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Pancreatic Neoplasms: HELP
Articles by Marco del Chiaro
Based on 66 articles published since 2009
(Why 66 articles?)
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Between 2009 and 2019, M. Del Chiaro wrote the following 66 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline European experts consensus statement on cystic tumours of the pancreas. 2013

Del Chiaro, Marco / Verbeke, Caroline / Salvia, Roberto / Klöppel, Gunter / Werner, Jens / McKay, Colin / Friess, Helmut / Manfredi, Riccardo / Van Cutsem, Eric / Löhr, Matthias / Segersvärd, Ralf / Anonymous3140750. ·Division of Surgery, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden. Electronic address: marco.del-chiaro@karolinska.se. ·Dig Liver Dis · Pubmed #23415799.

ABSTRACT: Cystic lesions of the pancreas are increasingly recognized. While some lesions show benign behaviour (serous cystic neoplasm), others have an unequivocal malignant potential (mucinous cystic neoplasm, branch- and main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm). European expert pancreatologists provide updated recommendations: diagnostic computerized tomography and/or magnetic resonance imaging are indicated in all patients with cystic lesion of the pancreas. Endoscopic ultrasound with cyst fluid analysis may be used but there is no evidence to suggest this as a routine diagnostic method. The role of pancreatoscopy remains to be established. Resection should be considered in all symptomatic lesions, in mucinous cystic neoplasm, main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm as well as in branch duct intraductal papillary mucinous neoplasm with mural nodules, dilated main pancreatic duct >6mm and possibly if rapidly increasing in size. An oncological partial resection should be performed in main duct intraductal papillary mucinous neoplasm and in lesions with a suspicion of malignancy, otherwise organ preserving procedures may be considered. Frozen section of the transection margin in intraductal papillary mucinous neoplasm is suggested. Follow up after resection is recommended for intraductal papillary mucinous neoplasm, solid pseudo-papillary neoplasm and invasive cancer.

2 Guideline Familial pancreatic cancer in Italy. Risk assessment, screening programs and clinical approach: a position paper from the Italian Registry. 2010

Del Chiaro, Marco / Zerbi, Alessandro / Capurso, Gabriele / Zamboni, Giuseppe / Maisonneuve, Patrick / Presciuttini, Silvano / Arcidiacono, Paolo Giorgio / Calculli, Lucia / Falconi, Massimo / Anonymous7420665. ·Division of General and Transplant Surgery, Pisa University Hospital, Via Paradisa 2, 56124 Cisanello, Pisa, Italy. m.delchiaro@ao-pisa.toscana.it ·Dig Liver Dis · Pubmed #20627831.

ABSTRACT: In Italy, pancreatic cancer is the fifth leading cause of tumor related death with about 7000 new cases per year and a mortality rate of 95%. In a recent prospective epidemiological study on the Italian population, a family history was found in about 10% of patients suffering from a ductal adenocarcinoma of the pancreas (PDAC). A position paper from the Italian Registry for Familial Pancreatic Cancer was made to manage these high-risk individuals. Even though in the majority of high-risk individuals a genetic test to identify familial predisposition is not available, a screening protocol seems to be reasonable for subjects who have a >10-fold greater risk for the development of PDAC. However this kind of screening should be included in clinical trials, performed in centers with high expertise in pancreatic disease, using the least aggressive diagnostic modalities.

3 Review Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. 2019

van Huijgevoort, Nadine C M / Del Chiaro, Marco / Wolfgang, Christopher L / van Hooft, Jeanin E / Besselink, Marc G. ·Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands. · Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands. m.g.besselink@amsterdamumc.nl. ·Nat Rev Gastroenterol Hepatol · Pubmed #31527862.

ABSTRACT: Pancreatic cystic neoplasms (PCN) are a heterogeneous group of pancreatic cysts that include intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystic neoplasms and other rare cystic lesions, all with different biological behaviours and variable risk of progression to malignancy. As more pancreatic cysts are incidentally discovered on routine cross-sectional imaging, optimal surveillance for patients with PCN is becoming an increasingly common clinical problem, highlighting the need to balance cancer prevention with the risk of (surgical) overtreatment. This Review summarizes the latest developments in the diagnosis and management of PCN, including the quality of available evidence. Also discussed are the most important differences between the PCN guidelines from the American Gastroenterological Association, the International Association of Pancreatology and the European Study Group on Cystic Tumours of the Pancreas, including diagnostic and follow-up strategies and indications for surgery. Finally, new developments in the management of patients with PCN are addressed.

4 Review Trials and tribulations of neoadjuvant therapy in pancreatic cancer. 2018

Del Chiaro, M / Søreide, K. ·Department of Surgery, University of Colorado Anschutz Medical Campus, 12 631 East 17th Avenue, C-313, Aurora, Colorado 80045, USA. · Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Stavanger University Hospital, Stavanger, Norway. ·Br J Surg · Pubmed #30221767.

ABSTRACT: -- No abstract --

5 Review Pancreatic Cystic Neoplasms: Different Types, Different Management, New Guidelines. 2018

Scholten, Lianne / van Huijgevoort, Nadine C M / van Hooft, Jeanin E / Besselink, Marc G / Del Chiaro, Marco. ·Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. · Department of Gastroenterology, Amsterdam Gastroenterology and Metabolism, Academic Medical Center, Amsterdam, the Netherlands. · Department of Division of Surgery, Departments of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden. ·Visc Med · Pubmed #30182024.

