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Pancreatic Neoplasms: HELP
Articles by Sebastien Gaujoux
Based on 44 articles published since 2010
(Why 44 articles?)
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Between 2010 and 2020, S. Gaujoux wrote the following 44 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial [Cystic lesion of the pancreas… The epidemic in yet not under control!] 2019

Gaujoux, Sébastien / Coriat, Romain. ·AP-HP, hôpital Cochin, service de chirurgie pancréatique et endocrinienne, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France. Electronic address: sebastien.gaujoux@aphp.fr. · Université Paris Descartes, 75006 Paris, France; AP-HP, hôpital Cochin, service de gastroentérologie, d'endoscopie et d'oncologie digestive, 75014 Paris, France. ·Presse Med · Pubmed #31303373.

ABSTRACT: -- No abstract --

2 Editorial Pancreatic cancer is still waiting for the big leap forward. 2019

Gaujoux, Sébastien / Belghiti, Jacques. ·AP-HP, hôpital Cochin, department of hepato-pancreato-biliary and endocrine surgery, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France. Electronic address: sebastien.gaujoux@aphp.fr. · AP-HP, hôpital Beaujon, department of hepato-pancreato-biliary surgery, pôle des maladies de l'appareil digestif (PMAD), 92110 Clichy, France; Université Paris Diderot, Paris, France. ·Presse Med · Pubmed #30878337.

ABSTRACT: -- No abstract --

3 Review Does neoadjuvant therapy for pancreatic head adenocarcinoma increase postoperative morbidity? A systematic review of the literature with meta-analysis. 2020

Araujo, Raphael L C / Silva, Raphael O / de Pádua Souza, Cristiano / Milani, Jean M / Huguet, Florence / Rezende, Ana C / Gaujoux, Sebastien. ·Department of Digestive Surgery, Escola Paulista de Medicina (UNIFESP), São Paulo, São Paulo, Brazil. · Post-graduation Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. · Department of Oncology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil. · Department of Surgical Oncology, Hospital Santa Casa, Campo Mourão, Paraná, Brazil. · Department of Radiation Oncology, Hôpital Tenon AP-HP, Sorbonne University, Paris, France. · Department of Digestive, Pancreatic and Endocrine Surgery, Hôpital Cochin AP-HP, Paris, France. ·J Surg Oncol · Pubmed #31994193.

ABSTRACT: Neoadjuvant treatment (NT) for pancreatic head cancer may allow some patients to undergo curative resection, but its impact on postoperative complications remains unclear. A systematic review and meta-analysis were performed to compare overall postoperative morbidity, pancreatic fistula, and mortality between patients who underwent upfront surgery and those who underwent neoadjuvant therapy first. Forty-five studies with 3359 patients were included. No significant differences in morbidity and mortality rates associated with NT for pancreatic head cancer were detected in this study.

4 Review Pancreatic cancer surgical management. 2019

Jeune, Florence / Coriat, Romain / Prat, Frédéric / Dousset, Bertrand / Vaillant, Jean-Christophe / Gaujoux, Sébastien. ·AP-HP, Pierre-and-Marie-Curie university, Paris VI, Pitié-Salpêtrière hospital, department of hepatobiliary surgery, pancreatic surgery and liver transplantation, 75651 Paris cedex, France. Electronic address: florence.jeune@hotmail.fr. · AP-HP, Paris V, Paris Descartes faculty of medecine, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France. · AP-HP, Paris V, Paris Descartes faculty of medicine, Cochin hospital, department of digestive, hepatobiliary and pancreatic surgery, 75014 Paris, France. · AP-HP, Pierre-and-Marie-Curie university, Paris VI, Pitié-Salpêtrière hospital, department of hepatobiliary surgery, pancreatic surgery and liver transplantation, 75651 Paris cedex, France. ·Presse Med · Pubmed #30905395.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) remains a dismal prognosis and surgery is the only chance for cure. However, only few of the patients have localized tumor eligible for curative complete resection. Preoperative management and well-staging of the disease are the cornerstone for appropriate surgery and major issues to define the best therapeutic strategy. This review focuses on the surgical and optimal perioperative management of PDAC and summarizes updates data on the subject.

5 Review Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC). 2018

Neuzillet, Cindy / Gaujoux, Sébastien / Williet, Nicolas / Bachet, Jean-Baptiste / Bauguion, Lucile / Colson Durand, Laurianne / Conroy, Thierry / Dahan, Laetitia / Gilabert, Marine / Huguet, Florence / Marthey, Lysiane / Meilleroux, Julie / de Mestier, Louis / Napoléon, Bertrand / Portales, Fabienne / Sa Cunha, Antonio / Schwarz, Lilian / Taieb, Julien / Chibaudel, Benoist / Bouché, Olivier / Hammel, Pascal / Anonymous6240961 / Anonymous6250961 / Anonymous6260961 / Anonymous6270961 / Anonymous6280961 / Anonymous6290961 / Anonymous6300961 / Anonymous6310961 / Anonymous6320961 / Anonymous6330961. ·Department of Medical Oncology, Curie Institute, Versailles Saint-Quentin University (UVSQ), Saint-Cloud, France. Electronic address: cindy.neuzillet@gmail.com. · Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Cochin Hospital, AP-HP, Paris Descartes Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France. · Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France. · Hepato-Gastroenterology Department, Pitié Salpétrière University Hospital, AP-HP, Paris Cedex 13, France. · Hepato-Gastroenterology Department, Departmental Hospital Center, La Roche sur Yon, France. · Department of Radiotherapy, Henri Mondor Hospital, AP-HP, Université Paris Est Creteil, Créteil, France. · Department of Medical Oncology, Lorraine Institute of Oncology and Lorraine University, Vandoeuvre-lès-Nancy Cedex, France. · Digestive Oncology Department, "DACCORD" (Digestif, Anatomie pathologique, Chirurgie, CISIH, Oncologie, Radiothérapie, Dermatologie) pole, CHU Timone, Marseille Cedex 05, France. · Paoli Calmettes Institute, Department of Medical Oncology and Cancer Research Center of Marseille (CRCM), INSERM U1068 Stress Cell, Aix-Marseille University, Marseille, France. · Department of Oncology and Radiotherapy, Tenon Hospital, East Paris University Hospitals, AP-HP, Paris Sorbonne University, Paris, France. · Gastroenterology Department, Béclère Hospital, AP-HP, Clamart, France. · Pathology Department, Toulouse University Hospital, Toulouse, France. · Department of Gastroenterology-Pancreatology, Beaujon Hospital, APHP, Paris 7 University, Clichy, France. · Jean Mermoz Private Hospital, Ramsay Générale de Santé, Lyon, France. · Digestive Oncology Department, Regional Institute of Cancer, Montpellier, France. · INSERM UMR 935, Paul Brousse Hospital, Hepatobiliary Center, AP-HP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France. · Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France and Genomic and Personalized Medicine in Cancer and Neurological Disorders, UMR 1245 INSERM, Rouen University, France. · Hepato-Gastroenterology and Digestive Oncology Department, Georges Pompidou European Hospital, AP-HP, Paris, France. · Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France. · Hepato-Gastroenterology and Digestive Oncology Department, Robert Debré University Hospital, Avenue Général Koenig, 51092 Reims Cedex, France. · Department of Digestive Oncology, Beaujon University Hospital (AP-HP), Paris VII Diderot University, Clichy-la-Garenne, France. Electronic address: pascal.hammel@aphp.fr. ·Dig Liver Dis · Pubmed #30219670.

