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Pancreatic Neoplasms: HELP
Articles by Olivier R. Busch
Based on 25 articles published since 2009
(Why 25 articles?)
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Between 2009 and 2019, Olivier R. Busch wrote the following 25 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Consensus statement on mandatory measurements in pancreatic cancer trials (COMM-PACT) for systemic treatment of unresectable disease. 2018

Ter Veer, Emil / van Rijssen, L Bengt / Besselink, Marc G / Mali, Rosa M A / Berlin, Jordan D / Boeck, Stefan / Bonnetain, Franck / Chau, Ian / Conroy, Thierry / Van Cutsem, Eric / Deplanque, Gael / Friess, Helmut / Glimelius, Bengt / Goldstein, David / Herrmann, Richard / Labianca, Roberto / Van Laethem, Jean-Luc / Macarulla, Teresa / van der Meer, Jonathan H M / Neoptolemos, John P / Okusaka, Takuji / O'Reilly, Eileen M / Pelzer, Uwe / Philip, Philip A / van der Poel, Marcel J / Reni, Michele / Scheithauer, Werner / Siveke, Jens T / Verslype, Chris / Busch, Olivier R / Wilmink, Johanna W / van Oijen, Martijn G H / van Laarhoven, Hanneke W M. ·Department of Medical Oncology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, Netherlands. · Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, Netherlands. · Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA. · Department of Internal Medicine III, Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany. · Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France. · Royal Marsden NHS Foundation Trust, London and Surrey, UK. · Department of Medical Oncology, Institut de Cancérologie de Lorraine and Lorraine University, Vandoeuvre-lès-Nancy, France. · Department of Gastroenterology and Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium. · Department of Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland. · Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany. · Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. · Nelune Cancer Centre, Prince of Wales Hospital, Prince of Wales Clinical School University of New South Wales, Randwick, NSW, Australia. · Department of Medical Oncology, University Hospital Basel, Basel, Switzerland. · Cancer Center, ASST Papa Giovanni XXIII, Bergamo, Italy. · Department of Gastroenterology, Gastrointestinal Cancer Unit, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. · Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain. · Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. · Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan. · Gastrointestinal Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA. · Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany. · Department of Oncology, Karmanos Cancer Center, Wayne State University, Detroit, MI, USA. · Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy. · Department of Internal Medicine I, Medical University Vienna, Vienna, Austria. · Division of Solid Tumor Translational Oncology, West German Cancer Cancer, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany. · Department of Digestive Oncology, University Hospitals Leuven, Leuven, Belgium. · Department of Medical Oncology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, Netherlands. Electronic address: h.vanlaarhoven@amc.uva.nl. ·Lancet Oncol · Pubmed #29508762.

ABSTRACT: Variations in the reporting of potentially confounding variables in studies investigating systemic treatments for unresectable pancreatic cancer pose challenges in drawing accurate comparisons between findings. In this Review, we establish the first international consensus on mandatory baseline and prognostic characteristics in future trials for the treatment of unresectable pancreatic cancer. We did a systematic literature search to find phase 3 trials investigating first-line systemic treatment for locally advanced or metastatic pancreatic cancer to identify baseline characteristics and prognostic variables. We created a structured overview showing the reporting frequencies of baseline characteristics and the prognostic relevance of identified variables. We used a modified Delphi panel of two rounds involving an international panel of 23 leading medical oncologists in the field of pancreatic cancer to develop a consensus on the various variables identified. In total, 39 randomised controlled trials that had data on 15 863 patients were included, of which 32 baseline characteristics and 26 prognostic characteristics were identified. After two consensus rounds, 23 baseline characteristics and 12 prognostic characteristics were designated as mandatory for future pancreatic cancer trials. The COnsensus statement on Mandatory Measurements in unresectable PAncreatic Cancer Trials (COMM-PACT) identifies a mandatory set of baseline and prognostic characteristics to allow adequate comparison of outcomes between pancreatic cancer studies.

2 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 / Anonymous2270883. ·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.

3 Review Laparoscopic pancreatic surgery for benign and malignant disease. 2016

de Rooij, Thijs / Klompmaker, Sjors / Abu Hilal, Mohammad / Kendrick, Michael L / Busch, Olivier R / Besselink, Marc G. ·Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. · Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK. · Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota 55905, USA. ·Nat Rev Gastroenterol Hepatol · Pubmed #26882881.

ABSTRACT: Laparoscopic surgery for benign and malignant pancreatic lesions has slowly been gaining acceptance over the past decade and is being introduced in many centres. Some studies suggest that this approach is equivalent to or better than open surgery, but randomized data are needed to assess outcomes. In this Review, we aim to provide a comprehensive overview of the state of the art in laparoscopic pancreatic surgery by aggregating high-quality published evidence. Various aspects, including the benefits, limitations, oncological efficacy, learning curve and latest innovations, are discussed. The focus is on laparoscopic Whipple procedure and laparoscopic distal pancreatectomy for both benign and malignant disease, but robot-assisted surgery is also addressed. Surgical and oncological outcomes are discussed as well as quality of life parameters and the cost efficiency of laparoscopic pancreatic surgery. We have also included decision-aid algorithms based on the literature and our own expertise; these algorithms can assist in the decision to perform a laparoscopic or open procedure.

4 Review Minimally Invasive Versus Open Pancreatoduodenectomy: Systematic Review and Meta-analysis of Comparative Cohort and Registry Studies. 2016

de Rooij, Thijs / Lu, Martijn Z / Steen, M Willemijn / Gerhards, Michael F / Dijkgraaf, Marcel G / Busch, Olivier R / Lips, Daan J / Festen, Sebastiaan / Besselink, Marc G / Anonymous130858. ·*Department of Surgery, Academic Medical Center, Academic Medical Center, Amsterdam, The Netherlands†Department of Surgery, Onze Lieve Vrouwe Gasthuis, Academic Medical Center, Amsterdam, The Netherlands‡Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands§Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands. ·Ann Surg · Pubmed #26863398.

