PD. Patients who received preoperative biliary drainage for neoadjuvant treatment or cholangitis were excluded. Pre- and intraoperative data were collected by a standardized form. Serum bilirubin level and creatinine clearance were analyzed as categorical variables. Predictive factors of severe complications and poor survival (Kaplan-Meier method) were identified by univariate and multivariate analysis. RESULTS: Median follow-up was 21 months (95% CI, 19-23). Operative mortality was 3.9% (n = 47), with no predictive factors in multivariate analysis. Severe complications (Dindo-Clavien grade III to IV) occurred in 22% (n = 268), with male sex (p = 0.025), America Society of Anesthesiologists score 3 to 4 (p = 0.022), serum bilirubin level ≥300 μmol/L (p = 0.034), and creatinine clearance <60 mL/min/1.73 m(2) (p = 0.013) identified as predictive factors in multivariate analysis. Overall 3-year survival rate was 41% (95% CI, 37-45%). In multivariate analysis, serum bilirubin level ≥300 μmol/L (p = 0.048), low-volume center (p < 0.001), venous resection (p = 0.014), N1 status (p < 0.01), R1 status (p < 0.001), and absence of adjuvant treatment (p < 0.001) negatively impacted survival. There was a negative relationship between survival at 12 months or later and higher rates of bilirubin. Presence of a biliary stent did not influence early or long-term results. CONCLUSIONS: In this multicentric study, serum bilirubin level ≥300 μmol/L increased severe morbidity and decreased long-term survival after PD for PDAC. These findings suggest that biliary stenting is appropriately indicated before PD in patients with PDAC and severe jaundice.

23 Article The short- and long-term outcomes of pancreaticoduodenectomy for cancer in Child A patients are acceptable: a patient-control study from the Surgical French Association report for pancreatic surgery. 2015

Regimbeau, Jean-Marc / Rebibo, Lionel / Dokmak, Safi / Boher, Jean-Marie / Sauvanet, Alain / Chopin-Laly, Xavier / Adham, Mustapha / Lesurtel, Mickaël / Bigourdan, Jean-Marc / Truant, Stéphanie / Pruvot, François-René / Ortega-Deballon, Pablo / Paye, François / Bachellier, Philippe / Delpero, Jean-Robert. ·Department of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France. ·J Surg Oncol · Pubmed #25663324.

ABSTRACT: BACKGROUND: On the basis of now dated studies, cirrhosis is usually considered to be a contraindication in pancreatoduodenectomy (PD) for adenocarcinoma of the pancreatic head (APH). OBJECTIVE: Examine the outcomes of PD for APH in the presence of cirrhosis. METHODS: Retrospective, multicenter study of cirrhotic patients with APH having undergone PD between January 2004 and March 2012. Cirrhotic patients were matched 1:2 for demographic, surgical and histologic criteria with non-cirrhotic patients. Primary endpoint was morbidity and mortality. Secondary endpoints were surgical parameters, morbidity related to pancreatic surgery and cirrhosis, and follow-up. RESULTS: We included 35 patients with cirrhosis. Twenty-four patients (69%) were Child A and none were Child C. The Child A cirrhotic patients and non-cirrhotic patients respectively had complication rates of 79% vs. 43% (P = 0.002), major complication rates of 33% vs. 21% (P = 0.26), pancreatic fistula rates of 13% vs. 9% (P = 0.57), post-operative mortality of 4% vs. 5% (P = 0.94), 3-year overall survival rates of 44% vs. 50% (P = 0.46). All Child B cirrhotic patients experienced post-operative complications. CONCLUSION: Pancreatoduodenectomy for APH was possible in Child A cirrhotic patients with a mortality and long-term outcomes equivalent to non-cirrhotic patients. Child B cirrhosis remains a clear contraindication to surgery.