ABSTRACT: BACKGROUND: This document is a summary of the French intergroup guidelines regarding the management of pancreatic adenocarcinoma (PA), updated in July 2018. DESIGN: This collaborative work was produced under the auspices of all French medical and surgical societies involved in the management of PA. It is based on the previous guidelines, recent literature review and expert opinions. Recommendations were graded in three categories, according to the level of evidence. RESULTS: Over the last seven years, significant changes in PA management have been implemented in clinical practice. Imaging/staging: diffusion magnetic resonance imaging is useful before surgery to rule out small liver metastases. SURGERY: centralization of pancreatic surgery in expert centers is associated with a decreased postoperative mortality. Adjuvant chemotherapy: modified FOLFIRINOX in fit patients, or gemcitabine, or 5-FU, or gemcitabine plus capecitabine, to be discussed on a case-by-case basis. Locally advanced PA: no survival benefit of chemoradiotherapy. Metastatic PA: FOLFIRINOX and gemcitabine plus nab-paclitaxel combination are first-line standards in fit patients; second-line with 5FU/nal-IRI or 5FU/oxaliplatin combination after first-line gemcitabine. CONCLUSION: Guidelines for management of PA are continuously evolving and need to be regularly updated. This constant progress is made possible through clinical and translational research. However, as each individual case is particular, they cannot substitute to multidisciplinary tumor board discussion.

6 Review Surveillance strategy for small asymptomatic non-functional pancreatic neuroendocrine tumors - a systematic review and meta-analysis. 2017

Sallinen, Ville / Le Large, Tessa Y S / Galeev, Shamil / Kovalenko, Zahar / Tieftrunk, Elke / Araujo, Raphael / Ceyhan, Güralp O / Gaujoux, Sebastien. ·Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: ville.sallinen@helsinki.fi. · Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. · General Surgery Department, Saint Luke's Clinical Hospital, Saint-Petersburg, Russia. · Federal Medical and Rehabilitation Center, Department of Surgical Oncology, Moscow, Russia. · Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. · Department of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. · Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France. Electronic address: sebastien.gaujoux@aphp.fr. ·HPB (Oxford) · Pubmed #28254159.

ABSTRACT: BACKGROUND: Non-functional pancreatic neuroendocrine tumors (NF-PNET) are rare neoplasms being increasingly diagnosed. Surgical treatment or expectant management are both suggested for small NF-PNETs. The aim of this study was to evaluate the outcome of surveillance strategy for small NF-PNETs. METHODS: A systematic search was performed up to March 2016 in MEDLINE, EMBASE and the Cochrane Library according to the PRISMA guidelines. Data was pooled using the random-effects model. RESULTS: Nine articles including 344 patients with sporadic and 64 patients with MEN1 related NF-PNET were selected. Tumor growth was observed in 22% and 52%, development of metastases were reported on 0% and 9%, and rate of secondary surgical resection was 12% and 25% in patients with sporadic or MEN1 related NF-PNETs, respectively. All metastases (1 distant, 4 nodal) were reported by a single study in patients with MEN1. Reason for secondary surgery was tumor growth in half of patients undergoing surgery. DISCUSSION: Expectant management of small asymptomatic, sporadic, NF-PNETs could be a reasonable option in highly selected patients. However, the level of evidence is low and longer follow-up is needed to identify patients could benefit from upfront surgery instead of expectant treatment.

7 Review [Management of gastrinoma]. 2016

Hain, Elisabeth / Coriat, Romain / Dousset, Bertrand / Gaujoux, Sébastien. ·AP-HP, hôpital Cochin, service de chirurgie digestive hépato-biliaire et endocrienne, Paris, France. · AP-HP, hôpital Cochin, service de gastroentérologie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France. · AP-HP, hôpital Cochin, service de chirurgie digestive hépato-biliaire et endocrienne, Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France. · AP-HP, hôpital Cochin, service de chirurgie digestive hépato-biliaire et endocrienne, Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France. Electronic address: sebastien.gaujoux@aphp.fr. ·Presse Med · Pubmed #27262229.

ABSTRACT: Gastrinoma is a very rare tumor leading to gastrin hypersecretion and characterised by Zollinger-Ellisson syndrome (ZES) i.e. severe gastric and duodenal ulceration and profuse diarrhea. This disease can be sporadic or familial within a multiple endocrine neoplasia type 1 (MEN-1) syndrome. Diagnosis is based on hypergastrinemia/hypercholrhydria. Tumors are usually located in the duodeno-pancreas. Preoperative tumor location by CT, echoendoscopy and fibroscopy is not always possible because of the small size of the lesion that are frequently multiple. The aim of gastrinoma treatment is 1/to control the hormonal hypersecretion 2/to remove the neoplasm when it is possible. Surgery is the only chance to cure. Gastrinoma is a slow-growing tumor, and overall survival is good with a median survival above 10years and a 5-year survival above 80 % in surgically resected patients. Recurrence is frequent, a biochemical recurrence is observed in 65 % of cases and morphological recurrence in 40 % of patients at 2years. Metastases are associated with a dismal prognosis.