ABSTRACT: Pancreatic cystic neoplasms (PCN) include different types of cysts with various biological behavior. The most prevalent PCN are intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), and serous cystic neoplasm (SCN). Management of PCN should focus on the prevention of malignant progression, while avoiding unnecessary morbidity of surgery. This requires specialized centers with dedicated multidisciplinary PCN teams. The malignant potential of PCN varies enormously between the various types of PCN. A combination of computed tomography, magnetic resonance imaging/magnetic resonance cholangiopancreatography, and endoscopic ultrasound with or without fine needle aspiration is typically needed before a reliable diagnosis can be made. Several guidelines discuss the management of PCN; however, most of these are non-evidence-based without clear consensus on the optimal treatment and follow-up strategy. The 2018 European guidelines on PCN are the first evidence-based guidelines to include IPMN, MCN, SCN, and all other PCN. This guideline advises a more conservative approach to side-branch IPMN and MCN smaller than 40 mm and more often a surgical approach in IPMN with a main duct dilatation beyond 5 mm. The goal of this review is to summarize the different types and management of the most common PCN based on the current literature and guidelines.

6 Review Pancreatic Exocrine Insufficiency in Pancreatic Cancer. 2017

Vujasinovic, Miroslav / Valente, Roberto / Del Chiaro, Marco / Permert, Johan / Löhr, J-Matthias. ·Center for Digestive Diseases, Karolinska University Hospital, Stockholm SE-141 86, Sweden. miroslav.vujasinovic@karolinska.se. · Center for Digestive Diseases, Karolinska University Hospital, Stockholm SE-141 86, Sweden. roberto.valente@karolinska.se. · Center for Digestive Diseases, Karolinska University Hospital, Stockholm SE-141 86, Sweden. marco.del-chiaro@ki.se. · Center for Digestive Diseases, Karolinska University Hospital, Stockholm SE-141 86, Sweden. johan.permert@karolinska.se. · Center for Digestive Diseases, Karolinska University Hospital, Stockholm SE-141 86, Sweden. matthias.lohr@ki.se. ·Nutrients · Pubmed #28241470.

ABSTRACT:

7 Review Minimally Invasive Pancreaticoduodenectomy for the Treatment of Pancreatic-Head and Periampullary Tumors. 2017

Del Chiaro, Marco / Valente, Roberto / Arnelo, Urban. ·Pancreatic Surgery Unit, Division of Surgery, CLINTEC, Karolinska Institute at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. ·JAMA Surg · Pubmed #28030664.

ABSTRACT: -- No abstract --

8 Review Intraductal papillary mucinous neoplasms of the pancreas: reporting clinically relevant features. 2017

Del Chiaro, Marco / Verbeke, Caroline. ·Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Department of Pathology, Oslo University Hospital, Oslo, Norway. ·Histopathology · Pubmed #27878841.

ABSTRACT: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas can exhibit a wide spectrum of macroscopic and microscopic appearances. This not only causes occasional difficulties for the reporting pathologist in distinguishing these tumours from other lesions, but is also relevant clinically. As evidence accumulates, it becomes clear that multiple macroscopic and histological features of these neoplasms are relevant to the risk for malignant transformation and, consequently, of prime importance for clinical patient management. The need for detailed reporting is therefore increasing. This review discusses the panoply of gross and microscopic features of IPMN as well as the recommendations from recent consensus meetings regarding the pathology reporting on this tumour entity.

9 Review Nature and management of pancreatic mucinous cystic neoplasm (MCN): A systematic review of the literature. 2016

Nilsson, Linda N / Keane, Margaret G / Shamali, Awad / Millastre Bocos, Judith / Marijinissen van Zanten, Monica / Antila, Anne / Verdejo Gil, Cristina / Del Chiaro, Marco / Laukkarinen, Johanna. ·Karolinska Institutet, Stockholm, Sweden. · Institute for Liver and Digestive Health, University College London, UK. · Southampton University Hospital, UK. · Miguel Servet University Hospital, Zaragoza, Spain. · Radboud University Medical Center Nijmegen, Netherlands. · Tampere University Hospital, Tampere, Finland. · Ciudad Real University Hospital, Spain. · Tampere University Hospital, Tampere, Finland. Electronic address: johanna.laukkarinen@fimnet.fi. ·Pancreatology · Pubmed #27681503.

ABSTRACT: BACKGROUND: The current management of pancreatic mucinous cystic neoplasms (MCN) is defined by the consensus European, International Association of Pancreatology and American College of Gastroenterology guidelines. However, the criterion for surgical resection remains uncertain and differs between these guidelines. Therefore through this systematic review of the existing literature we aimed to better define the natural history and prognosis of these lesions, in order to clarify recommendations for future management. METHODS: A systematic literature search was performed (PubMed, EMBASE, Cochrane Library) for studies published in the English language between 1970 and 2015. RESULTS: MCNs occur almost exclusively in women (female:male 20:1) and are mainly located in the pancreatic body or tail (93-95%). They are usually found incidentally at the age of 40-60 years. Cross-sectional imaging and endoscopic ultrasound are the most frequently used diagnostic tools, but often it is impossible to differentiate MCNs from branch duct intraductal papillary mucinous neoplasms (BD-IPMN) or oligocystic serous adenomas pre-operatively. In resected MCNs, 0-34% are malignant, but in those less than 4 cm only 0.03% were associated with invasive adenocarcinoma. No surgically resected benign MCNs were associated with a synchronous lesion or recurrence; therefore further follow-up is not required after resection. Five-year survival after surgical resection of a malignant MCN is approximately 60%. CONCLUSIONS: Compared to other pancreatic tumors, MCNs have a low aggressive behavior, with exceptionally low rates of malignant transformation when less than 4 cm in size, are asymptomatic and lack worrisome features on pre-operative imaging. This differs significantly from the natural history of small BD-IPMNs, supporting the need to differentiate mucinous cyst subtypes pre-operatively, where possible. The findings support the recommendations from the recent European Consensus Guidelines, for the more conservative management of MCNs.

