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Pancreatic Neoplasms: HELP
Articles by Manju D. Chandrasegaram
Based on 4 articles published since 2010
(Why 4 articles?)
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Between 2010 and 2020, M. D. Chandrasegaram wrote the following 4 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Ampullary cancer of intestinal origin and duodenal cancer - A logical clinical and therapeutic subgroup in periampullary cancer. 2017

Chandrasegaram, Manju D / Gill, Anthony J / Samra, Jas / Price, Tim / Chen, John / Fawcett, Jonathan / Merrett, Neil D. ·the Prince Charles Hospital, Brisbane, Queensland 4032, Australia. · Sydney Medical School, University of Sydney, New South Wales 2006, Australia. · Queen Elizabeth Hospital, Adelaide, South Australia 5011, Australia. · Flinders Medical Centre, Adelaide, South Australia 5042, Australia. · School of Medicine, University of Queensland, Queensland 4006, Australia. · Department of Upper GI Surgery, Bankstown Hospital, Sydney, New South Wales 2200, Australia. ·World J Gastrointest Oncol · Pubmed #29085567.

ABSTRACT: Periampullary cancers include pancreatic, ampullary, biliary and duodenal cancers. At presentation, the majority of periampullary tumours have grown to involve the pancreas, bile duct, ampulla and duodenum. This can result in difficulty in defining the primary site of origin in all but the smallest tumors due to anatomical proximity and architectural distortion. This has led to variation in the reported proportions of resected periampullary cancers. Pancreatic cancer is the most common cancer resected with a pancreaticoduodenectomy followed by ampullary (16%-50%), bile duct (5%-39%), and duodenal cancer (3%-17%). Patients with resected duodenal and ampullary cancers have a better reported median survival (29-47 mo and 22-54 mo) compared to pancreatic cancer (13-19 mo). The poorer survival with pancreatic cancer relates to differences in tumour characteristics such as a higher incidence of nodal, neural and vascular invasion. While small ampullary cancers can present early with biliary obstruction, pancreatic cancers need to reach a certain size before biliary obstruction ensues. This larger size at presentation contributes to a higher incidence of resection margin involvement in pancreatic cancer. Ampullary cancers can be subdivided into intestinal or pancreatobiliary subtype cancers with histomolecular staining. This avoids relying on histomorphology alone, as even some poorly differentiated cancers preserve the histomolecular profile of their mucosa of origin. Histomolecular profiling is superior to anatomic location in prognosticating survival. Ampullary cancers of intestinal subtype and duodenal cancers are similar in their intestinal origin and form a logical clinical and therapeutic subgroup of periampullary cancers. They respond to 5-FU based chemotherapeutic regimens such as capecitabine-oxaliplatin. Unlike pancreatic cancers,

2 Review Advances in Molecular Pathology and Treatment of Periampullary Cancers. 2016

Chandrasegaram, Manju D / Chen, John W / Price, Timothy J / Zalcberg, John / Sjoquist, Katrin / Merrett, Neil D. ·From the *NHMRC Clinical Trials Centre; †Department of Surgery, The Prince Charles Hospital, Brisbane; ‡Department of Surgery, Flinders Medical Centre; §Queen Elizabeth Hospital, Adelaide; ∥University of Adelaide, South Australia; ¶School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne; #Cancer Care Centre, Department of Medical Oncology, St George Hospital; **Department of Surgery, Bankstown Hospital; and ††Division of Surgery, University of Western Sydney, Sydney, Australia. ·Pancreas · Pubmed #26348463.

ABSTRACT: OBJECTIVES: Periampullary cancers (PACs) include the following 4 traditional anatomic subtypes: pancreatic, ampullary, biliary, or duodenal cancers. This review was performed to highlight recent advances in the genomic and molecular understanding of each PAC subtype and the advances in chemotherapeutic and molecular trials in these cancer subtypes. RESULTS: Recent advances have highlighted differences in the genomic and molecular features within each PAC subtype. Ampullary cancers can now be further defined accurately into their intestinal and pancreatobiliary subtypes using histomolecular profiling. K-ras mutation, which occurs in most pancreatic cancers, is found to occur less frequently in ampullary (42%-52%), biliary (22%-23%), and duodenal cancers (32%-35%), suggesting crucial differences in targetable mutations in these cancer subtypes.Ampullary cancers of intestinal subtype and duodenal cancers seem to share similarities with colorectal cancer, given that they respond to similar chemotherapeutic regimens. This has potential implications for clinical trials and treatment selection, where PACs are often considered together. CONCLUSIONS: Future trials should be designed in view of our increased understanding of the different anatomic and histomolecularly profiled subtypes of PAC cancers, which respects their individual molecular characteristics, phenotype, and response to treatment.

3 Review Meta-analysis of radical resection rates and margin assessment in pancreatic cancer. 2015

Chandrasegaram, M D / Goldstein, D / Simes, J / Gebski, V / Kench, J G / Gill, A J / Samra, J S / Merrett, N D / Richardson, A J / Barbour, A P. ·National Health and Medical Research Clinical Trials Centre, University of Sydney, New South Wales, Australia. · Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia. · Department of Surgery, Prince Charles Hospital, Queensland, Australia. · Department of Medical Oncology, Prince of Wales Hospital, Prince of Wales Clinical School University of New South Wales, New South Wales, Australia. · Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, New South Wales, Australia. · Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. · Cancer Diagnosis and Pathology Research Group, Kolling Institute of Medical Research, University of Sydney, New South Wales, Australia. · Department of Surgery, Royal North Shore Hospital, New South Wales, Australia. · Discipline of Surgery, School of Medicine, University of Western Sydney, New South Wales, Australia. · Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia. · University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia. ·Br J Surg · Pubmed #26350029.

