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Pancreatic Neoplasms: HELP
Articles by Davide Caramella
Based on 5 articles published since 2010
(Why 5 articles?)
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Between 2010 and 2020, Davide Caramella wrote the following 5 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Robotic pancreatoduodenectomy with vascular resection. 2016

Kauffmann, Emanuele F / Napoli, Niccolò / Menonna, Francesca / Vistoli, Fabio / Amorese, Gabriella / Campani, Daniela / Pollina, Luca Emanuele / Funel, Niccola / Cappelli, Carla / Caramella, Davide / Boggi, Ugo. ·Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy. · Division of Anesthesia and Intensive Care, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. · Division of Pathology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. · Division of Radiology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. · Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy. u.boggi@med.unipi.it. ·Langenbecks Arch Surg · Pubmed #27553112.

ABSTRACT: PURPOSE: This study aims to define the current status of robotic pancreatoduodenectomy (RPD) with resection and reconstruction of the superior mesenteric/portal vein (RPD-SMV/PV). METHODS: Our experience on RPD, including RPD-SMV/PV, is presented along with a description of the surgical technique and a systematic review of the literature on RPD-SMV/PV. RESULTS: We have performed 116 RPD and 14 RPD-SMV/PV. Seven additional cases of RPD-SMV/PV were identified in the literature. In our experience, RPD and RPD-SMV/PV were similar in all baseline variables, but lower mean body mass and higher prevalence of pancreatic cancer in RPD-SMV/PV. Regarding the type of vein resection, there were one type 2 (7.1 %), five type 3 (35.7 %) and eight type 4 (57.2 %) resections. As compared to RPD, RPD-SMV/PV required longer operative time, had higher median estimated blood loss, and blood transfusions were required more frequently. Incidence and severity of post-operative complications were not increased in RPD-SMV/PV, but post-pancreatectomy hemorrhage occurred more frequently after this procedure. In pancreatic cancer, RPD-SMV/PV was associated with a higher mean number of examined lymph nodes (60.0 ± 13.9 vs 44.6 ± 11.0; p = 0.02) and with the same rate of microscopic margin positivity (25.0 % vs 26.1 %). Mean length or resected vein was 23.1 ± 8.08 mm. Actual tumour infiltration was discovered in ten patients (71.4 %), reaching the adventitia in four patients (40.0 %), the media in two patients (20.0 %), and the intima in four patients (40.0 %). Literature review identified seven additional cases, all reported to have successful outcome. CONCLUSIONS: RPD-SMV/PV is feasible in carefully selected patients. The generalization of these results remains to be demonstrated.

2 Article Early Tumor Shrinkage and Depth of Response Evaluation in Metastatic Pancreatic Cancer Treated with First Line Chemotherapy: An Observational Retrospective Cohort Study. 2019

Vivaldi, Caterina / Fornaro, Lorenzo / Cappelli, Carla / Pecora, Irene / Catanese, Silvia / Salani, Francesca / Cacciato Insilla, Andrea / Kauffmann, Emanuele / Donati, Francescamaria / Pasquini, Giulia / Massa, Valentina / Napoli, Niccolò / Lencioni, Monica / Boraschi, Piero / Campani, Daniela / Boggi, Ugo / Caramella, Davide / Falcone, Alfredo / Vasile, Enrico. ·Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy. caterinavivaldi@gmail.com. · Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy. caterinavivaldi@gmail.com. · Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy. · Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. · Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. · Department of Transplant and General Surgery, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. · Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. · Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy. ·Cancers (Basel) · Pubmed #31277449.