10 Review Are there still indications for total pancreatectomy? 2016

Del Chiaro, Marco / Rangelova, Elena / Segersvärd, Ralf / Arnelo, Urban. ·Pancreatic Surgery Unit-Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases-Karolinska University Hospital, K53-14186, Stockholm, Sweden. marco.del.chiaro@ki.se. · Pancreatic Surgery Unit-Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases-Karolinska University Hospital, K53-14186, Stockholm, Sweden. ·Updates Surg · Pubmed #27605208.

ABSTRACT: Total pancreatectomy is associated with short- and long-term high complication rate and without evidence of oncologic advantages. Several metabolic consequences are co-related with the apancreatic state. The unstable diabetes related to the total resection of the pancreas expose the patients to short- and long-term life-threatening complications. Severe hypoglycemia is a short-term dangerous complication that can also cause patients' death. Chronic complications of severe diabetes (cardiac and vascular diseases, neuropathy, nephropathy, and retinopathy) are also cause of morbidity, mortality and worsening of quality of life. For this reasons the number of total pancreatectomies performed has certainly decreased over time. However, today there are still some indications for this kind of procedures. Chronic pancreatitis untreatable with conventional treatments, surgical treatment of precancerous pancreatic lesions, surgical treatment of locally advanced pancreatic cancer and the management of patients with extraordinary high-risk pancreatic texture after pancreaticoduodenectomy represent possible indications for total pancreatectomy and are analyzed in the present paper.

11 Review Increased incidence of extrapancreatic neoplasms in patients with IPMN: Fact or fiction? A critical systematic review. 2015

Pugliese, Luigi / Keskin, Muharrem / Maisonneuve, Patrick / D'Haese, Jan G / Marchegiani, Giovanni / Wenzel, Patrick / Del Chiaro, Marco / Ceyhan, Güralp O. ·Unit of General Surgery 2, Department of Surgery, IRCCS Policlinico San Matteo, Pavia, Italy. · Division of Gastroenterology, Department of Internal Medicine, Ege University, Izmir, Turkey. · Division of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy. · Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy. · Department of Gastroenterology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Division of Surgery, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden. · Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: gueralp.ceyhan@tum.de. ·Pancreatology · Pubmed #25841270.

ABSTRACT: BACKGROUND: To identify potential associations between intraductal papillary mucinous neoplasm of the pancreas (IPMN) and extrapancreatic neoplasms (EPN), a systematic review of the literature has been performed. METHODS: A systematic search of Medline/Pubmed was performed according to the PRISMA guidelines for reporting systematic reviews and meta-analysis for the following search terms: "extrapancreatic", "non pancreatic", "additional pancreatic", "additional primary" and alternatively matched with "neoplasms/tumours/cancers/malignancies/lesions". The results obtained specifically for IPMN were examined one by one by two independent investigators for further data selection and extraction. RESULTS: Fifteen studies were identified to be suitable and included for systematic review. Fourteen reported an elevated risk for extrapancreatic malignancy, particularly gastric and colon cancer, while the largest and only prospective study did not find any association. Most studies were retrospective with a weak level of evidence that was not substantially enhanced even by a recent multicentre case series. CONCLUSIONS: The available data on this clinically relevant question remain inconclusive. Due to lacking evidence on extrapancreatic neoplasms in IPMN patients, only a standard surveillance can be advised.

12 Review Pathology reporting of pancreatic cancer following neoadjuvant therapy: challenges and uncertainties. 2015

Verbeke, C / Löhr, M / Karlsson, J Severin / Del Chiaro, M. ·Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden; Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden. Electronic address: caroline.verbeke@ki.se. · Gastrocentrum, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden. Electronic address: matthias.lohr@ki.se. · Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden. Electronic address: josefin.severin-karlsson@karolinska.se. · Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden. Electronic address: marco.del-chiaro@karolinska.se. ·Cancer Treat Rev · Pubmed #25434282.

ABSTRACT: An increasing number of studies investigate the use of neoadjuvant treatment for ductal adenocarcinoma of the pancreas. While a strong rationale supports this approach, study results are difficult to interpret and compare due to marked variance in multiple aspects of study design and performance. Divergence in pathology examination and reporting as a cause for heterogeneity and incomparability of study results has not been brought into this discussion yet, despite the fact that several key outcome measures for neoadjuvant treatment are pathology-based. This article discusses areas of controversy and difficulty regarding the evaluation of the extent of residual tumour tissue, grading of tumour regression and assessment of the margins, and explains the important clinical implications of the present uncertainty and divergence in pathology practice.

13 Review Early detection and prevention of pancreatic cancer: is it really possible today? 2014

Del Chiaro, Marco / Segersvärd, Ralf / Lohr, Matthias / Verbeke, Caroline. ·Marco Del Chiaro, Ralf Segersvärd, Matthias Löhr, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, 141 86 Stockholm, Sweden. ·World J Gastroenterol · Pubmed #25232247.

ABSTRACT: Pancreatic cancer is the 4(th) leading cause of cancer-related death in Western countries. Considering the low incidence of pancreatic cancer, population-based screening is not feasible. However, the existence of a group of individuals with an increased risk to develop pancreatic cancer has been well established. In particular, individuals suffering from a somatic or genetic condition associated with an increased relative risk of more than 5- to 10-fold seem to be suitable for enrollment in a surveillance program for prevention or early detection of pancreatic cancer. The aim of such a program is to reduce pancreatic cancer mortality through early or preemptive surgery. Considering the risk associated with pancreatic surgery, the concept of preemptive surgery cannot consist of a prophylactic removal of the pancreas in high-risk healthy individuals, but must instead aim at treating precancerous lesions such as intraductal papillary mucinous neoplasms or pancreatic intraepithelial neoplasms, or early cancer. Currently, results from clinical trials do not convincingly demonstrate the efficacy of this approach in terms of identification of precancerous lesions, nor do they define the outcome of the surgical treatment of these lesions. For this reason, surveillance programs for individuals at risk of pancreatic cancer are thus far generally limited to the setting of a clinical trial. However, the acquisition of a deeper understanding of this complex area, together with the increasing request for screening and treatment by individuals at risk, will usher pancreatologists into a new era of preemptive pancreatic surgery. Along with the growing demand to treat individuals with precancerous lesions, the need for low-risk investigation, low-morbidity operation and a minimally invasive approach becomes increasingly pressing. All of these considerations are reasons for preemptive pancreatic surgery programs to be undertaken in specialized centers only.