ABSTRACT: OBJECTIVE: This study aimed to appraise and to evaluate the current evidence on minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy only in comparative cohort and registry studies. BACKGROUND: Outcomes after MIPD seem promising, but most data come from single-center, noncomparative series. METHODS: Comparative cohort and registry studies on MIPD versus open pancreatoduodenectomy published before August 23, 2015 were identified systematically and meta-analyses were performed. Primary endpoints were mortality and International Study Group on Pancreatic Fistula grade B/C postoperative pancreatic fistula (POPF). RESULTS: After screening 2293 studies, 19 comparative cohort studies (1833 patients) with moderate methodological quality and 2 original registry studies (19,996 patients) were included. For cohort studies, the median annual hospital MIPD volume was 14. Selection bias was present for cancer diagnosis. No differences were found in mortality [odds ratio (OR) = 1.1, 95% confidence interval (CI) = 0.6-1.9] or POPF [(OR) = 1.0, 95% CI = 0.8 to 1.3]. Publication bias was present for POPF. MIPD was associated with prolonged operative times [weighted mean difference (WMD) = 74 minutes, 95% CI = 29-118], but lower intraoperative blood loss (WMD = -385 mL, 95% CI = -616 to -154), less delayed gastric emptying (OR = 0.6, 95% = CI 0.5-0.8), and shorter hospital stay (WMD = -3 days, 95% CI = -5 to -2). For registry studies, the median annual hospital MIPD volume was 2.5. Mortality after MIPD was increased in low-volume hospitals (7.5% vs 3.4%; P = 0.003). CONCLUSIONS: Outcomes after MIPD seem promising in comparative cohort studies, despite the presence of bias, whereas registry studies report higher mortality in low-volume centers. The introduction of MIPD should be closely monitored and probably done only within structured training programs in high-volume centers.

5 Article Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis. 2019

Klompmaker, Sjors / Peters, Niek A / van Hilst, Jony / Bassi, Claudio / Boggi, Ugo / Busch, Olivier R / Niesen, Willem / Van Gulik, Thomas M / Javed, Ammar A / Kleeff, Jorg / Kawai, Manabu / Lesurtel, Mickael / Lombardo, Carlo / Moser, A James / Okada, Ken-Ichi / Popescu, Irinel / Prasad, Raj / Salvia, Roberto / Sauvanet, Alain / Sturesson, Christian / Weiss, Matthew J / Zeh, Herbert J / Zureikat, Amer H / Yamaue, Hiroki / Wolfgang, Christopher L / Hogg, Melissa E / Besselink, Marc G / Anonymous2651208. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. · Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. · Department of Surgery, University of Utrecht Medical Center, Utrecht, The Netherlands. · Department of Surgery, Pancreas Institute University of Verona, Verona, Italy. · Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. · Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany. · Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany. · Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. · Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France. · The Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania. · Department of HPB and Transplant Services, National Health Service, Leeds, UK. · Department of HPB Surgery, Hôpital Beaujon, APHP, University Paris VII, Clichy, France. · Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden. · Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. · Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. · Department of Surgery, Northshore University HealthSystem, Chicago, IL, USA. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. m.g.besselink@amc.nl. ·Ann Surg Oncol · Pubmed #30610560.

ABSTRACT: BACKGROUND: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. METHODS: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. RESULTS: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (≥ 1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P = 0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P = 0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19 months (95 CI, 15-25 months). CONCLUSIONS: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor.

6 Article Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and meta-analysis. 2019

van Hilst, Jony / Korrel, Maarten / de Rooij, Thijs / Lof, Sanne / Busch, Olivier R / Groot Koerkamp, Bas / Kooby, David A / van Dieren, Susan / Abu Hilal, Mo / Besselink, Marc G / Anonymous4941168. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: j.vanhilst@amc.nl. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom. · Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. · Department of Surgery, Emory University Hospital, Atlanta, USA. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: m.g.besselink@amc.nl. ·Eur J Surg Oncol · Pubmed #30579652.

ABSTRACT: In the absence of randomized trials, uncertainty regarding the oncologic efficacy of minimally invasive distal pancreatectomy (MIDP) remains. This systematic review aimed to compare oncologic outcomes after MIDP (laparoscopic or robot-assisted) and open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). Matched and non-matched studies were included. Pooled analyses were performed for pathology (e.g., microscopically radical (R0) resection and lymph node retrieval) and oncologic outcomes (e.g., overall survival). After screening 1760 studies, 21 studies with 11,246 patients were included. Overall survival (hazard ratio 0.86; 95% confidence interval (CI) 0.73 to 1.01; p = 0.06), R0 resection rate (odds ratio (OR) 1.24; 95%CI 0.97 to 1.58; p = 0.09) and use of adjuvant chemotherapy (OR 1.07; 95%CI 0.89 to 1.30; p = 0.46) were comparable for MIDP and ODP. The lymph node yield (weighted mean difference (WMD) -1.3 lymph nodes; 95%CI -2.46 to -0.15; p = 0.03) was lower after MIDP. Patients undergoing MIDP were more likely to have smaller tumors (WMD -0.46 cm; 95%CI -0.67 to -0.24; p < 0.001), less perineural (OR 0.48; 95%CI 0.33 to 0.70; p < 0.001) and less lymphovascular invasion (OR 0.53; 95%CI 0.38 to 0.74; p < 0.001) reflecting earlier staged disease as a result of treatment allocation bias. Based on these results we can conclude that in patients with PDAC, MIDP is associated with comparable survival, R0 resection, and use of adjuvant chemotherapy, but a lower lymph node yield, as compared to ODP. Due to treatment allocation bias and lower lymph node yield the oncologic efficacy of MIDP remains uncertain.

7 Article Tuberculosis presenting as a pancreatic cystic neoplasm. 2018

van der Naald, Niels / Engelsman, Anton F / Engelbrecht, Marc R W / Verheij, Joanne / Besselink, Marc G / Busch, Olivier R / van Gulik, Thomas. ·Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Radiology, Amsterdam UMC, University of Amsterdam, The Netherlands. · Department of Pathology, Amsterdam UMC, University of Amsterdam, The Netherlands. ·BMJ Case Rep · Pubmed #30567214.