ABSTRACT: BACKGROUND: R0 resection rates (complete tumour removal with negative resection margins) in pancreatic cancer are 70-80 per cent when a 0-mm margin is used, declining to 15-24 per cent with a 1-mm margin. This review evaluated the R0 resection rates according to different margin definitions and techniques. METHODS: Three databases (MEDLINE from 1946, PubMed from 1946 and Embase from 1949) were searched to mid-October 2014. The search terms included 'pancreatectomy OR pancreaticoduodenectomy' and 'margin'. A meta-analysis was performed with studies in three groups: group 1, axial slicing technique (minimum 1-mm margin); group 2, other slicing techniques (minimum 1-mm margin); and group 3, studies with minimum 0-mm margin. RESULTS: The R0 rates were 29 (95 per cent c.i. 26 to 32) per cent in group 1 (8 studies; 882 patients) and 49 (47 to 52) per cent in group 2 (6 studies; 1568 patients). The combined R0 rate (groups 1 and 2) was 41 (40 to 43) per cent. The R0 rate in group 3 (7 studies; 1926 patients) with a 0-mm margin was 72 (70 to 74) per cent The survival hazard ratios (R1 resection/R0 resection) revealed a reduction in the risk of death of at least 22 per cent in group 1, 12 per cent in group 2 and 23 per cent in group 3 with an R0 compared with an R1 resection. Local recurrence occurred more frequently with an R1 resection in most studies. CONCLUSION: Margin clearance definitions affect R0 resection rates in pancreatic cancer surgery. This review collates individual studies providing an estimate of achievable R0 rates, creating a benchmark for future trials.

4 Article Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy. 2015

Chandrasegaram, Manju D / Chiam, Su C / Chen, John W / Khalid, Aisha / Mittinty, Murthy L / Neo, Eu L / Tan, Chuan P / Dolan, Paul M / Brooke-Smith, Mark E / Kanhere, Harsh / Worthley, Chris S. ·HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. manju.chandrasegaram@adelaide.edu.au. · Division of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, 5005, Australia. manju.chandrasegaram@adelaide.edu.au. · HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. suchuenchiam@yahoo.co.uk. · HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. john.chen@flinders.edu.au. · Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. john.chen@flinders.edu.au. · Flinders University, Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia. john.chen@flinders.edu.au. · Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. aisha.khalid000@gmail.com. · School of Population Health, University of Adelaide, 178 North Terrace, Adelaide, SA, 5005, Australia. murthy.mittinty@adelaide.edu.au. · HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. eu.neo@health.sa.gov.au. · Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. eu.neo@health.sa.gov.au. · HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. tanchuanping@gmail.com. · HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. paul.dolan@health.sa.gov. · HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. mark.brooke-smith@flinders.edu.au. · Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. mark.brooke-smith@flinders.edu.au. · Flinders University, Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia. mark.brooke-smith@flinders.edu.au. · Division of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, 5005, Australia. Kanhere.Harsh@health.sa.gov.au. · HPB Surgery Unit, Queen Elizabeth Hospital, 28 Woodville Road, Adelaide, SA, 5011, Australia. Kanhere.Harsh@health.sa.gov.au. · HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. chris.worthley@health.sa.gov.au. ·World J Surg Oncol · Pubmed #25890023.

ABSTRACT: BACKGROUND: Pancreatic cancer (PC) has the worst survival of all periampullary cancers. This may relate to histopathological differences between pancreatic cancers and other periampullary cancers. Our aim was to examine the distribution and histopathologic features of pancreatic, ampullary, biliary and duodenal cancers resected with a pancreaticoduodenectomy (PD) and to examine local trends of periampullary cancers resected with a PD. METHODS: A retrospective review of PD between January 2000 and December 2012 at a public metropolitan database was performed. The institutional ethics committee approved this study. RESULTS: There were 142 PDs during the study period, of which 70 cases were pre-2010 and 72 post-2010, corresponding to a recent increase in the number of cases. Of the 142 cases, 116 were for periampullary cancers. There were also proportionately more PD for PC (26/60, 43% pre-2010 vs 39/56, 70% post-2010, P = 0.005). There were 65/116 (56%) pancreatic, 29/116 (25%), ampullary, 17/116 (15%) biliary and 5/116 (4%) duodenal cancers. Nodal involvement occurred more frequently in PC (78%) compared to ampullary (59%), biliary (47%) and duodenal cancers (20%), P = 0.002. Perineural invasion was also more frequent in PC (74%) compared to ampullary (34%), biliary (59%) and duodenal cancers (20%), P = 0.002. Microvascular invasion was seen in 57% pancreatic, 38% ampullary, 41% biliary and 20% duodenal cancers, P = 0.222. Overall, clear margins (R0) were achieved in fewer PC 41/65 (63%) compared to ampullary 27/29 (93%; P = 0.003) and biliary cancers 16/17 (94%; P = 0.014). CONCLUSIONS: This study highlights that almost half of PD was performed for cancers other than PC, mainly ampullary and biliary cancers. The volume of PD has increased in recent years with an increased proportion being for PC. PC had higher rates of nodal and perineural invasion compared to ampullary, biliary and duodenal cancers.