14 Review The state of the art of robotic pancreatectomy. 2014

Del Chiaro, Marco / Segersvärd, Ralf. ·Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Center for Digestive Diseases, Karolinska University Hospital, Huddinge, K53, 14186 Stockholm, Sweden. ·Biomed Res Int · Pubmed #24982913.

ABSTRACT: During the last decades an increasing number of minimally invasive pancreatic resections have been reported in the literature. With the development of robotic surgery a new enthusiasm has not only increased the number of centers approaching minimally invasive pancreatic surgery in general but also enabled the use of this technique for major pancreatic procedures, in particular in minimally invasive pancreatoduodenectomy. The aim of this review was to define the state of the art of pancreatic robotic surgery. No prospective randomized trials have been performed comparing robotic, laparoscopic, and open pancreatic procedures. From the literature one may conclude that robotic pancreatectomies seem to be as feasible and safe as open procedures. The general idea that the overall perioperative costs of robotic surgery would be higher than traditional procedures is not supported. With the current lack of evidence of any oncologic advantages, the cosmetic benefits offered by robotic surgery are not enough to justify extensive use in cancer patients. In contrast, the safety of these procedure can justify the use of the robotic technique in patient with benign/low grade malignant tumors of the pancreas.

15 Review Critical role of laser microdissection for genetic, epigenetic and proteomic analyses in pancreatic cancer. 2011

Funel, Niccola / Giovannetti, Elisa / Pollina, Luca E / del Chiaro, Marco / Mosca, Franco / Boggi, Ugo / Campani, Daniela. ·Department of Surgery, Unit of Experimental Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy. niccolafunel@blu.it ·Expert Rev Mol Diagn · Pubmed #21902531.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease, and molecular studies to unravel novel biomarkers and therapeutic targets are warranted. However, PDAC is characterized by different precursor lesions, as well as by an intense desmoplastic reaction, with islet of neoplastic cells often representing a minor population. Moreover, normal ductal cells, which are considered to be the normal counterpart of pancreatic adenocarcinoma cells, comprise approximately 5% of the total population of cells making up this organ. For all these reasons, molecular techniques to identify critical mutations, as well as the pattern of altered mRNA/microRNA/protein expression should be performed on selected pancreatic cell subpopulations. Therefore, the use of the newest laser microdissection techniques is critical for the analysis of PDAC biological characteristics. This article highlights the most recent and clinically relevant aspects of genetic, epigenetic and proteomic analyses of PDAC from the perspective of the application of laser microdissection.

16 Article Integrated targeted metabolomic and lipidomic analysis: A novel approach to classifying early cystic precursors to invasive pancreatic cancer. 2019

Gaiser, Rogier Aäron / Pessia, Alberto / Ateeb, Zeeshan / Davanian, Haleh / Fernández Moro, Carlos / Alkharaan, Hassan / Healy, Katie / Ghazi, Sam / Arnelo, Urban / Valente, Roberto / Velagapudi, Vidya / Sällberg Chen, Margaret / Del Chiaro, Marco. ·Division of Clinical Diagnostics and Surgery, DENTMED, Karolinska Institutet, Huddinge, Sweden. · Metabolomics Unit, Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland. · Division of Surgery, CLINTEC, Karolinska University Hospital, Stockholm, Sweden. · Department of Clinical Pathology/Cytology, Division of Pathology, Karolinska University Hospital, Huddinge, Sweden. · Division of Pathology, LABMED, Karolinska Institutet, Huddinge, Sweden. · Department for Digestive Diseases, Sapienza University of Rome, Rome, Italy. · Division of Clinical Diagnostics and Surgery, DENTMED, Karolinska Institutet, Huddinge, Sweden. margaret.chen@ki.se. · Tenth People's Hospital, Tongji University, Shanghai, China. margaret.chen@ki.se. · Division of Surgery, CLINTEC, Karolinska University Hospital, Stockholm, Sweden. marco.delchiaro@ucdenver.edu. · Division of Surgical Oncology, Department of Surgery, University of Colorado Denver, Aurora, CO, USA. marco.delchiaro@ucdenver.edu. ·Sci Rep · Pubmed #31308419.

ABSTRACT: Pancreatic cystic neoplasms (PCNs) are a highly prevalent disease of the pancreas. Among PCNs, Intraductal Papillary Mucinous Neoplasms (IPMNs) are common lesions that may progress from low-grade dysplasia (LGD) through high-grade dysplasia (HGD) to invasive cancer. Accurate discrimination of IPMN-associated neoplastic grade is an unmet clinical need. Targeted (semi)quantitative analysis of 100 metabolites and >1000 lipid species were performed on peri-operative pancreatic cyst fluid and pre-operative plasma from IPMN and serous cystic neoplasm (SCN) patients in a pancreas resection cohort (n = 35). Profiles were correlated against histological diagnosis and clinical parameters after correction for confounding factors. Integrated data modeling was used for group classification and selection of the best explanatory molecules. Over 1000 different compounds were identified in plasma and cyst fluid. IPMN profiles showed significant lipid pathway alterations compared to SCN. Integrated data modeling discriminated between IPMN and SCN with 100% accuracy and distinguished IPMN LGD or IPMN HGD and invasive cancer with up to 90.06% accuracy. Free fatty acids, ceramides, and triacylglycerol classes in plasma correlated with circulating levels of CA19-9, albumin and bilirubin. Integrated metabolomic and lipidomic analysis of plasma or cyst fluid can improve discrimination of IPMN from SCN and within PMNs predict the grade of dysplasia.