ABSTRACT: A 33-year-old Thai born woman was referred to our tertiary referral hospital with back and epigastric pain. Investigations included abdominal ultrasound and CT scan of the abdomen which demonstrated a 3 cm cystic lesion in the head of the pancreas, most likely a mucinous cystadenoma. Because of its malignant potential resection was advised. During surgical exploration, the tumour appeared unresectable, due to involvement of the common hepatic artery. PCR on biopsy revealed

8 Article Association of the location of pancreatic ductal adenocarcinoma (head, body, tail) with tumor stage, treatment, and survival: a population-based analysis. 2018

van Erning, Felice N / Mackay, Tara M / van der Geest, Lydia G M / Groot Koerkamp, B / van Laarhoven, Hanneke W M / Bonsing, Bert A / Wilmink, Johanna W / van Santvoort, Hjalmar C / de Vos-Geelen, Judith / van Eijck, Casper H J / Busch, Olivier R / Lemmens, Valery E / Besselink, Marc G / Anonymous2081202. ·a Department of Research , Netherlands Comprehensive Cancer Organisation (IKNL) , Utrecht , Netherlands. · b Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC , University of Amsterdam , Amsterdam , Netherlands. · c Department of Surgery , Erasmus Medical Center , Rotterdam , the Netherlands. · d Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC , University of Amsterdam , Amsterdam , the Netherlands. · e Department of Surgery , Leiden University Medical Center , Leiden , the Netherlands. · f Department of Surgery, Regional Academic Cancer Center Utrecht , University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein , Nieuwegein , the Netherlands. · g Department of Internal Medicine, Division of Medical Oncology , GROW - School for Oncology and Developmental Biology, Maastricht UMC+ , Maastricht , the Netherlands. · h Department of Public Health , Erasmus Medical Center , Rotterdam , the Netherlands. ·Acta Oncol · Pubmed #30264642.

ABSTRACT: BACKGROUND: The association between pancreatic ductal adenocarcinoma (PDAC) location (head, body, tail) and tumor stage, treatment and overall survival (OS) is unclear. METHODS: Patients with PDAC diagnosed between 2005 and 2015 were included from the population-based Netherlands Cancer Registry. Patient, tumor and treatment characteristics were compared with the tumor locations. Multivariable logistic and Cox regression analyses were used. RESULTS: Overall, 19,023 patients were included. PDAC locations were 13,451 (71%) head, 2429 (13%) body and 3143 (16%) tail. Differences were found regarding metastasized disease (head 42%, body 69%, tail 84%, p < .001), size (>4 cm: 21%, 40%, 51%, p < .001) and resection rate (17%, 4%, 7%, p < .001). For patients without metastases, median OS did not differ between head, body, tail (after resection: 16.8, 15.0, 17.3 months, without resection: 5.2, 6.1, 4.6 months, respectively). For patients with metastases, median OS differed slightly (2.6, 2.4, 1.9 months, respectively, adjusted HR body versus head 1.17 (95%CI 1.10-1.23), tail versus head 1.35 (95%CI 1.29-1.41)). CONCLUSIONS: PDAC locations in body and tail are larger, more often metastasized and less often resectable than in the pancreatic head. Whereas survival is similar after resection, survival in metastasized disease is somewhat less for PDAC in the pancreatic body and tail.

9 Article Pathological Margin Clearance and Survival After Pancreaticoduodenectomy in a US and European Pancreatic Center. 2018

van Roessel, Stijn / Kasumova, Gyulnara G / Tabatabaie, Omidreza / Ng, Sing Chau / van Rijssen, L Bengt / Verheij, Joanne / Najarian, Robert M / van Gulik, Thomas M / Besselink, Marc G / Busch, Olivier R / Tseng, Jennifer F. ·Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Department of Surgery, Cancer Center Amsterdam, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. · Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. · Department of Pathology, Cancer Center Amsterdam, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. · Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. · Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Jennifer.Tseng@bmc.org. · Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. Jennifer.Tseng@bmc.org. ·Ann Surg Oncol · Pubmed #29651577.

ABSTRACT: BACKGROUND: The optimal definition of a margin-negative resection and its exact prognostic significance on survival in resected pancreatic adenocarcinoma remains unknown. This study was designed to assess the relationship between pathological margin clearance, margin type, and survival. METHODS: Patients who underwent pancreaticoduodenectomy with curative intent at two academic institutions, in Amsterdam, the Netherlands, and Boston, Massachusetts, between 2000 and 2014 were retrospectively evaluated. Overall survival, recurrence rates, and progression-free survival (PFS) were assessed by Kaplan-Meier estimates and multivariate Cox proportional hazards analysis, according to pathological margin clearance and type of margin involved. RESULTS: Of 531 patients identified, the median PFS was 12.9, 15.4, and 24.1 months, and the median overall survival was 17.4, 22.9, and 27.7 months for margin clearances of 0, < 1, and ≥1 mm, respectively (all log-rank p < 0.001). On multivariate analysis, patients with a margin clearance of ≥1 mm demonstrated a survival advantage relative to those with 0 mm clearance [hazard ratio (HR) 0.71, p < 0.01], whereas survival was comparable for patients with a margin clearance of < 1 mm versus 0 mm (HR: 0.93, p = 0.60). Patients with involvement (0 or < 1 mm margin clearance) of the SMV/PV margin demonstrated prolonged median overall survival (25.7 months) relative to those with SMA involvement (17.5 months). CONCLUSIONS: In patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, a margin clearance of ≥1 mm correlates with improved survival relative to < 1 mm clearance and may be a more accurate predictor of a complete margin-negative resection in pancreatic cancer. The type of margin involved also appears to impact survival.

10 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 / Anonymous1461438. ·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.

11 Article The Dutch Pancreas Biobank Within the Parelsnoer Institute: A Nationwide Biobank of Pancreatic and Periampullary Diseases. 2018

Strijker, Marin / Gerritsen, Arja / van Hilst, Jony / Bijlsma, Maarten F / Bonsing, Bert A / Brosens, Lodewijk A / Bruno, Marco J / van Dam, Ronald M / Dijk, Frederike / van Eijck, Casper H / Farina Sarasqueta, Arantza / Fockens, Paul / Gerhards, Michael F / Groot Koerkamp, Bas / van der Harst, Erwin / de Hingh, Ignace H / van Hooft, Jeanin E / Huysentruyt, Clément J / Kazemier, Geert / Klaase, Joost M / van Laarhoven, Cornelis J / van Laarhoven, Hanneke W / Liem, Mike S / de Meijer, Vincent E / van Rijssen, L Bengt / van Santvoort, Hjalmar C / Suker, Mustafa / Verhagen, Judith H / Verheij, Joanne / Verspaget, Hein W / Wennink, Roos A / Wilmink, Johanna W / Molenaar, I Quintus / Boermeester, Marja A / Busch, Olivier R / Besselink, Marc G / Anonymous5040939. · ·Pancreas · Pubmed #29521943.