8 Review Pathology and Surgical Treatment of High-Grade Pancreatic Neuroendocrine Carcinoma: an Evolving Landscape. 2016

Haugvik, Sven-Petter / Kaemmerer, Daniel / Gaujoux, Sebastien / Labori, Knut Jørgen / Verbeke, Caroline Sophie / Gladhaug, Ivar Prydz. ·Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Postbox 4950, Nydalen, 0424, Oslo, Norway. svhaug@ous-hf.no. · Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern, 0318, Oslo, Norway. svhaug@ous-hf.no. · Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004, Drammen, Norway. svhaug@ous-hf.no. · Department of General and Visceral Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, Bad Berka, 99437, Germany. · Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Université Paris Descartes, 27, rue du Faubourg Saint Jacques, 74014, Paris, France. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Postbox 4950, Nydalen, 0424, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern, 0318, Oslo, Norway. · Department of Pathology, Oslo University Hospital, Rikshospitalet, Postbox 4956, Nydalen, 0424, Oslo, Norway. ·Curr Oncol Rep · Pubmed #26984415.

ABSTRACT: Pancreatic neuroendocrine neoplasms (PNENs) are rare, accounting for less than 5% of all pancreatic tumors. High-grade pancreatic neuroendocrine carcinomas (hgPNECs) represent about 5% of all PNENs. They show highly aggressive behavior with dismal prognosis. Throughout the last two decades, there has been a notable progress in basic and clinical research of PNENs and a therapeutic trend towards both more aggressive and minimally invasive surgery. Despite these advances, hgPNECs as a distinct clinical entity remains largely unexplored among surgeons. This review of current development in pathology reporting and surgical treatment of hgPNECs aims at increasing the awareness of an evolving field in pancreatic surgery.

9 Review Influence of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma: a systematic review. 2015

Ozola Zalite, I / Zykus, R / Francisco Gonzalez, M / Saygili, F / Pukitis, A / Gaujoux, S / Charnley, R M / Lyadov, V. ·Pauls Stradins Clinical University Hospital, Riga, Latvia. · Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania. · Complexo Hospitalario Universitario de Ourense, Ourense, Spain. · Department of Gastroenterology Pamukkale University, Denizli, Turkey. · Pauls Stradins Clinical University Hospital, Riga, Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia. · Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Faculté de Medecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France. · North East's Hepato-Pancreato-Biliary Centre at the Freeman Hospital, Newcastle, United Kingdom. · Department of Surgical Oncology, Medical and Rehabilitation Center under the Ministry of Health of Russian Federation, Moscow, Russia. Electronic address: vlyadov@gmail.com. ·Pancreatology · Pubmed #25524484.

ABSTRACT: BACKGROUND/OBJECTIVES: Cachexia affects ∼ 80% of pancreatic cancer patients. An international consensus defines cachexia as an ongoing loss of skeletal muscle mass (sarcopenia) with or without loss of fat, which impairs body functioning and cannot be reversed by conventional nutritional measures. Weight loss percentage and elevated inflammation markers have been employed to define this condition earlier. This review aimed to assess the prevalence and consequences of cachexia and sarcopenia on survival in patients with pancreatic ductal adenocarcinoma. METHODS: The systematic review was performed by searching the articles with preset terms published in PubMed and Cochrane Database until December 2013. After identifying relevant titles, abstracts were read and eligible articles data retrieved on preformatted sheets. The prevalence and impact of sarcopenia/cachexia on survival was evaluated. RESULTS: In total 1145 articles were retrieved, only 10 were eligible. Definitions of cachexia and sarcopenia were heterogeneous. In patients with normal weight (BMI 18.5-24.9 kg/m(2)) the prevalence of sarcopenia ranged from 29.7 to 65%. In overweight or obese patients (BMI >25 kg/m(2)) were 16.2%-67%. Sarcopenia alone was not demonstrated to be an independent factor of decreased survival, although obese sarcopenic patients were shown to have significantly worse survival in two studies. CONCLUSIONS: Impact of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma is currently understudied in the available literature. Definitive association between cachexia and survival cannot be drawn from available studies, although weight loss and sarcopenic obesity might be considered as poor prognostic factors. Further prospective trials utilizing the consensus definition of cachexia and including other confounding factors are needed to investigate the impact of cachexia and sarcopenia on survival in pancreatic adenocarcinoma.

10 Article Computed tomography features of acinar cell carcinoma of the pancreas. 2020

Barat, M / Dohan, A / Gaujoux, S / Hoeffel, C / Jornet, D / Oudjit, A / Coriat, R / Barret, M / Terris, B / Soyer, P. ·Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France. Electronic address: maxime.barat@aphp.fr. · Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France. · Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Abdominal Surgery, Hôpital Cochin, AP-HP, 75014 Paris, France. · Department of Radiology, Hôpital Robert Debré, 51092 Reims, France. · Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France. · Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, AP-HP, 75014 Paris, France. · Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 75014 Paris, France. ·Diagn Interv Imaging · Pubmed #32146131.

ABSTRACT: PURPOSE: To report the computed tomography (CT) features of pancreatic acinar cell carcinoma (ACC) and identify CT features that may help discriminate between pancreatic ACC and pancreatic ductal adenocarcinoma (PDA). MATERIALS AND METHODS: The CT examinations of 20 patients (13 men, 7 women; mean age, 66.5±10.7 [SD] years; range: 51-88 years) with 20 histopathologically proven pancreatic ACC were reviewed. CT images were analyzed qualitatively and quantitatively and compared to those obtained in 20 patients with PDA. Comparisons were performed using univariate analysis with a conditional logistic regression model. RESULTS: Pancreatic ACC presented as an enhancing (20/20; 100%), oval (15/20; 75%), well-delineated (14/20; 70%) and purely solid (13/20; 65%) pancreatic mass with a mean diameter of 52.6±28.0 (SD) mm (range: 24-120mm) in association with visible lymph nodes (14/20; 70%). At univariate analysis, well-defined margins (Odds ratio [OR], 7.00; P=0.005), nondilated bile ducts (OR, 9.00; P=0.007), visible lymph nodes (OR, 4.33; P=0.028) and adjacent organ involvement (OR, 5.67; P=0.02) were the most discriminating CT features to differentiate pancreatic ACC from PDA. When present, lymph nodes were larger in patients with pancreatic ACC (14±4.8 [SD]; range: 7-25mm) than in those with PDA (8.8±4.1 [SD]; range: 5-15mm) (P=0.039). CONCLUSION: On CT, pancreatic ACC presents as an enhancing, predominantly oval and purely solid pancreatic mass that most frequently present with no bile duct dilatation, no visible lymph nodes, no adjacent organ involvement and larger visible lymph nodes compared to PDA.