17 Article Enrichment of oral microbiota in early cystic precursors to invasive pancreatic cancer. 2019

Gaiser, Rogier Aäron / Halimi, Asif / Alkharaan, Hassan / Lu, Liyan / Davanian, Haleh / Healy, Katie / Hugerth, Luisa W / Ateeb, Zeeshan / Valente, Roberto / Fernández Moro, Carlos / Del Chiaro, Marco / Sällberg Chen, Margaret. ·Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden. · Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Universitetsjukhuset i Huddinge, Huddinge, Sweden. · Tenth People's Hospital, Tongji University, Shanghai, China. · Center for Translational Microbiome Research, CTMR, Department of Microbiology, Tumour and Cell Biology (MTC), Karolinska Institutet, Science for Life Laboratory, Huddinge, Sweden. · Division of Pathology, Department of Laboratory Medicine (LABMED), Karolinska Institutet, Huddinge, Sweden. · Department of Clinical Pathology/Cytology, Karolinska University Hospital, Huddinge, Sweden. · Division of Surgical Oncology, Department of Surgery, University of Colorado at Denver-Anschutz Medical Campus, Aurora, Colorado, USA. ·Gut · Pubmed #30872392.

ABSTRACT: OBJECTIVES: Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cysts that can progress to invasive pancreatic cancer. Associations between oncogenesis and oral microbiome alterations have been reported. This study aims to investigate a potential intracystic pancreatic microbiome in a pancreatic cystic neoplasm (PCN) surgery patient cohort. DESIGN: Paired cyst fluid and plasma were collected at pancreatic surgery from patients with suspected PCN (n=105). Quantitative and qualitative assessment of bacterial DNA by qPCR, PacBio sequencing (n=35), and interleukin (IL)-1β quantification was performed. The data were correlated to diagnosis, lesion severity and clinical and laboratory profile, including proton-pump inhibitor (PPI) usage and history of invasive endoscopy procedures. RESULTS: Intracystic bacterial 16S DNA copy number and IL-1β protein quantity were significantly higher in IPMN with high-grade dysplasia and IPMN with cancer compared with non-IPMN PCNs. Despite high interpersonal variation of intracystic microbiota composition, bacterial network and linear discriminant analysis effect size analyses demonstrated co-occurrence and enrichment of oral bacterial taxa including CONCLUSIONS: Collectively, these findings warrant further investigation into the role of oral bacteria in cystic precursors to pancreatic cancer and have added values on the aetiopathology as well as the management of pancreatic cysts.

18 Article Main Duct Dilatation Is the Best Predictor of High-grade Dysplasia or Invasion in Intraductal Papillary Mucinous Neoplasms of the Pancreas. 2019

Del Chiaro, Marco / Beckman, Ross / Ateeb, Zeeshan / Orsini, Nicola / Rezaee, Neda / Manos, Lindsey / Valente, Roberto / Yuan, Chunhui / Ding, Ding / Margonis, Georgios A / Yin, Lingdi / Cameron, John L / Makary, Martin A / Burkhart, Richard A / Weiss, Matthew J / He, Jin / Arnelo, Urban / Yu, Jun / Wolfgang, Christopher L. ·Pancreatic Surgery Unit, Division of Surgery, CLINTEC, Stockholm, Sweden. · Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. · Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden. · Department of Medical Surgical Translational Sciences, Sapienza University of Rome, Rome, Italy. · Department of General Surgery, Peking University Third Hospital, Beijing, China. · Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China. · Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD. · Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD. ·Ann Surg · Pubmed #30672797.

ABSTRACT: MINI: This retrospective analysis of 901 patients who underwent pancreatic resection for IPMN shows significant risk of malignancy associated with main duct dilatation greater than 5 mm. While previous studies and guidelines have focused on a 10 mm cutoff for criteria for resection, we provide evidence that lower levels of dilatation may warrant consideration for surgery as well. OBJECTIVE: The purpose of this study is to determine preoperative factors that are predictive of malignancy in patients undergoing pancreatic resection for intraductal papillary mucinous neoplasms (IPMN). SUMMARY BACKGROUND DATA: IPMN of the pancreas may be precursor lesions to pancreatic cancer (PC) and represent a target for early diagnosis or prevention. While there has been much effort to define preoperative risk factors for malignant pathology, guidelines are ever-changing and controversy remains surrounding which patients would benefit most from resection. METHODS: We performed a retrospective analysis of 901 consecutive patients obtained from two tertiary referral centers who underwent pancreatic resection for histologically proven IPMN between 2004 and 2017. Collected data included patient demographic characteristics, preoperative symptoms, radiological findings, and laboratory data. RESULTS: Main pancreatic duct (MPD) dilatation was the only variable that was significantly associated with increased probability of malignancy (defined high-dysplasia or invasion) on both univariate and multivariate analysis. Even middle-range MPD dilatation from 5 mm to 9.9 mm (n = 286) was associated with increased odds of HG-IPMN (OR = 2.74; 95% CI = 1.80-4.16) and invasion (OR = 4.42; 95% CI = 2.55-7.66). MPD dilatation >10 mm (n = 150) had even greater odds of HG-IPMN (OR = 6.57; 95% CI = 3.94-10.98) and invasion (OR = 15.07; 95% CI = 8.21-27.65). A cutoff of 5 to 7 mm MPD diameter was determined to be the best predictor to discriminate between malignant and benign lesions. CONCLUSIONS: In agreement with current IPMN management guidelines, we found MPD dilatation, even low levels from 5 mm to 9.9 mm, to be the single best predictor of HG-IPMN or invasion, highlighting the critical role that MPD plays in the selection of surgical candidates.