24 Article Short- and long-term outcomes of pancreatectomy with or without biliary tract and duodenum preservation for benign and borderline neoplasms. 2014

Perinel, Julie / Adham, Mustapha. ·Department of Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, Lyon Faculty of Medicine - UCBL1, Lyon, France. ·Dig Surg · Pubmed #25277317.

ABSTRACT: OBJECTIVES: The aim of this study was to compare short- and long-term outcomes of biliary tract and duodenum-preserving pancreatectomy (BT-DPP) versus non-conservative pancreatectomy (NCP). PATIENTS AND METHODS: From 2008 to 2012, 39 of 259 patients underwent pancreatectomy for benign or borderline neoplasms. Patients were classified as BT-DPP (n = 15) or NCP (n = 24). Data were prospectively collected and retrospectively analyzed on an intention-to-treat basis. RESULTS: Both groups were comparable regarding demography, intra- and postoperative data (operative time, blood loss) and length of hospital stay. Overall complications occurred in 10 and 19 (p = 0.31), postpancreatectomy fistula in 2 and 4 (p = 0.6), biliary fistula in 3 and 1 (p = 0.15), and postpancreatectomy hemorrhage in 3 and 7 (p = 0.4) patients in the BT-DPP and NCP groups, respectively. One patient in the NCP group died. The median follow-up was 27 (4.4-56.5) and 23.4 (0.3-53) months in the BT-DPP and NCP groups, respectively. One BT-DPP patient had biliary stenosis treated endoscopically and 1 patient in the NCP group required surgery. The incidence of diabetes was equal. CONCLUSION: Our study shows that BT-DPP is feasible without an increase in morbidity compared with NCP. In the long term, BT-DPP was not associated with higher morbidity.

25 Article Pancreatic resection in elderly patients: should it be denied? 2014

Adham, M / Bredt, L C / Robert, M / Perinel, J / Lombard-Bohas, C / Ponchon, T / Valette, P J. ·Department of Hepato-Biliary and Pancreatic Surgery, Lyon Faculty of Medicine-UCBL1, Edouard Herriot Hospital-HCL, Lyon, France, mustapha.adham@chu-lyon.fr. ·Langenbecks Arch Surg · Pubmed #24671518.

ABSTRACT: BACKGROUND: Surgery remains the only potential curative therapy for pancreatic cancer, but compromised physiological reserve and comorbidities may deny pancreatic resection from elderly patients. METHODS: The medical records of all patients who underwent pancreatic resection at our institution (2005-2012) were retrospectively reviewed. Postoperative and long-term outcomes were compared between patients with cutoff age of 70 years. RESULTS: A total of 228 (66 %) and 116 (34 %) patients were <70 and ≥70 years, respectively. Elderly group had worse ASA scores (P < 0.0001) with higher rates of invasive malignant pathologies (75 vs. 67 %, P = 0.14), mainly pancreatic ductal adenocarcinoma (58.6 vs. 44.7 %, P = 0.01). The most common type of resection was pancreaticoduodenectomy (PD) (59 %), followed by distal pancreatectomy (19.8 %). Mean hospital stay was comparable. Elderly patients had less grade ≥IIIb postoperative complications (12 vs. 20.1 %; P = 0.04) and higher postoperative mortality rates (12.9 vs. 3.9 %; P = 0.04). In multivariable Cox proportional hazards model for postoperative mortality, age ≥ 70 years (HR, 3.5; 95 % CI, 1.3-9.3), pancreaticoduodenectomy (HR, 12.6; 95 % CI, 1.6-96), and intraoperative blood loss were significant (P = 0.012; P = 0.015, and P = 0.005, respectively). The overall 5-year survival rates for all patients, for patients aged <70 and ≥70 years were 56, 55, and 41 %, respectively (P = 0.003). CONCLUSIONS: Elderly patients are at higher risk of mortality after pancreatic resection than usually reported case series. Nonetheless, elderly patients can undergo pancreatic resection with acceptable 5-year survival results. Our results contribute for a better, informed decision-making for elderly patients and their family.

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