ABSTRACT: OBJECTIVES: Large biobanks with uniform collection of biomaterials and associated clinical data are essential for translational research. The Netherlands has traditionally been well organized in multicenter clinical research on pancreatic diseases, including the nationwide multidisciplinary Dutch Pancreatic Cancer Group and Dutch Pancreatitis Study Group. To enable high-quality translational research on pancreatic and periampullary diseases, these groups established the Dutch Pancreas Biobank. METHODS: The Dutch Pancreas Biobank is part of the Parelsnoer Institute and involves all 8 Dutch university medical centers and 5 nonacademic hospitals. Adult patients undergoing pancreatic surgery (all indications) are eligible for inclusion. Preoperative blood samples, tumor tissue from resected specimens, pancreatic cyst fluid, and follow-up blood samples are collected. Clinical parameters are collected in conjunction with the mandatory Dutch Pancreatic Cancer Audit. RESULTS: Between January 2015 and May 2017, 488 patients were included in the first 5 participating centers: 4 university medical centers and 1 nonacademic hospital. Over 2500 samples were collected: 1308 preoperative blood samples, 864 tissue samples, and 366 follow-up blood samples. CONCLUSIONS: Prospective collection of biomaterials and associated clinical data has started in the Dutch Pancreas Biobank. Subsequent translational research will aim to improve treatment decisions based on disease characteristics.

12 Article Added value of CA19-9 response in predicting resectability of locally advanced pancreatic cancer following induction chemotherapy. 2018

van Veldhuisen, Eran / Vogel, Jantien A / Klompmaker, Sjors / Busch, Olivier R / van Laarhoven, Hanneke W M / van Lienden, Krijn P / Wilmink, Johanna W / Marsman, Hendrik A / Besselink, Marc G. ·Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands. · Department of Medical Oncology, Cancer Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands. · Department of Radiology, Cancer Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands. · Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1100DD, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl. ·HPB (Oxford) · Pubmed #29475787.

ABSTRACT: BACKGROUND: Determining the resectability of locally advanced pancreatic cancer (LAPC) after induction chemotherapy is complex since CT-imaging cannot accurately portray tumor response. We hypothesized that CA19-9 response adds to RECIST-staging in predicting resectability of LAPC. METHODS: Post-hoc analysis within a prospective study on LAPC (>90° arterial or >270° venous involvement). CA19-9 response was determined after induction chemotherapy. Surgical exploration was performed in RECIST-stable or -regressive disease. The relation between CA19-9 response, resectability and survival was assessed. RESULTS: Restaging in 54 patients with LAPC after induction chemotherapy (mostly FOLFIRINOX) identified 6 RECIST-regressive, 32 RECIST-stable, and 16 patients with RECIST-progressive disease. The resection rate was 20.3% (11/54 patients). Sensitivity and specificity of RECIST-regression for resection were 40% and 87% whereas the positive predictive value (PPV) and negative predictive value (NPV) were 67% and 68%. Using a 30% decrease of CA19-9 as cut-off, 9/10 patients were correctly classified as resectable (90% sensitivity, PPV 43%) and 3/15 as unresectable (20% specificity, NPV 75%). In the total cohort, a CA19-9 decrease ≥30% was associated with improved survival (22.4 vs. 12.7 months, p = 0.02). CONCLUSION: Adding CA19-9 response after induction chemotherapy seems useful in determining which patients with RECIST non-progressive LAPC should undergo exploratory surgery.

13 Article Lasagna plots to visualize results in surgical studies. 2017

Jalalzadeh, Hamid / van Beek, Sytse C / Indrakusuma, Reza / Bemelman, Willem A / Busch, Olivier R / Balm, Ron. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: r.balm@amc.nl. ·Int J Surg · Pubmed #28578083.

ABSTRACT: BACKGROUND: A lasagna plot is a graphical tool that can display multiple longitudinal outcomes. To our knowledge, lasagna plots have not been used in publications of surgical studies before. The objective of this study was to demonstrate the results of surgical randomized controlled trials (RCTs) with lasagna plots in order to assess whether this can lead to new observations of the data presented in the original studies. MATERIAL AND METHODS: Lasagna plots were created with R for an RCT comparing endovascular and open repair for patients with a ruptured abdominal aortic aneurysm (AJAX trial), an RCT comparing laparoscopy or open surgery combined with either fast track or standard care for patients with colon cancer (LAFA trial) and an RCT comparing preoperative biliary drainage and early surgery for patients with pancreatic cancer (DROP trial). RESULTS: Regarding the AJAX trial, the original article had reported the rate of outcomes at 30 days after repair in two tables. The plots additionally demonstrated the moments of occurrence, increase and decrease of multiple outcomes such as renal replacement therapy and occurrence of death within one plot. These observations were not presented in the original article. The lasagna plots of the LAFA and DROP trial revealed similar new observations on multiple longitudinal outcomes. CONCLUSION: By revealing new observations of the previously published data, lasagna plots generate new hypotheses and theories regarding the outcomes. As such, lasagna plots may be a useful addition to traditional tables and figures and could improve the interpretation of results.

14 Article Induction Chemotherapy Followed by Resection or Irreversible Electroporation in Locally Advanced Pancreatic Cancer (IMPALA): A Prospective Cohort Study. 2017

Vogel, Jantien A / Rombouts, Steffi J / de Rooij, Thijs / van Delden, Otto M / Dijkgraaf, Marcel G / van Gulik, Thomas M / van Hooft, Jeanin E / van Laarhoven, Hanneke W / Martin, Robert C / Schoorlemmer, Annuska / Wilmink, Johanna W / van Lienden, Krijn P / Busch, Olivier R / Besselink, Marc G. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands. · Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, University of Louisville, Louisville, KY, USA. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. m.g.besselink@amc.nl. ·Ann Surg Oncol · Pubmed #28560601.