19 Article Main pancreatic duct dilation greater than 6 mm is associated with an increased risk of high-grade dysplasia and cancer in IPMN patients. 2019

Ateeb, Zeeshan / Valente, Roberto / Pozzi-Mucelli, Raffaella M / Malgerud, Linnéa / Schlieper, Yasmine / Rangelova, Elena / Fernandez-Moro, Carlos / Löhr, Johannes Matthias / Arnelo, Urban / Del Chiaro, Marco. ·Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden. · Digestive and Liver Diseases Unit, Sapienza University of Rome, Rome, Italy. · Division of Radiology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden. · Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. · Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden. marco.delchiaro@ucdenver.edu. · Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, C-313, Aurora, CO, 80045, USA. marco.delchiaro@ucdenver.edu. ·Langenbecks Arch Surg · Pubmed #30612152.

ABSTRACT: INTRODUCTION: IPMNs, considered precursor lesions of pancreatic adenocarcinoma (PDAC), might display histological alteration varying from low-grade dysplasia (LGD) to cancer. Nevertheless, the prevalence of PDAC is far below the prevalence of IPMN; therefore, not all of these precursor lesions finally progress to cancer. Preoperative features consistent with and finding at final histology of high-grade dysplasia (HGD) or cancer are currently lacking. The aim of this study is to correlate the presence of preoperative clinical features with the finding of advance lesions at final histology. METHODS: This is retrospective cohort analysis of patients who underwent surgery for histologically confirmed IPMNs at Karolinska University Hospital, from 2008 to 2015. RESULTS: MPD 6-9.9 mm and ≥ 10 mm were associated with an increased risk of HGD/cancer (respectively, OR 2.92, CI 1.38-6.20, p = 0.005 and OR 2.65, CI 1.12-6.25, p = 0.02). Preoperative high CA19.9 and jaundice were both associated with a higher risk of HGD/cancer at final histology (respectively, OR 4.15, CI 1.90-9.05, p = 0.0003 and OR 15.36, CI 1.94-121.22, p = 0.009). At sex- and age-adjusted multivariable logistic regression analysis, MPD between 6 and 9.9 mm (OR 2.64, CI 1.15-6.06, p = 0.02), jaundice (OR 12.43, CI 1.44-106.93, p = 0.02), and elevated CA19.9 (OR 3.71, CI 1.63-8.46, p = 0.001) remained associated with the occurrence of HGD/cancer. DISCUSSION: The presence of MPD dilation ≥ 6 mm, jaundice, and elevated CA19.9 in IPMN patients are consistent with the finding for HGD/cancer at final histology, thus representing possible markers of advanced lesions suitable for earlier or preventive curative surgical treatment.

20 Article Neoepitope targets of tumour-infiltrating lymphocytes from patients with pancreatic cancer. 2019

Meng, Qingda / Valentini, Davide / Rao, Martin / Moro, Carlos Fernández / Paraschoudi, Georgia / Jäger, Elke / Dodoo, Ernest / Rangelova, Elena / Del Chiaro, Marco / Maeurer, Markus. ·Department of Laboratory Medicine (LABMED), Division of Therapeutic Immunology (TIM), Karolinska Institutet, Stockholm, Sweden. · Centre for Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden. · Department of Laboratory Medicine (LABMED), Division of Pathology, Karolinska Institutet, Stockholm, Sweden. · Krankenhaus Nordwest, Division of Oncology and Haematology, Frankfurt, Germany. · Department of Clinical Science, Pancreatic Surgery Unit, Division of Surgery, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. · Department of Laboratory Medicine (LABMED), Division of Therapeutic Immunology (TIM), Karolinska Institutet, Stockholm, Sweden. markus.maeurer@gmail.com. · Centre for Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden. markus.maeurer@gmail.com. · Department of Oncology/Haematology, KHNW, Frankfurt, Germany & ImmunoSurgery Unit, Champalimaud Foundation, Lisbon, Portugal. markus.maeurer@gmail.com. ·Br J Cancer · Pubmed #30377343.

ABSTRACT: BACKGROUND: Pancreatic cancer exhibits a poor prognosis and often presents with metastasis at diagnosis. Immunotherapeutic approaches targeting private cancer mutations (neoantigens) are a clinically viable option to improve clinical outcomes. METHODS: 3/40 TIL lines (PanTT26, PanTT39, PanTT77) were more closely examined for neoantigen recognition. Whole-exome sequencing was performed to identify non-synonymous somatic mutations. Mutant peptides were synthesised and assessed for antigen-specific IFN-γ production and specific tumour killing in a standard Cr51 assay. TIL phenotype was tested by flow cytometry. Lymphocytes and HLA molecules in tumour tissue were visualised by immunohistochemistry. RESULTS: PanTT26 and PanTT39 TILs recognised and killed the autologous tumour cells. PanTT26 TIL recognised the KRAS CONCLUSION: This study provides methods to robustly screen T-cell targets for pancreatic cancer. Pancreatic cancer is immunogenic and immunotherapeutic approaches can be used to develop improved, targeted therapies.