11 Article McCune Albright syndrome is a genetic predisposition to intraductal papillary and mucinous neoplasms of the pancreas associated pancreatic cancer in relation with GNAS somatic mutation - a case report. 2019

Gaujoux, Sébastien / Pasmant, Eric / Silve, Caroline / Mehsen-Cetre, Nadia / Coriat, Romain / Rouquette, Alexandre / Douset, Bertrand / Prat, Frédéric / Leroy, Karen. ·Department of Digestive, Hepato-biliary and Pancreatic Surgery, Cochin Hospital, APHP. · Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité. · INSERM Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin. · Service de Génétique et Biologie Moléculaires, Hôpital Cochin. · EA7331, Université Paris Descartes. · INSERM U1169, Hôpital Bicêtre. · Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore / Filière OSCAR. · Service de Rhumatologie CHU Bordeaux-Tripode. · Department of Gastroenterology, Cochin Hospital, APHP. · Department of Pathology, Cochin Hospital, APHP, Paris, France. ·Medicine (Baltimore) · Pubmed #31852070.

ABSTRACT: RATIONALE: Intraductal papillary and mucinous neoplasms of the pancreas (IPMN) are preneoplastic lesions diagnosed with an increasing incidence. Recently, several groups have described, in up to 70% of IPMN, activating mutations of the G-protein alpha stimulatory sub-unit (Gsα subunit) gene (GNAS). GNAS-activating somatic, post-zygotic, mutations are also associated with McCune-Albright syndrome (MCAS) characterized by fibrous dysplasia, precocious puberty, and café-au-lait spots. PATIENT CONCERNS: We herein report a patient with McCune Albright Syndrome that presented with malignant IPMN and underwent pancreatic resection. DIAGNOSES AND INTERVENTIONS: Leucocyte and duodenum juice DNA analysis, endoscopically collected from secretin-stimulated pancreatic juice revealed the same (GNAS) activating mutation also found in the invasive pancreatic colloid adenocarcinoma arising from intestinal subtype IPMN. OUTCOMES: Thirty months after surgery, the patient was alive with recurrence (bone only metastasis). LESSONS: In this observation, we show that MCAS should be view as a new genetic predisposition to IPMN associated pancreatic cancer, and consequently a targeted screening in this high-risk population might be proposed.

12 Article GNAS but Not Extended RAS Mutations Spectrum are Associated with a Better Prognosis in Intraductal Pancreatic Mucinous Neoplasms. 2019

Gaujoux, Sébastien / Parvanescu, Alina / Cesaretti, Manuella / Silve, Caroline / Bieche, Ivan / Rebours, Vinciane / Lévy, Philippe / Sauvanet, Alain / Cros, Jérôme. ·Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Clichy, France. sebastien.gaujoux@aphp.fr. · Université Paris Descartes, Paris, France. sebastien.gaujoux@aphp.fr. · INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France. sebastien.gaujoux@aphp.fr. · Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Clichy, France. · Institut National de la Santé et de la Recherche Médicale - Centre de Recherche Biomédicale Bichat Beaujon (CRI)/INSERM U1149, Clichy, France. · Institut National de la Santé et de la Recherche Médicale-U986, Groupe Hospitalier Paris-Sud, Le Kremlin-Bicêtre, France. · Service de Génétique et Biologie Moléculaires, Hôpital Cochin, Paris, France. · Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphore/Filière OSCAR, Le Kremlin-Bicêtre, France. · Unité de Pharmagogénomique, Institut Curie, Paris, France. · Department of Pancreatology-Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Hôpital Beaujon, Clichy, France. · Université Paris Diderot, Paris, France. · Department of Pathology, AP-HP, Hôpital Beaujon, Clichy, France. ·Ann Surg Oncol · Pubmed #31025231.

ABSTRACT: BACKGROUND: The management of intraductal papillary mucinous neoplasms (IPMNs) is mainly based on imaging features and clinical symptoms, and remains challenging. OBJECTIVE: The aim of this study was to assess GNAS, RAS family (KRAS, NRAS and HRAS), BRAF, and PIK3CA mutation status in resected IPMNs and correlate it with clinicopathological characteristics and patient survival. METHODS: Overall, 149 consecutive unselected patients who underwent pancreatectomy for IPMNs were included. After dissection from formalin-fixed and paraffin-embedded tumors, GNAS mutational screening was assessed by allelic discrimination using Taqman RESULTS: Gastric- and intestinal-type IPMNs were the most frequent lesions (52% and 41%, respectively). Intestinal-type IPMNs were more frequently associated high-grade dysplasia (49%) and were the only IPMNs associated with colloid-type carcinoma. All pancreatobiliary IPMNs were invasive lesions, located in the main pancreatic duct. GNAS-activating mutations were strongly associated with the intestinal phenotype (p < 10 CONCLUSION: In patients selected for surgery, GNAS mutation analysis and tumor phenotype can help to better predict patient prognosis. In the near future, a more precise mutational analysis of IPMNs might help to better tailor their management.

13 Article Risk and Predictors of Postoperative Morbidity and Mortality After Pancreaticoduodenectomy for Pancreatic Neuroendocrine Neoplasms: A Comparative Study With Pancreatic Ductal Adenocarcinoma. 2019

Partelli, Stefano / Tamburrino, Domenico / Cherif, Rim / Muffatti, Francesca / Moggia, Elisabetta / Gaujoux, Sébastien / Sauvanet, Alain / Falconi, Massimo / Fusai, Giuseppe. ·Department of HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London, United Kingdom. · Chirurgie Hépato-Bilio-Pancréatique, Beaujon Hospital, Paris. ·Pancreas · Pubmed #30946244.

ABSTRACT: OBJECTIVES: Pancreaticoduodenectomy (PD) is associated with a high risk of postoperative complications and mortality. The aim of this study was to compare postoperative morbidity after PD in patients undergoing resections for pancreatic neuroendocrine neoplasms (PanNENs) with patients undergoing the same resection for pancreatic ductal adenocarcinoma (PDAC). METHODS: Data of 566 patients from 3 European tertiary referral centers between 1998 and 2014 were considered. RESULTS: Overall, 566 patients (179 with PanNENs, 387 with PDAC) who underwent PD were analyzed. Patients with PanNENs were significantly younger (56 vs 64 years, P < 0.0001). The consistency of the pancreas was soft in 147 patients (82%) with PanNENs and in 162 patients (42%) with PDAC (P < 0.0001). Patients in the PanNENs group had a significantly higher rate of pancreatic fistula (P < 0.0001), bile leak (P = 0.004), abdominal collection (P = 0.017), and development of sepsis (P = 0.042). No differences in terms of overall postoperative complications, median length of stay, and in-hospital mortality were found. On multivariate analysis sex (male), PanNENs indication, blood transfusion, and a soft pancreatic texture were independent predictors of pancreatic fistula after PD. CONCLUSIONS: Pancreaticoduodenectomy for PanNENs is associated with higher rate of surgical-specific postoperative complications than those for PDAC.