ABSTRACT: BACKGROUND: Following induction chemotherapy, both resection or irreversible electroporation (IRE) may further improve survival in patients with locally advanced pancreatic cancer (LAPC). However, prospective studies combining these strategies are currently lacking, and available studies only report on subgroups that completed treatment. This study aimed to determine the applicability and outcomes of resection and IRE in patients with nonprogressive LAPC after induction chemotherapy. METHODS: This was a prospective, single-center cohort study in consecutive patients with LAPC (September 2013 to March 2015). All patients were offered 3 months of induction chemotherapy (FOLFIRINOX or gemcitabine depending on performance status), followed by exploratory laparotomy for resection or IRE in patients with Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 nonprogressive, IRE-eligible tumors. RESULTS: Of 132 patients with LAPC, 70% (n = 93) started with chemotherapy (46% [n = 61] FOLFIRINOX). After 3 months, 59 patients (64%) had nonprogressive disease, of whom 36 (27% of the entire cohort) underwent explorative laparotomy, resulting in 14 resections (11% of the entire cohort, 39% of the explored patients) and 15 IREs (11% of the entire cohort, 42% of the explored patients). After laparotomy, 44% (n = 16) of patients had Clavien-Dindo grade 3 or higher complications, and 90-day all-cause mortality was 11% (n = 4). With a median follow-up of 24 months, median overall survival after resection, IRE, and for all patients with nonprogressive disease without resection/IRE (n = 30) was 34, 16, and 15 months, respectively. The resection rate in 61 patients receiving FOLFIRINOX treatment was 20%. CONCLUSION: Induction chemotherapy followed by IRE or resection in nonprogressive LAPC led to resection or IRE in 22% of all-comers, with promising survival rates after resection but no apparent benefit of IRE, despite considerable morbidity. Registered at Netherlands Trial Register (NTR4230).

15 Article Comparing 3 guidelines on the management of surgically removed pancreatic cysts with regard to pathological outcome. 2017

Lekkerkerker, Selma J / Besselink, Marc G / Busch, Olivier R / Verheij, Joanne / Engelbrecht, Marc R / Rauws, Erik A / Fockens, Paul / van Hooft, Jeanin E. ·Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. ·Gastrointest Endosc · Pubmed #27693645.

ABSTRACT: BACKGROUND AND AIMS: Currently, 3 guidelines are available for the management of pancreatic cysts. These guidelines vary in their indication for resection of high-risk cysts. We retrospectively compared the final pathologic outcome of surgically removed pancreatic cysts with the indications for resection according to 3 different guidelines. METHODS: Patients who underwent pancreatic resection were extracted from our prospective pancreatic cyst database (2006-present). The final histopathologic diagnosis was compared with the initial indication for surgery stated by the guidelines of the International Association of Pancreatology (IAP), European Study Group on Cystic tumors of the Pancreas and American Gastroenterological Association (AGA). We considered surgery in retrospect justified for malignancy, high-grade dysplasia, solid pseudopapillary neoplasms, neuroendocrine tumors or symptom improvement. Furthermore, we evaluated the patients with suspected intraductal papillary mucinous neoplasm (IPMN) separately. RESULTS: Overall, 115 patients underwent pancreatic resection. The preoperative diagnosis was correct in 83 of 115 patients (72%) and differentiation between benign and premalignant in 99 of 115 patients (86%). In retrospect, surgery was justified according to the aforementioned criteria in 52 of 115 patients (45%). For patients with suspected IPMN (n = 75) resection was justified in 36 of 67 (54%), 36 of 68 (53%), and 32 of 54 (59%) of patients who would have had surgery based on the IAP, European, or AGA guidelines, respectively. The AGA guideline would have avoided resection in 21 of 75 (28%) patients, versus 8 of 75 (11%) and 7 of 75 (9%) when the IAP or European guideline would have been applied strictly. Nevertheless, 4 of 33 patients (12%) with high-grade dysplasia or malignancy would have been missed with the AGA guidelines, compared with none with the IAP or European guidelines. CONCLUSION: Although fewer patients undergo unnecessary surgery based on the AGA guidelines, the risk of missing malignancy or high-grade dysplasia with this guideline seems considerably high.

16 Article Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS). 2016

de Rooij, Thijs / van Hilst, Jony / Boerma, Djamila / Bonsing, Bert A / Daams, Freek / van Dam, Ronald M / Dijkgraaf, Marcel G / van Eijck, Casper H / Festen, Sebastiaan / Gerhards, Michael F / Koerkamp, Bas Groot / van der Harst, Erwin / de Hingh, Ignace H / Kazemier, Geert / Klaase, Joost / de Kleine, Ruben H / van Laarhoven, Cornelis J / Lips, Daan J / Luyer, Misha D / Molenaar, I Quintus / Patijn, Gijs A / Roos, Daphne / Scheepers, Joris J / van der Schelling, George P / Steenvoorde, Pascal / Vriens, Menno R / Wijsman, Jan H / Gouma, Dirk J / Busch, Olivier R / Hilal, Mohammed Abu / Besselink, Marc G / Anonymous13940884. ·*Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands †Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands ‡Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands §Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands ||Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands ¶Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands #Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands **Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands ††Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands ‡‡Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands §§Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands ||||Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ¶¶Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands ##Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands ***Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands †††Department of Surgery, Isala Clincs, Zwolle, The Netherlands ‡‡‡Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands §§§Department of Surgery, Amphia Hospital, Breda, The Netherlands ||||||Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom. ·Ann Surg · Pubmed #27741008.

ABSTRACT: OBJECTIVE: To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP). SUMMARY OF BACKGROUND DATA: Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal pancreatectomies were in a minimally invasive fashion and 85% of surgeons welcomed MIDP training. The feasibility and impact of a nationwide training program is unknown. METHODS: From 2014 to 2015, 32 pancreatic surgeons from 17 centers participated in a nationwide training program in MIDP, including detailed technique description, video training, and proctoring on-site. Outcomes of MIDP before training (2005-2013) were compared with outcomes after training (2014-2015). RESULTS: In total, 201 patients were included; 71 underwent MIDP in 9 years before training versus 130 in 22 months after training (7-fold increase, P < 0.001). The conversion rate (38% [n = 27] vs 8% [n = 11], P < 0.001) and blood loss were lower after training and more pancreatic adenocarcinomas were resected (7 [10%] vs 28 [22%], P = 0.03), with comparable R0-resection rates (4/7 [57%] vs 19/28 [68%], P = 0.67). Clavien-Dindo score ≥III complications (15 [21%] vs 19 [15%], P = 0.24) and pancreatic fistulas (20 [28%] vs 41 [32%], P = 0.62) were not significantly different. Length of hospital stay was shorter after training (9 [7-12] vs 7 [5-8] days, P < 0.001). Thirty-day mortality was 3% vs 0% (P = 0.12). CONCLUSION: A nationwide MIDP training program was feasible and followed by a steep increase in the use of MIDP, also in patients with pancreatic cancer, and decreased conversion rates. Future studies should determine whether such a training program is applicable in other settings.