21 Article Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study. 2019

van Hilst, Jony / de Rooij, Thijs / Klompmaker, Sjors / Rawashdeh, Majd / Aleotti, Francesca / Al-Sarireh, Bilal / Alseidi, Adnan / Ateeb, Zeeshan / Balzano, Gianpaolo / Berrevoet, Frederik / Björnsson, Bergthor / Boggi, Ugo / Busch, Olivier R / Butturini, Giovanni / Casadei, Riccardo / Del Chiaro, Marco / Chikhladze, Sophia / Cipriani, Federica / van Dam, Ronald / Damoli, Isacco / van Dieren, Susan / Dokmak, Safi / Edwin, Bjørn / van Eijck, Casper / Fabre, Jean-Marie / Falconi, Massimo / Farges, Olivier / Fernández-Cruz, Laureano / Forgione, Antonello / Frigerio, Isabella / Fuks, David / Gavazzi, Francesca / Gayet, Brice / Giardino, Alessandro / Groot Koerkamp, Bas / Hackert, Thilo / Hassenpflug, Matthias / Kabir, Irfan / Keck, Tobias / Khatkov, Igor / Kusar, Masa / Lombardo, Carlo / Marchegiani, Giovanni / Marshall, Ryne / Menon, Krish V / Montorsi, Marco / Orville, Marion / de Pastena, Matteo / Pietrabissa, Andrea / Poves, Ignaci / Primrose, John / Pugliese, Raffaele / Ricci, Claudio / Roberts, Keith / Røsok, Bård / Sahakyan, Mushegh A / Sánchez-Cabús, Santiago / Sandström, Per / Scovel, Lauren / Solaini, Leonardo / Soonawalla, Zahir / Souche, F Régis / Sutcliffe, Robert P / Tiberio, Guido A / Tomazic, Aleš / Troisi, Roberto / Wellner, Ulrich / White, Steven / Wittel, Uwe A / Zerbi, Alessandro / Bassi, Claudio / Besselink, Marc G / Abu Hilal, Mohammed / Anonymous161525. ·Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands. · Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom. · Department of Surgery, San Raffaele Hospital, Milan, Italy. · Department of Surgery, Morriston Hospital, Swansea, United Kingdom. · Department of Surgery, Virginia Mason Medical Center, Seattle, United States. · Department of Surgery, Karolinska Institute, Stockholm, Sweden. · Department of General and HPB surgery and liver transplantation, Ghent University Hospital, Ghent, Belgium. · Department of Surgery, Linköping University, Linköping, Sweden. · Department of Surgery, Universitá di Pisa, Pisa, Italy. · Department of Surgery, Pederzoli Hospital, Peschiera, Italy. · Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy. · Department of Surgery, Universitätsklinikum Freiburg, Freiburg, Germany. · Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. · Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy. · Department of Surgery, Hospital of Beaujon, Clichy, France. · Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway. · Department of Surgery, Erasmus MC, Rotterdam, the Netherlands. · Department of Surgery, Hopital Saint Eloi, Montpellier, France. · Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain. · Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy. · Department of Surgery, Institut Mutualiste Montsouris, Paris, France. · Department of Surgery, Humanitas University Hospital, Milan, Italy. · Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany. · Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom. · Clinic for Surgery, UKSH Campus Lübeck, Lübeck, Germany. · Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation. · Department of Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia. · Department of Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom. · Department of Surgery, University hospital Pavia, Pavia, Italy. · Department of Surgery, Hospital del Mar, Barcelona, Spain. · Department of Surgery, University Hospital Birmingham, Birmingham, United Kingdom. · Surgical Clinic, Department of clinical and experimental sciences, University of Brescia, Brescia, Italy. · Department of Surgery, The Freeman Hospital Newcastle Upon Tyne, Newcastle, United Kingdom. ·Ann Surg · Pubmed #29099399.

ABSTRACT: OBJECTIVE: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC. METHODS: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival. RESULTS: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60-400) vs 300 mL (150-500), P = 0.001] and hospital stay [8 (6-12) vs 9 (7-14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade ≥3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8-22) vs 22 (14-31), P < 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22-34] versus 31 (95% CI, 26-36) months (P = 0.929). CONCLUSIONS: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.

22 Article Radiological assessment of local resectability status in patients with pancreatic cancer: Interreader agreement and reader performance in two different classification systems. 2018

Loizou, Louiza / Duran, Carlos Valls / Axelsson, Elisabet / Andersson, Mats / Keussen, Inger / Strinnholm, Jörgen / Bartholomä, Wolf / Del Chiaro, Marco / Segersvärd, Ralf / Lundell, Lars / Kartalis, Nikolaos. ·Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Abdominal Radiology, Karolinska University Hospital, 14186, Stockholm, Sweden. · Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Abdominal Radiology, Karolinska University Hospital, 14186, Stockholm, Sweden; Department of Radiology, Uppsala University Hospital, 75185, Uppsala, Sweden. · Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, 41345, Gothenburg, Sweden. · Diagnostic Radiology, Department of Clinical Sciences and Center for Medical Imaging and Physiology, Skåne University Hospital, 22185, Lund, Sweden. · Diagnostic Radiology, Department of Radiation Sciences, Umeå University, 90187, Umeå, Sweden. · Department of Radiology and Department of Medical and Health Sciences, Linköping University Hospital, 58185, Linköping, Sweden. · Pancreatic Surgery Unit, Division of Surgery, CLINTEC, Karolinska Institutet, 14186, Stockholm, Sweden; Department of Upper GI diseases, Cancer Theme, Karolinska University Hospital, Stockholm, 14186 Sweden. · Pancreatic Surgery Unit, Division of Surgery, CLINTEC, Karolinska Institutet, 14186, Stockholm, Sweden. · Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Abdominal Radiology, Karolinska University Hospital, 14186, Stockholm, Sweden. Electronic address: nikolaos.kartalis@sll.se. ·Eur J Radiol · Pubmed #30150053.

ABSTRACT: OBJECTIVES: To assess the interreader agreement and reader performance in the evaluation of patients with pancreatic cancer (PC) in two classification systems of local resectability status prior to initiation of therapy, namely the National Comprehensive Cancer Network (NCCN) and Karolinska classification system (KCS). METHODS: In this ethics review board-approved retrospective study, six radiologists independently evaluated pancreatic CT-examinations of 30 patients randomly selected from a tertiary referral centre's multidisciplinary tumour board database. Based on well-defined criteria of tumour-vessel relationship, each patient was assigned to one of three NCCN and six KCS categories. We assessed the intraclass correlation coefficient (ICC) and compared the percentages of correct tumour classification of the six readers in both systems (Chi-square test; a P-value <0.05 was considered significant). The standard of reference was a consensus evaluation of CT-examinations by three readers not involved in the image analysis. RESULTS: The ICC for NCCN and KCS was 0.82 and 0.84, respectively (very strong agreement). The percentages of correct tumour classification at NCCN and KCS were 53-83% and 30-57%, respectively, with no statistically significant differences in the overall reader comparison per classification system. In pair-wise comparison between readers for NCCN/KCS, there were statistically significant differences between reader 5 vs. readers 4 (P = 0.012) and 3 (P = 0.045)/ reader 5 vs. reader 4 (P = 0.037). CONCLUSION: Interreader agreement in both PC classification systems is very strong. NCCN may be advantageous in terms of reader performance compared to KCS.