ABSTRACT: Early tumor shrinkage (ETS) and depth of response (DoR) predict favorable outcomes in metastatic colorectal cancer. We aim to evaluate their prognostic role in metastatic pancreatic cancer (PC) patients treated with first-line modified-FOLFIRINOX (FOLFOXIRI) or Gemcitabine + Nab-paclitaxel (GemNab). Hence, 138 patients were tested for ETS, defined as a ≥20% reduction in the sum of target lesions' longest diameters (SLD) after 6-8 weeks from baseline, and DoR, i.e., the maximum percentage shrinkage in the SLD from baseline. Association of ETS and DoR with progression-free survival (PFS) and overall survival (OS) was assessed. ETS was reached in 49 patients (39.5% in the FOLFOXIRI, 29.8% in the GemNab group;

3 Article 3 T MR perfusion of solid pancreatic lesions using dynamic contrast-enhanced DISCO sequence: Usefulness of qualitative and quantitative analyses in a pilot study. 2019

Donati, Francescamaria / Boraschi, Piero / Cervelli, Rosa / Pacciardi, Federica / Lombardo, Carlo / Boggi, Ugo / Falaschi, Fabio / Caramella, Davide. ·Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. · Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. Electronic address: p.boraschi@do.med.unipi.it. · Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. · Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. · Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. Electronic address: u.boggi@med.unipi.it. · Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. Electronic address: f.falaschi@ao-pisa.toscana.it. · Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. Electronic address: davide.caramella@med.unipi.it. ·Magn Reson Imaging · Pubmed #30878601.

ABSTRACT: PURPOSE: To assess the usefulness of qualitative and quantitative analyses of pancreatic focal diseases by using the dynamic contrast-enhanced Differential Subsampling with Cartesian Ordering (DISCO) sequence at 3 T MR device. MATERIALS AND METHODS: Ten patients without pancreatic diseases and twenty-five patients with pathologically confirmed pancreatic focal disease (ductal adenocarcinoma, n = 14; endocrine tumour, n = 8; focal chronic pancreatitis, n = 3), underwent MRI by 3 T-device. Multiphasic contrast-enhanced MR perfusion, consisting of a 3D axial navigator, based free-breathing T1-weighted DISCO sequence, was repeated for 5 min. A dose of 0.1 mL/kg of Gadobutrolo with a 20 mL saline flush was injected at a flow rate of 5 mL/s. Perfusion MRI were processed using a dedicated software package (GeniQ; GE Healthcare), obtaining both a time-signal-intensity curve (TSIC) and perfusion maps for each healthy pancreatic parenchyma and focal disease. The TSIC were grouped into four types according to their shapes and the MR perfusion parameters (Ktrans, Kep, Ve, IAUGC) were calculated. The one-way analysis of variance and the Student's t-test were used to correlate the quantitative and qualitative parameters with the tissue histology. RESULTS: All 10 patients with healthy pancreas presented a TSIC-type 1; TSIC-type 2 was observed in all 14 ductal adenocarcinomas and in one neuroendocrine tumour; TSIC-type 3 was recognized in the remaining 7 neuroendocrine neoplasms; TSIC-type 4 was identified in all 3 focal chronic pancreatitis. All perfusion parameters were significantly different (p < 0.0001) for each type of lesion. Furthermore, Ve was also very useful to discriminate between normal and pathological tissues (p = 0.0005). CONCLUSION: Qualitative and quantitative analyses of contrast-enhanced 3 T MR perfusion, using the dynamic contrast-enhanced DISCO sequence, could be considered an interesting tool to improve the diagnosis of focal pancreatic diseases, of solid lesions in particular. Further investigations with prospective larger sample studies are required to confirm these preliminary results.

4 Article A propensity score-matched analysis of robotic versus open pancreatoduodenectomy for pancreatic cancer based on margin status. 2019

Kauffmann, Emanuele F / Napoli, Niccolò / Menonna, Francesca / Iacopi, Sara / Lombardo, Carlo / Bernardini, Juri / Amorese, Gabriella / Cacciato Insilla, Andrea / Funel, Niccola / Campani, Daniela / Cappelli, Carla / Caramella, Davide / Boggi, Ugo. ·Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. · Division of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy. · Division of Pathology, University of Pisa, Pisa, Italy. · Division of Radiology, University of Pisa, Pisa, Italy. · Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. u.boggi@med.unipi.it. · Azienda Ospedaliera Universitaria Pisana, Università di Pisa, Via Paradisa 2, 56124, Pisa, Italy. u.boggi@med.unipi.it. ·Surg Endosc · Pubmed #29943061.