17 Article Long-term follow-up of neoplastic pancreatic cysts without high-risk stigmata: how often do we change treatment strategy because of malignant transformation? 2016

Lekkerkerker, Selma J / Besselink, Marc G / Busch, Olivier R / Dijk, Frederike / Engelbrecht, Marc R / Rauws, Erik A / Fockens, Paul / van Hooft, Jeanin E. ·a Department of Gastroenterology and Hepatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands ; · b Department of Surgery , Academic Medical Center , Amsterdam , The Netherlands ; · c Department of Pathology , Academic Medical Center , Amsterdam , The Netherlands ; · d Department of Radiology , Academic Medical Center , Amsterdam , The Netherlands. ·Scand J Gastroenterol · Pubmed #27175891.

ABSTRACT: OBJECTIVE: Patients with potentially premalignant neoplastic pancreatic cysts without high-risk stigmata usually enter a surveillance program. Data on outcomes of such surveillance programs are scarce. We aimed to evaluate the resection rate and malignancy rate during follow-up. MATERIAL AND METHODS: From our prospective database (2006-2015) of patients with pancreatic cysts, we analyzed patients with pancreatic cysts without high-risk stigmata with at least six months follow-up. RESULTS: In total, 146 patients were followed for a median of 29 months (IQR 13.5-50 months). In 124 patients (84.9%), no changes in clinical or imaging characteristics occurred during follow-up. Thirteen patients (8.9%) developed an indication for surgery after a median follow-up of 25 months (IQR 12-42 months). Two patients did not undergo surgery because of comorbidity, 11 patients (7.5%) underwent resection. Indications for surgery were symptoms (n = 2), development of a pancreatic mass (n = 1), a new nodule (n = 2), thickened cyst wall (n = 1), pancreatic duct dilation (n = 3), and/or suspicion of mucinous cystic neoplasm (MCN) (n = 3). Postoperative histology showed one pancreatic malignancy not originating from the cyst, three mixed type-intraductal papillary mucinous neoplasm (IPMN), one side branch-IPMN, two MCN, one neuroendocrine tumor, one serous cystadenoma, one inflammatory cyst, and one lymphangioma. The highest grade of cyst dysplasia was borderline dysplasia. CONCLUSIONS: Most neoplastic pancreatic cysts without high-risk stigmata at initial presentation show no substantial change during 1-4-year follow-up. Only 7.5% of patients underwent surgery and less than 1% of patients developed pancreatic malignancy. This indicates that additional markers are needed to tailor treatment of pancreatic cysts.

18 Article Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis. 2016

Marsman, E Madelief / de Rooij, Thijs / van Eijck, Casper H / Boerma, Djamila / Bonsing, Bert A / van Dam, Ronald M / van Dieren, Susan / Erdmann, Joris I / Gerhards, Michael F / de Hingh, Ignace H / Kazemier, Geert / Klaase, Joost / Molenaar, I Quintus / Patijn, Gijs A / Scheepers, Joris J / Tanis, Pieter J / Busch, Olivier R / Besselink, Marc G / Anonymous1930864. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. · Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. · Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands. · Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. · Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. · Department of Surgery, VU Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, Isala Clinics, Zwolle, The Netherlands. · Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl. ·Surgery · Pubmed #27059639.

ABSTRACT: BACKGROUND: Microscopically radical (R0) resection of pancreatic, periampullary, or colon cancer may occasionally require a pancreatoduodenectomy with colon resection (PD-colon), but the benefits of this procedure have been disputed, and multicenter studies on morbidity and oncologic outcomes after PD-colon are lacking. This study aimed to assess complications and survival after PD-colon. METHODS: Patients who had undergone PD-colon from 2004-2014 in 1 of 13 centers were analyzed retrospectively. Ninety-day morbidity was scored using the Clavien-Dindo score and the Comprehensive Complication Index (CCI, 0 = no complications, 100 = death). Survival was analyzed per histopathologic diagnosis. RESULTS: After screening 3,218 consecutive PDs, 50 (1.6%) PD-colon patients (median age 66 years [interquartile range 55-72], 33 [66%] men) were included. Twenty-three (46%) patients had pancreatic ductal adenocarcinoma (PDAC), 19 (38%) other pathology, and 8 (16%) colon cancer. Ninety-day Clavien-Dindo ≥3 complications occurred in 30 (60%) patients without differences per diagnosis (P > .99); mean CCI was 39 (standard deviation 27). Colonic anastomosis leak, pancreatic fistula, and 90-day mortality occurred in 3 (6%), 2 (4%), and 4 (8%) patients, respectively. A total of 11/23 (48%) patients with PDAC and 8/8 (100%) patients with colon cancer underwent an R0 resection. Patients with PDAC had a median postoperative survival of 13 months (95% confidence interval = 5-21). One-, 3-, and 5-year cumulative survival was 56%, 21%, and 14%, respectively. Median survival after R0 resection for PDAC was 21 months (95% confidence interval = 6-35). All patients with colon cancer were alive at end of follow-up (median 24 months [95% confidence interval = 9-110]). CONCLUSION: In this retrospective, multicenter study, PD-colon was associated with considerable complications and acceptable survival rates when a tumor negative resection margin was achieved.

19 Article Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis. 2016

Lekkerkerker, Selma J / Nio, Chung Y / Issa, Yama / Fockens, Paul / Verheij, Joanne / Busch, Olivier R / van Gulik, Thomas M / Rauws, Erik A / Boermeester, Marja A / van Hooft, Jeanin E / Besselink, Marc G. ·Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. ·J Gastroenterol Hepatol · Pubmed #26997497.