23 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.

24 Article Risk of malignancy in resected pancreatic mucinous cystic neoplasms. 2018

Keane, M G / Shamali, A / Nilsson, L N / Antila, A / Millastre Bocos, J / Marijinissen Van Zanten, M / Verdejo Gil, C / Maisonneuve, P / Vaalavuo, Y / Hoskins, T / Robinson, S / Ceyhan, G O / Abu Hilal, M / Pereira, S P / Laukkarinen, J / Del Chiaro, M. ·Institute for Liver and Digestive Health, University College London, London. · Department of Surgery, Southampton University Hospital, Southampton, UK. · Department of Surgery, Karolinska University Hospital, Stockholm, Sweden. · Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. · Department of Gastroenterology, Miguel Servet University Hospital, Zaragoza, Spain. · Department of Pathology, Nijmegen University Hospital, Nijmegen, The Netherlands. · Department of Gastroenterology, Ciudad Real University Hospital, Ciudad Real, Spain. · European Institute of Oncology, Milan, Italy. · Department of Hepato-Pancreato-Biliary Surgery, Freeman Hospital, Newcastle upon Tyne, UK. · Surgical Clinic, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. ·Br J Surg · Pubmed #29488646.

ABSTRACT: BACKGROUND: Pancreatic mucinous cystic neoplasms (MCNs) are rare mucin-producing cystic tumours defined by the presence of ovarian-type stroma. MCNs have a malignant potential and thus surgery is frequently performed. The aim of this cohort study was to define better the criteria for surgical resection in patients with MCN. METHODS: This multicentre retrospective study included all resected MCNs between 2003 and 2015 in participating centres. Lesions without ovarian-type stroma were excluded. Patient characteristics, preoperative findings, histopathology findings and follow-up data were recorded. RESULTS: The study included 211 patients; their median age was 53 (range 18-82) years, and 202 (95·7 per cent) were women. Median preoperative tumour size was 55 (range 12-230) mm. Thirty-four of the 211 (16·1 per cent) were malignant, and high-grade dysplasia (HGD) was found in a further 13 (6·2 per cent). One-third of MCNs in men were associated with invasive cancer, compared with 15·3 per cent in women. Five cases of malignant transformation occurred in MCNs smaller than 4 cm. All cases of malignancy or HGD were associated with symptoms or features of concern on preoperative cross-sectional imaging. In multivariable analysis, raised carbohydrate antigen 19-9 (odds ratio (OR) 10·54, 95 per cent c.i. 2·85 to 218·23; P < 0·001), tumour size (OR 4·23, 3·02 to 11·03; P = 0·001), mural nodules (OR 3·55, 1·31 to 20·55; P = 0·002) and weight loss (OR 3·40, 2·34 to 12·34; P = 0·034) were independent factors predictive of malignant transformation. CONCLUSIONS: Small indeterminate MCNs with no symptoms or features of concern may safely be observed as they have a low risk of malignant transformation.

25 Article Pancreatectomies for pancreatic neoplasms in pediatric and adolescent age: A single institution experience. 2018

Scandavini, Chiara / Valente, Roberto / Rangelova, Elena / Segersvärd, Ralf / Arnelo, Urban / Permert, Johan / Svensson, Pär-Johan / Stenman, Jakob / Del Chiaro, Marco. ·Pancreatic Surgery Unit, Division of Surgery (KLINTEC) - Karolinska Institutet at Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden. · Pancreatic Surgery Unit, Division of Surgery (KLINTEC) - Karolinska Institutet at Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden; Digestive and Liver Diseases Unit - Sapienza University of Rome, Italy. · Astrid Lindgren Children's Hospital, Karolinska University Hospital and Department for Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. · Pancreatic Surgery Unit, Division of Surgery (KLINTEC) - Karolinska Institutet at Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden. Electronic address: marco.del.chiaro@ki.se. ·Pancreatology · Pubmed #29277262.

ABSTRACT: BACKGROUND: There are very few data in the current literature regarding the short- and long-term outcome of surgery for pediatric pancreatic tumors (PPT). No data are available on the impact of pancreatic surgery on the children's growth. METHODS: This is a retrospective cohort study on a consecutive series of pediatric/adolescent patients who underwent pediatric surgery at Karolinska University Hospital from January 2005 to July 2017. RESULTS: Overall 14 pancreatic operations were performed in 13 patients. The median age was 11.4 years (range 3-15). Six pancreaticoduodenectomies (42.8%), 5 distal pancreatectomies (35.7%), and 3 enucleations (21.5%) were performed. The final histology revealed a solid pseudopapillary tumor in 9 cases (69.2%), neuroblastoma in 1 (7.7%), ganglioneuroma in 1 (7.7%), pancreatoblastoma in 1 (7.7%), and insulinoma in 1 (7.7%). Overall, 3 patients developed post-operative complications (23%). There was no peri-operative mortality. All patients are alive after a median follow-up time of 80 months. Exocrine insufficiency was detected post-operatively in 4 patients (30.7%) Endocrine insufficiency requiring insulin treatment developed in one patient (7.7%). No significant impact on growth was detected in any of the patients after pancreatic resection. CONCLUSIONS: In our series, surgery performed for PPTs seems to be safe and effective. The effect of pancreatic surgery on children's growth does not seem to be significant.

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