14 Article On the origin of "indolent" and "aggressive" non-functioning pancreatic neuroendocrine tumour: genetically unrelated or close relative? 2019

Gaujoux, Sébastien. ·Hôpital Cochin, Department of Hepato-Pancreato-Biliary and Endocrine Surgery, AP-HP, Paris, France; Université Paris Descartes, Paris, France. Electronic address: sebastien.gaujoux@aphp.fr. ·Dig Liver Dis · Pubmed #30857826.

ABSTRACT: -- No abstract --

15 Article MR imaging features of pancreatic acinar cell carcinoma. 2019

Jornet, D / Soyer, P / Terris, B / Hoeffel, C / Oudjit, A / Legmann, P / Gaujoux, S / Barret, M / Dohan, A. ·Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. · Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; UMR Inserm 965, 2, rue Amboise-Paré, 75010 Paris, France. · Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. · Department of Radiology, Hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France. · Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France. · Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Abdominal surgery, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. · Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. · Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; UMR Inserm 965, 2, rue Amboise-Paré, 75010 Paris, France. Electronic address: anthony.dohan@aphp.fr. ·Diagn Interv Imaging · Pubmed #30846400.

ABSTRACT: PURPOSE: This study aimed to report the magnetic resonance imaging (MRI) features of acinar cell carcinoma (ACC) of the pancreas including diffusion-weighted MRI findings. MATERIALS AND METHODS: The MRI examinations of five patients (3 men, 2 women; median age, 61years) with histopathologically proven ACC of the pancreas were retrospectively reviewed. MR images were analyzed qualitatively (location, shape, homogeneity, signal intensity, vascular involvement and extrapancreatic extent of ACC) and quantitatively (tumor size, apparent diffusion coefficient [ADC] and normalized ADC of ACC). RESULTS: All ACC were visible on MRI, presenting as an oval pancreatic mass (5/5; 100%), with moderate and heterogeneous enhancement (5/5; 100%), with a median transverse diameter of 43mm (Q CONCLUSIONS: On MRI, ACC of the pancreas presents as a large, oval pancreatic mass with moderate and heterogeneous enhancement after intravenous administration of a gadolinium chelate, with restricted diffusion and a median ADC value of 1.061×10

16 Article Pancreatectomy for pancreatic incidentaloma: What are the risks? 2018

Bouquot, Morgane / Gaujoux, Sébastien / Cauchy, François / Birnbaum, David / Dokmak, Safi / Levy, Philippe / Soubrane, Olivier / Sauvanet, Alain. ·AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery - DHU Unity, Clichy, 92110, France. · AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery - DHU Unity, Clichy, 92110, France; University Paris Descartes, Paris, France. · AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery - DHU Unity, Clichy, 92110, France; University Paris Diderot, Paris, France. · University Paris Diderot, Paris, France; AP-HP, Hôpital Beaujon, Department of Pancreatology- DHU Unity, Clichy, 92110, France. · AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery - DHU Unity, Clichy, 92110, France; University Paris Diderot, Paris, France. Electronic address: alain.sauvanet@aphp.fr. ·Pancreatology · Pubmed #29146108.

ABSTRACT: BACKGROUND: Pancreatic incidentalomas (PI) are nowadays common but the benefit-risk balance of surgery remains difficult to determine. METHODS: Monocentric retrospective study of 881 pancreatectomies comparing resected PI with symptomatic lesion. Univariate and multivariate (MV) analyses were done to identify risk factors of malignancy in PI undergoing surgery. RESULTS: Overall, 32% of pancreatectomies were performed for PI. Median size of PI was 30 mm (vs 28 mm; p = 0.15) and 49% were cystic (vs 42%; p = 0.197). Resected PI were mostly located in distal pancreas (61% vs 34%; p < 0.001), less frequently malignant (49% vs 59%; p = 0.004). PNETs were more frequent in PI (50% vs 21%; p < 0.001). Distal pancreatectomy (36% vs 23%; p < 0.001) or parenchyma-sparing surgery (34% vs 13%; p < 0.001) were more frequently performed for PI. Overall mortality (1.1% vs 1.2%) and morbidity (70% vs 68%) were not significantly different between both groups. Severe morbidity was lower for PI (15% vs 22%; p = 0.007). In multivariate analysis, age>55 years (HR 6.14; p < 0.001), size >20 mm (HR:26.7; p < 0.001) and biliary dilatation (HR 29.9; p = 0.027) were independent risk factors of malignancy and, when associated, the likelihood of malignancy was above 90%. CONCLUSIONS: PI represent about 30% of indications for pancreatectomy and when resected after careful selection are malignant in 50% of cases.

17 Article Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors - a multi-institutional study. 2018

Sallinen, Ville J / Le Large, Tessa Y S / Tieftrunk, Elke / Galeev, Shamil / Kovalenko, Zahar / Haugvik, Sven-Petter / Antila, Anne / Franklin, Oskar / Martinez-Moneo, Emma / Robinson, Stuart M / Panzuto, Francesco / Regenet, Nicolas / Muffatti, Francesca / Partelli, Stefano / Wiese, Dominik / Ruszniewski, Philippe / Dousset, Bertrand / Edwin, Bjørn / Bartsch, Detlef K / Sauvanet, Alain / Falconi, Massimo / Ceyhan, Güralp O / Gaujoux, Sebastien / Anonymous100922. ·Department of Abdominal Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. Electronic address: ville.salinen@helsinki.fi. · Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. · General Surgery Department, Saint Luke's Clinical Hospital, Saint Petersburg, Russia. · Federal Medical and Rehabilitation Center, Department of Surgical Oncology, Moscow, Russia. · The Intervention Center, Oslo University Hospital, Oslo, Norway; Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. · Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. · Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden. · Gastroenterology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain. · Department of HPB Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. · Digestive and Liver Disease Unit, Sant'Andrea Hospital - Sapienza University of Rome, Italy. · Department of Digestive and Endocrine Surgery, Institut des Maladies Digestives (IMAD), Nantes 44093, France. · Chirurgia Del Pancreas, Chirurgia Del Pancreas, Pancreas Translational & Clinical Research Center, Università Vita e Salute, Ospedale San Raffaele IRCC, Milano, Italy. · Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany. · Department of Gastroenterology, Pôle des Maladies de L'Appareil Digestif (PMAD), DHU Unity, Clichy 92110, France; Université Paris Diderot, Paris, France. · Department of Digestive, Pancreatic and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. · The Intervention Center, Oslo University Hospital, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Université Paris Diderot, Paris, France; AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de L'Appareil Digestif (PMAD), DHU Unity, University Paris VII, AP-HP, Hôpital Beaujon, Clichy 92110, France. ·HPB (Oxford) · Pubmed #28988702.