ABSTRACT: BACKGROUND AND AIM: Data on non-surgical treatment of groove pancreatitis (GP) and the risk of cancer are lacking. We aimed to determine the prevalence and predictors of cancer in patients in whom the diagnosis GP was considered, and to evaluate symptom improvement after treatment. STUDY: Patients referred with possible GP (2001-2014) were retrospectively included. An experienced radiologist reassessed imaging. GP patients received questionnaires evaluating their symptoms. RESULTS: From the 38 possible GP patients, 10 had cancer (26%) and 28 GP (74%). Compared with cancer patients, GP patients more frequently had cysts (2/10 vs. 18/28, P = 0.03), less often jaundice (6/10 vs 3/27, P < 0.01), an abrupt caliber change of the CBD (5/10 vs. 2/28, P < 0.01) or suspicious cytology (5/9 vs 2/20, P = 0.02). Of the 28 GP patients, 14 patients were treated conservatively of whom 12 reported symptom improvement after a median follow-up of 45 months (range 7-127 months). All 6 patients treated endoscopically and 7/8 patients treated surgically reported symptom improvement. Surgery, performed because of treatment failure (3/8) or inability to exclude malignancy (5/8), caused mortality in 1/8 patients. CONCLUSIONS: Suspicion of pancreatic cancer should be high in patients presenting with possible GP. Conservative, endoscopic and surgical treatment can all lead to symptom improvement, suggesting a 'step-up approach' to GP once cancer is excluded.

20 Article Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer. 2016

de Rooij, Thijs / Besselink, Marc G / Shamali, Awad / Butturini, Giovanni / Busch, Olivier R / Edwin, Bjørn / Troisi, Roberto / Fernández-Cruz, Laureano / Dagher, Ibrahim / Bassi, Claudio / Abu Hilal, Mohammad / Anonymous1540859. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl. · Department of Surgery, Southampton University Hospital, NHS Foundation Trust, Southampton, United Kingdom. · Department of Surgery, Verona University Hospital Trust, Verona, Italy. · Interventional Centre and Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo University, Oslo, Norway. · Department of Surgery, Ghent University Hospital, Ghent, Belgium. · Department of Surgery, Barcelona University Hospital, Barcelona, Spain. · Department of Surgery, Antoine Béclère Hospital, Paris-Sud University, Paris, France. · Department of Surgery, Southampton University Hospital, NHS Foundation Trust, Southampton, United Kingdom. Electronic address: abuhilal9@gmail.com. ·HPB (Oxford) · Pubmed #26902136.

ABSTRACT: BACKGROUND: Minimally invasive (MI) pancreatic surgery appears to be gaining popularity, but its implementation throughout Europe and the opinions regarding its use in pancreatic cancer patients are unknown. METHODS: A 30-question survey was sent between June and December 2014 to pancreatic surgeons of the European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association and 5 European national pancreatic societies. Incomplete responses were excluded. RESULTS: In total, 237 pancreatic surgeons responded. After excluding 34 incomplete responses, 203 responses from 27 European countries were included. 164 (81%) surgeons were employed at a university hospital, 184 (91%) performed advanced MI surgery and 148 (73%) performed MI distal pancreatectomy. MI pancreatoduodenectomy was performed by 42 (21%) surgeons, whereas 9 (4.4%) surgeons had performed more than 10 procedures. Robot-assisted MI pancreatic surgery was performed by 28 (14%) surgeons. 63 (31%) surgeons expected MI distal pancreatectomy for cancer to be inferior to open distal pancreatectomy concerning oncological outcomes. 151 (74%) surgeons expected to benefit from training in MI distal pancreatectomy and 149 (73%) were willing to participate in a randomized trial on this topic. CONCLUSIONS: MI distal pancreatectomy is a common procedure, although its use for cancer is still disputed. MI pancreatoduodenectomy is still an uncommon procedure. Specific training and a randomized trial regarding MI pancreatic cancer surgery are welcomed.

21 Article Developing a core set of patient-reported outcomes in pancreatic cancer: A Delphi survey. 2016

Gerritsen, Arja / Jacobs, Marc / Henselmans, Inge / van Hattum, Jons / Efficace, Fabio / Creemers, Geert-Jan / de Hingh, Ignace H / Koopman, Miriam / Molenaar, I Quintus / Wilmink, Hanneke W / Busch, Olivier R / Besselink, Marc G / van Laarhoven, Hanneke W / Anonymous5130858. ·Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. · Department of Medical Psychology, Academic Medical Center, Amsterdam, the Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. · Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy. · Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands. · Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. · Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. · Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands. · Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: h.vanlaarhoven@amc.nl. ·Eur J Cancer · Pubmed #26886181.

ABSTRACT: BACKGROUND: Patient-reported outcomes (PROs) are amongst the most relevant outcome measures in pancreatic cancer care and research. However, it is unknown which out of the numerous PROs are most important to patients and health care professionals (HCPs) in this setting. The aim of this study was to identify a core set of PROs to be incorporated in a nationwide prospective multidisciplinary pancreatic cancer registry. PATIENTS AND METHODS: We performed a two-round Delphi survey among 150 patients diagnosed with pancreatic or periampullary cancer (treated either with curative intent or in palliative setting) and 78 HCPs (surgeons, medical oncologists, gastroenterologists, radiotherapists, nurses, and dietitians) in The Netherlands. In round 1, participants were invited to rate the importance of 53 PROs, which were extracted from 17 different PRO measures and grouped into global domains, on a 1-9 Likert scale. PROs rated as very important (score 7-9) by the majority (≥ 80%) of curative and/or palliative patients as well as HCPs were considered sufficiently important to be incorporated in the core set. PROs not fulfilling these criteria in round 1 were presented again to the participants in round 2 along with individual and group feedback. RESULTS: A total of 97 patients (94%) in curative-intent setting, 38 patients (81%) in palliative setting and 73 HCPs (94%) completed both rounds 1 and 2. After the first round, 7 PROs were included in the core set: general quality of life, general health, physical ability, satisfaction with caregivers, satisfaction with services and care organisation, coping and defecation. After the second round, 10 additional PROs were added: appetite, ability to work/do usual activities, medication use, weight changes, fatigue, negative feelings, positive feelings, fear of recurrence, relationship with partner/family, and pancreatic enzyme replacement therapy use. CONCLUSION: This study provides a core set of PROs selected by patients and HCPs, which may be incorporated in pancreatic cancer care and research. Validation outside the Dutch context is recommended for generalisation and use in international studies.