ABSTRACT: BACKGROUND: No study has shown the oncologic non-inferiority of robotic pancreatoduodenectomy (RPD) versus open pancreatoduodenectomy (OPD) for pancreatic cancer (PC). METHODS: This is a single institution propensity score matched study comparing RPD and ODP for resectable PC, based on factors predictive of R1 resection (≤ 1 mm). Only patients operated on after completion of the learning curve in both procedures and for whom circumferential margins were assessed according to the Leeds pathology protocol were included. The primary study endpoint was the rate of R1 resection. Secondary study endpoints were as follows: number of examined lymph nodes (N), rate of perioperative transfusions, percentage of patients receiving adjuvant therapies, occurrence of local recurrence, overall survival, disease-free survival, and sample size calculation for randomized controlled trials (RCT). RESULTS: Factors associated with R1 resection were tumor diameter, number of positive N, N ratio, logarithm odds of positive N, and duodenal infiltration. The matching process identified 20 RPDs and 24 OPDs. All RPDs were completed robotically. R1 resection was identified in 11 RPDs (55.0%) and in 10 OPDs (41.7%) (p = 0.38). There was no difference in the rate of R1 at each margin as well as in the proportion of patients with multiple R1 margins. RPD and OPD were also equivalent with respect to all secondary study endpoints, with a trend towards lower rate of blood transfusions in RPD. Based on the figures presented herein, a non-inferiority RCT comparing RPD and OPD having the rate of R1 resection as the primary study endpoint requires 3355 pairs. CONCLUSIONS: RPD and OPD achieved the same rate of R1 resections in resectable PC. RPD was also non-inferior to OPD with respect to all secondary study endpoints. Because of the high number of patients required to run a RCT, further assessment of RPD for PC would require the implementation of an international registry.

5 Article Management of pregnancy-associated pancreatic cystic tumors: Review of the literature and results of a Pancreas Club Inc. Survey. 2018

Iacopi, Sara / Lombardo, Carlo / Menonna, Francesca / Mazzeo, Salvatore / Caramella, Davide / Amorese, Gabriella / Vistoli, Fabio / Boggi, Ugo. ·Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. · Division of Radioloy, University of Pisa, Pisa, Italy. · Division of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy. · Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. Electronic address: u.boggi@med.unipi.it. ·Pancreatology · Pubmed #30274883.

ABSTRACT: BACKGROUND/OBJECTIVES: Management of patients with pregnancy-associated cyst pancreatic cystic tumors (PA-PCT) is complicated by lack of large series. METHODS: A systematic literature review was conducted to extrapolate data on management of PA-PCT, and make a questionnaire on pending issues to be administered to the members of the Pancreas Club Inc. RESULTS: The literature review demonstrated a total of 35 PA-PCT in 34 women, described exclusively in the form of case reports, and permitted the identification of eleven key questions to be addressed in the survey. The combined analysis of literature review and survery responses provided several information. First, PA-PCT are predominantly located in the body-tail of the pancreas, cause non-specific symptoms, are of large size (mean size: 11.2 ± 4.5 cm), and are nearly always malignant or premalignant, making timing of surgery, and not indication for surgery, the main issue in the management of these tumors. Second, there is a risk of PA-PCT rupture during pregnancy. Ruptured PA-PCT had a mean size 13.5 ± 4.9 cm, but no prognostic factor could be identified. Survey opinions suggested that this occurrence is quite rare, even for large tumors. Third, most pregnancies were conducted to term (mean gestational age: 40.5 ± 0.7 weeks), with a vaginal delivery. Fourth, all procedures were carried out through an open approach and the spleen was rarely preserved. Survey indicated instead that laparoscopy could play a role, and that the spleen should be preserved when feasible. CONCLUSIONS: PA-PCT require individualized treatment. The definition of a management algorithm requires the implementation of an International Registry.