ABSTRACT: BACKGROUND: Malignant potential of small (≤20 mm) nonfunctional pancreatic neuroendocrine tumors (sNF-PNET) is difficult to predict and management remain controversial. The aim of this study was to assess the prognosis of sporadic nonmetastatic sNF-PNETs. METHODS: Patients were identified from databases of 16 centers. Outcomes and risk factors for recurrence were identified by uni- and multivariate analyses. RESULTS: sNF-PNET was resected in 210 patients, and 66% (n = 138) were asymptomatic. Median age was 60 years, median tumor size was 15 mm, parenchyma-sparing surgery was performed in 42%. Postoperative mortality was 0.5% (n = 1), severe morbidity rate was 14.3% (n = 30), and 14 of 132 patients (10.6%) with harvested lymph nodes had metastatic lymph nodes. Tumor size, presence of biliary or pancreatic duct dilatation, and WHO grade 2-3 were independently associated with recurrence. Patients with tumors sized ≤10 mm were disease free at last follow-up. The 1-, 3- and 5-year disease-free survival rates for patients with tumors sized 11-20 mm on preoperative imaging were 95.1%, 91.0%, and 87.3%, respectively. CONCLUSIONS: In sNF-PNETs, the presence of biliary or pancreatic duct dilatation or WHO grade 2-3 advocate for surgical treatment. In the remaining patients, a wait-and-see policy might be considered.

18 Article Insulinoma enucleation after echoendoscopic fiducial placement. 2018

Gaujoux, Sébastien / Genc, Seray / Leblanc, Sarah / Dousset, Bertrand / Prat, Frédéric. ·Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne, Paris, France; INSERM Unité 1016, Centre National de la Recherche Scientifique, Institut Cochin, Paris, France. · Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France. · Department of Gastroenterology, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France. · Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne, Paris, France; Department of Gastroenterology, Cochin Hospital, Assistance Publique - Hopitaux de Paris, Paris, France. ·Gastrointest Endosc · Pubmed #28807758.

ABSTRACT: -- No abstract --

19 Article Consequences of metabolic syndrome on postoperative outcomes after pancreaticoduodenectomy. 2017

Zarzavadjian Le Bian, Alban / Fuks, David / Chopinet, Sophie / Gaujoux, Sébastien / Cesaretti, Manuela / Costi, Renato / Belgaumkar, Ajay P / Smadja, Claude / Gayet, Brice. ·Alban Zarzavadjian Le Bian, Manuela Cesaretti, Renato Costi, Department of Digestive Surgery, Centre Hospitalier Simone Veil, 95600 Eaubonne, France. ·World J Gastroenterol · Pubmed #28533671.

ABSTRACT: AIM: To analyze immediate postoperative outcomes after pancreaticoduodenectomy regarding metabolic syndrome. METHODS: In two academic centers, postoperative outcomes of patients undergoing pancreaticoduodenectomy from 2002 to 2014 were prospectively recorded. Patients presenting with metabolic syndrome [defined as at least three criteria among overweight (BMI ≥ 28 kg/m²), diabetes mellitus, arterial hypertension and dyslipidemia] were compared to patients without metabolic syndrome. RESULTS: Among 270 consecutive patients, 29 (11%) presented with metabolic syndrome. In univariable analysis, patients with metabolic syndrome were significantly older (69.4 years CONCLUSION: In spite of logical reasoning and appropriate methodology, present series suggests that metabolic syndrome does not jeopardize postoperative outcomes after pancreaticoduodenectomy. Therefore, definition of metabolic syndrome seems to be inappropriate and fatty pancreas needs to be assessed with an international consensual histopathological classification.

20 Article Surgery for pancreatic neoplasms: How accurate are our surgical indications? 2017

Birnbaum, David Jérémie / Gaujoux, Sébastien / Berbis, Julie / Dokmak, Safi / Hammel, Pascal / Vullierme, Marie Pierre / Lévy, Philippe / Sauvanet, Alain. ·AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France. · AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Clichy, France. · AP-HM, Hospital Timone, EA3279 Self-perceived Health Assessment Research Unit and Department of Public Health, Aix-Marseille University, Marseille, France. · Université Paris Diderot, Paris, France; AP-HP, Hôpital Beaujon, Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France. · AP-HP, Hôpital Beaujon, Department of Radiology, Clichy, France. · AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France; Université Paris Diderot, Paris, France. Electronic address: alain.sauvanet@aphp.fr. ·Surgery · Pubmed #28237644.

ABSTRACT: BACKGROUND: Accurate preoperative diagnosis is critical for the determination of appropriate surgical indications. The aim of this study was to assess the accuracy of preoperative diagnosis and indications for operative therapy for presumed pancreatic neoplasms. METHODS: From 2005 to 2013, 851 patients underwent pancreatectomies for presumed pancreatic neoplasms. A formal preoperative diagnosis was established during a multidisciplinary tumor board and compared to the final pathologic examination. The preoperative diagnosis and its accuracy were assessed according to demographics, symptoms, and diagnostic workup. RESULTS: Tumors were benign in 8% of patients (n = 67), premalignant in 43% (n = 370), and malignant in 49% (n = 414). The mean number of preoperative examinations was 3.2; 27% (n = 144) of patients had computed tomography, magnetic resonance imaging, endoscopic ultrasonography, and fine needle examination all performed together. Preoperative diagnosis was confirmed in 89% of patients (n = 754). The morbidity and mortality rates were 65% and 1%, respectively. Of the 97 patients (11%) with a misdiagnosis, operative resection was ultimately relevant (premalignant, malignant tumor, or symptomatic benign tumor) in 51 (6%) but inappropriate in 46 (5%). The rate of misdiagnosis was increased for cystic lesions and in patients under 50 years of age. For lesions <2 cm, diagnostic accuracy was increased when computed tomography, magnetic resonance imaging, endoscopic ultrasonography, and fine needle examination were all performed together. CONCLUSION: Misdiagnosis can lead to an inappropriate resection in 5% of patients with presumed pancreatic neoplasms. For lesions difficult to characterize, such as small and cystic lesions, association of several modalities of preoperative workup could help to decrease the rate of inappropriate operative care.