22 Article Outcomes of Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma in the Netherlands: A Nationwide Retrospective Analysis. 2016

de Rooij, Thijs / Tol, Johanna A / van Eijck, Casper H / Boerma, Djamila / Bonsing, Bert A / Bosscha, Koop / van Dam, Ronald M / Dijkgraaf, Marcel G / Gerhards, Michael F / van Goor, Harry / van der Harst, Erwin / de Hingh, Ignace H / Kazemier, Geert / Klaase, Joost M / Molenaar, I Quintus / Patijn, Gijs A / van Santvoort, Hjalmar C / Scheepers, Joris J / van der Schelling, George P / Sieders, Egbert / Busch, Olivier R / Besselink, Marc G / Anonymous210847. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. · Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands. · Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. · Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. · Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands. · Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. · Department of Surgery, VU Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands. · Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, Isala Clinics, Zwolle, The Netherlands. · Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands. · Department of Surgery, Amphia Hospital, Breda, The Netherlands. · Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. m.g.besselink@amc.uva.nl. ·Ann Surg Oncol · Pubmed #26508153.

ABSTRACT: BACKGROUND: Large multicenter series on outcomes and predictors of survival after distal pancreatectomy (DP) for pancreatic ductal adenocarcinoma (PDAC) are scarce. METHODS: Adults who underwent DP for PDAC in 17 Dutch pancreatic centers between January 2005 and September 2013 were analyzed retrospectively. The primary outcome was survival, and predictors of survival were identified using Cox regression analysis. RESULTS: In total, 761 consecutive patients after DP were assessed, of whom 620 patients were excluded because of non-PDAC histopathology (n = 616) or a lack of data (n = 4), leaving a total of 141 patients included in the study [45 % (n = 63) male, mean age 64 years (SD = 10)]. Multivisceral resection was performed in 43 patients (30 %) and laparoscopic resection was performed in 7 patients (5 %). A major complication (Clavien-Dindo score of III or higher) occurred in 46 patients (33 %). Mean tumor size was 44 mm (SD 23), and histopathological examination showed 70 R0 resections (50 %), while 30-day and 90-day mortality was 3 and 6 %, respectively. Overall, 63 patients (45 %) received adjuvant chemotherapy. Median survival was 17 months [interquartile range (IQR) 13-21], with a median follow-up of 17 months (IQR 8-29). Cumulative survival at 1, 3 and 5 years was 64, 29, and 22 %, respectively. Independent predictors of worse postoperative survival were R1/R2 resection [hazard ratio (HR) 1.6, 95 % confidence interval (CI) 1.1-2.4], pT3/pT4 stage (HR 1.9, 95 % CI 1.3-2.9), a major complication (HR 1.7, 95 % CI 1.1-2.5), and not receiving adjuvant chemotherapy (HR 1.5, 95 % CI 1.0-2.3). CONCLUSION: Survival after DP for PDAC is poor and is related to resection margin, tumor stage, surgical complications, and adjuvant chemotherapy. Further studies should assess to what extent prevention of surgical complications and more extensive use of adjuvant chemotherapy can improve survival.

23 Article Impact of centralization of pancreatoduodenectomy on reported radical resections rates in a nationwide pathology database. 2015

Onete, Veronica G / Besselink, Marc G / Salsbach, Chanielle M / Van Eijck, Casper H / Busch, Olivier R / Gouma, Dirk J / de Hingh, Ignace H / Sieders, Egbert / Dejong, Cornelis H / Offerhaus, Johan G / Molenaar, I Quintus / Anonymous1680832. ·Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. · Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. · Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands. · Department of Surgery, University Medical Center Maastricht, Maastricht and NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands. · Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. ·HPB (Oxford) · Pubmed #26037776.

ABSTRACT: BACKGROUND: Centralization of a pancreatoduodenectomy (PD) leads to a lower post-operative mortality, but is unclear whether it also leads to improved radical (R0) or overall resection rates. METHODS: Between 2004 and 2009, pathology reports of 1736 PDs for pancreatic and peri-ampullary neoplasms from a nationwide pathology database were analysed. Pre-malignant lesions were excluded. High-volume hospitals were defined as performing ≥ 20 PDs annually. The relationship between R0 resections, PD-volume trends, quality of pathology reports and hospital volume was analysed. RESULTS: During the study period, the number of hospitals performing PDs decreased from 39 to 23. High-volume hospitals reported more R0 resections in the pancreatic head and distal bile duct tumours than low-volume hospitals (60% versus 54%, P = 0.035) although they operated on more advanced (T3/T4) tumours (72% versus 58%, P < 0.001). The number of PDs increased from 258 in 2004 to 394 in 2009 which was partly explained by increased overall resection rates of pancreatic head and distal bile duct tumours (11.2% in 2004 versus 17.5% in 2009, P < 0.001). The overall reported R0 resection rate of pancreatic head and distal bile duct tumours increased (6% in 2004 versus 11% in 2009, P < 0.001). Pathology reports of low-volume hospitals lacked more data including tumour stage (25% versus 15%, P < 0.001). CONCLUSIONS: Centralization of PD was associated with both higher resection rates and more reported R0 resections. The impact of this finding on overall survival should be further assessed.

24 Minor Laparoscopic Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma: Time for a Randomized Controlled Trial? Results of an All-inclusive National Observational Study. 2017

de Rooij, Thijs / van Hilst, Jony / Busch, Olivier R / Dijkgraaf, Marcel G / Kooby, David A / Abu Hilal, Mohammed / Besselink, Marc G. ·Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. ·Ann Surg · Pubmed #29137000.

ABSTRACT: -- No abstract --

25 Minor Current Strategies for Detection and Treatment of Recurrence of Pancreatic Ductal Adenocarcinoma After Resection: A Nationwide Survey. 2017

Groot, Vincent P / Daamen, Lois A / Hagendoorn, Jeroen / Borel Rinkes, Inne H M / Busch, Olivier R / van Santvoort, Hjalmar C / Besselink, Marc G / Molenaar, I Quintus / Anonymous8150919. ·Department of Surgery UMC Utrecht Cancer Center University Medical Center Utrecht Utrecht, the Netherlands Department of Surgery Academic Medical Center Amsterdam Amsterdam, the Netherlands Department of Surgery UMC Utrecht Cancer Center University Medical Center Utrecht Utrecht, the Netherlands Department of Surgery St Antonius Hospital Nieuwegein Nieuwegein, the Netherlands Department of Surgery Academic Medical Center Amsterdam Amsterdam, the Netherlands Department of Surgery UMC Utrecht Cancer Center University Medical Center Utrecht Utrecht, the Netherlands i.q.molenaar@umcutrecht.nl. ·Pancreas · Pubmed #28902799.

ABSTRACT: -- No abstract --