21 Article Reappraisal of pancreatic enucleations: A single-center experience of 126 procedures. 2015

Faitot, Francois / Gaujoux, Sébastien / Barbier, Louise / Novaes, Marleny / Dokmak, Safi / Aussilhou, Béatrice / Couvelard, Anne / Rebours, Vinciane / Ruszniewski, Philippe / Belghiti, Jacques / Sauvanet, Alain. ·AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France. · AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France. · AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France. · AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France; AP-HP, Department of Pathology, Hôpital Beaujon, DHU UNITY, Clichy, France. · Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France; AP-HP, Department of Gastroenterology, Hôpital Beaujon, DHU UNITY, Clichy, France. · AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France. Electronic address: alain.sauvanet@bjn.aphp.fr. ·Surgery · Pubmed #25956743.

ABSTRACT: BACKGROUND: Parenchyma-sparing pancreatectomies, especially enucleations, could avoid disappointing functional results associated with standard resections for benign/low-grade pancreatic neoplasms. This study aimed to assess short- and long-term outcomes in a large, single-center series of enucleations. METHODS: All 126 patients who underwent enucleation for benign/low-grade neoplasms between 1996 and 2011 were included retrospectively. RESULTS: Lesions were mainly incidentally diagnosed (71%), most often located in the head (46%), and with a median size of 20 mm. Enucleations were mainly performed for branch-duct intraductal papillary mucinous neoplasm (30%), nonfunctioning pancreatic neuroendocrine tumors (29%), and mucinous cystadenoma (21%). Overall mortality was 0.8% and morbidity 63%, mainly owing to pancreatic fistula (57%). Most were significant clinically, that is, grade B or C (41%), but managed conservatively (85%). Reoperation rate was 3%, mainly owing to hemorrhage. Postoperative de novo diabetes was 0.8%, and exocrine insufficiency never observed. The 1-, 3-, and 5-year recurrence-free survival were 100%, 98%, and 93%, respectively. CONCLUSION: Enucleation is associated with substantial morbidity, especially pancreatic fistula. Enucleations as an alternative to standard resection are best indicated for small, benign, and low-grade lesions located far from the main pancreatic duct. Enucleations should be proposed to young and fit patients able to tolerate postoperative morbidity and who could benefit from the excellent long-term results.

22 Article Obesity and Fatty Pancreatic Infiltration Are Risk Factors for Pancreatic Precancerous Lesions (PanIN). 2015

Rebours, Vinciane / Gaujoux, Sébastien / d'Assignies, Gaspard / Sauvanet, Alain / Ruszniewski, Philippe / Lévy, Philippe / Paradis, Valérie / Bedossa, Pierre / Couvelard, Anne. ·Pancreatology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. vinciane.rebours@bjn.aphp.fr. · Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. Pancreatic Surgery Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. · Radiology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. · Pancreatic Surgery Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. · Pancreatology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. · Pancreatology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. · Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. Pathology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, Paris-Diderot University, Paris, France. · Inserm U773-CRB3, DHU Unity, Paris-Diderot University, Paris, France. Pathology Department, Bichat Hospital, DHU Unity, AP-HP, Paris-Diderot University, Paris, France. ·Clin Cancer Res · Pubmed #25700304.

ABSTRACT: PURPOSE: The roles of intravisceral and subcutaneous fat are unknown, and the prevalence of precancerous lesions in obese patients was never evaluated. This study aims to assess the frequency and severity of pancreatic intraepithelial neoplasia (PanIN) and to correlate pathologic findings with metabolic abnormalities, type of fat, and fatty pancreatic infiltration. EXPERIMENTAL DESIGN: Normal pancreatic tissue from surgical specimens was analyzed. Fatty infiltration and fibrosis in intra- and extralobular locations and PanIN lesions were assessed. General characteristics were collected: body mass index (BMI), diabetes, and tobacco intake. Liver steatosis and subcutaneous and intravisceral fat were assessed by CT scan (ImageJ software). RESULTS: Of note, 110 patients were included [median age, 53.8 (17-85) years]. Arterial hypertension, diabetes, and tobacco intake were found in 19%, 9%, and 23%, respectively. Median BMI was 24 (16-37; BMI < 25: 45%, 25 ≤ 30: 24%, ≥30: 11%). Overall, PanIN lesions were found in 65% (type I, II, and III PanIN in 62%, 38%, and 1%, respectively). Fibrosis and fatty pancreas (intra- and extralobular locations) were found in 1% and 24% and in 30% and 51%, respectively. A correlation was observed between PanIN lesions and fatty pancreas [extralobular (0.01) and intralobular (<0.0001)], intralobular fibrosis (0.003), high BMI (P = 0.02), and subcutaneous (P = 0.02) and intravisceral fat (P = 0.02). The number of PanIN lesions was correlated with intravisceral fat (r = 0.22, P = 0.04), but not with subcutaneous fat (r = 0.14, P = 0.22). In multivariate analysis, PanIN lesions were associated with intralobular fibrosis [OR, 5.61; 95% confidence interval (CI), 1.18-42.99] and intralobular fat (OR, 17.86; 95% CI, 4.935-88.12). CONCLUSIONS: Obesity (especially android obesity) and pancreatic fatty infiltration are risk factors for pancreatic precancerous lesions.

23 Article Long-term Prognosis of Resected Pancreatic Neuroendocrine Tumors in von Hippel-Lindau Disease Is Favorable and Not Influenced by Small Tumors Left in Place. 2015

de Mestier, Louis / Gaujoux, Sébastien / Cros, Jérôme / Hentic, Olivia / Vullierme, Marie-Pierre / Couvelard, Anne / Cadiot, Guillaume / Sauvanet, Alain / Ruszniewski, Philippe / Richard, Stéphane / Hammel, Pascal. ·*Department of Gastroenterology and Pancreatology, Beaujon Hospital, Clichy, France; †Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré Hospital, Reims-Champagne-Ardennes University, Reims, France; ‡Department of Hepato-Pancreatico-Biliary Surgery, Beaujon Hospital, Clichy, France; §Denis-Diderot University, Paris, France; Departments of ¶Pathology, and ‖Radiology, Beaujon Hospital, Clichy, France; **Department of Pathology, Bichat Hospital, Paris, France; ††Expert National Center for Rare Cancers PREDIR, INCa/APHP, Bicêtre Hospital, Le Kremlin-Bicêtre, France; and ‡‡Oncogenetics EPHE Laboratory and INSERM U753, Faculty of Medicine Paris Sud, Le Kremlin-Bicêtre, France. ·Ann Surg · Pubmed #25185468.

ABSTRACT: BACKGROUND: Management of pancreatic neuroendocrine tumors (PNETs) associated with von Hippel-Lindau disease (VHL) is challenging because of the malignant potential and difficulty in predicting prognosis. OBJECTIVE: Compare the long-term outcome of resected VHL-PNET and sporadic PNET. METHODS: Data of all patients with VHL (n = 23) operated on for nonmetastatic PNET were reviewed. Patient characteristics and recurrence-free survival rates were compared with those in patients operated on for sporadic PNET, matched for tumor size, stage, and Ki-67 index. RESULTS: Patients in both groups had similar demographic characteristics, except that patients with VHL were younger (36 vs 56 years, P < 0.0001). Median tumor size was 30 mm. Median Ki-67 index was 3% and 4% in the VHL and sporadic groups (P = 0.95), respectively, and lymph node metastases were present in 43% and 30% of cases, respectively (P = 0.45). Sixteen (70%) patients with VHL had multiple PNET; lesions less than 15 mm were left in place in 11 patients. Median postoperative follow-up was 107 months (interquartile range, 57-124 months) and 71 months (interquartile range, 58-131 months) in the VHL and control groups, respectively. Median recurrence-free survival could not have been estimated in the VHL group due to the low number of events (hazard ratio, 5.6; 95% confidence interval, 1.4-22.6; P = 0.013). Five patients with VHL died (3 from VHL-related tumors including 1 from PNET), whereas only one control patient died due to unrelated causes. CONCLUSIONS: The long-term outcome of resected VHL-PNET is better than that of sporadic PNET. PNET less than 15 mm left in place did not progress. A parenchyma-sparing surgical strategy seems appropriate in patients with VHL-PNET, who may develop more life-threatening tumors of other organs.

24 Article Lessons from McCune-Albright syndrome-associated intraductal papillary mucinous neoplasms: : GNAS-activating mutations in pancreatic carcinogenesis. 2014

Parvanescu, Alina / Cros, Jérôme / Ronot, Maxime / Hentic, Olivia / Grybek, Virginie / Couvelard, Anne / Levy, Philippe / Chanson, Philippe / Ruszniewski, Philippe / Sauvanet, Alain / Gaujoux, Sebastien. ·Assistance Publique-Hôpitaux de Paris, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France2Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris. · Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris-Nord Val de Seine, Paris, France3Assistance Publique-Hôpitaux de Paris, Department of Pathology, Hôpital Beaujon, Clichy, France4Université Paris Diderot, Paris. · Université Paris Diderot, Paris, France5Assistance Publique-Hôpitaux de Paris, Department of Radiology, Hôpital Beaujon, Clichy, France. · Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France. · Institut National de la Santé et de la Recherche Médicale, Unité 986, Groupe Hospitalier Paris-Sud, Le Kremlin-Bicêtre, France. · Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris-Nord Val de Seine, Paris, France4Université Paris Diderot, Paris, France8Assistance Publique-Hôpitaux de Paris, Department of Pathology, Hôpital Bichat, Paris. · Université Paris Diderot, Paris, France6Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France. · Université Paris-Sud 11, Unité Mixte de Recherche 693, Le Kremlin-Bicêtre, France10Assistance Publique-Hôpitaux de Paris, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Service d'Endocrinologie et des Maladies de la Reproduction. · Institut National de la Santé et de la Recherche Médicale, Unité 773, Groupe Hospitalier Paris-Nord Val de Seine, Paris, France4Université Paris Diderot, Paris, France6Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology, Hôpital Beaujon. · Assistance Publique-Hôpitaux de Paris, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, Pôle des Maladies de l'Appareil Digestif, Clichy, France4Université Paris Diderot, Paris, France. ·JAMA Surg · Pubmed #24898823.

ABSTRACT: GNAS-activating mutations are reported in intraductal papillary mucinous neoplasms (IPMNs) and in McCune-Albright syndrome, characterized by fibrous dysplasia, precocious puberty, and café au lait spots. Recently, IPMNs have been described as a McCune-Albright syndrome-associated tumor, present in about 15% of patients. The aim of the present work was to assess the prevalence of polyostotic fibrous dysplasia and McCune-Albright syndrome among patients operated on for presumptive sporadic IPMNs. All patients operated on for IPMNs between January 1, 2007, and December 31, 2012, with available imaging were retrospectively screened for polyostotic fibrous dysplasia based on their preoperative abdominal or thoracoabdominal spiral computed tomography images. Systematic screening of 272 patients operated on for IPMNs revealed 1 patient with axial and peripheral polyostotic fibrous dysplasia and café au lait spots on clinical examination suggestive of McCune-Albright syndrome. This patient had been operated on for an unusually large invasive colloid adenocarcinoma (pT3N0M0 R0) derived from an intestinal subtype GNAS-mutated IPMN. The patient underwent adjuvant chemotherapy with gemcitabine for 6 months and was alive without recurrence 6 years later. Besides providing additional evidence of a syndromic IPMN as a feature of McCune-Albright syndrome, this observation is further evidence of the functional oncogenic consequences of GNAS mutations in the pancreas.

25 Article Reappraisal of central pancreatectomy a 12-year single-center experience. 2014

Goudard, Yvain / Gaujoux, Sebastien / Dokmak, Safi / Cros, Jérôme / Couvelard, Anne / Palazzo, Maxime / Ronot, Maxime / Vullierme, Marie-Pierre / Ruszniewski, Philippe / Belghiti, Jacques / Sauvanet, Alain. · ·JAMA Surg · Pubmed #24740703.

ABSTRACT: IMPORTANCE: Central pancreatectomy, as an alternative to standard resection for benign and low-grade pancreatic neoplasms, has been described in mainly small retrospective series. OBJECTIVE: To describe a large single-center experience with central pancreatectomy. DESIGN, SETTING, AND PARTICIPANTS: A retrospective case series in a tertiary referral center included 100 consecutive patients undergoing central pancreatectomy with pancreaticogastrostomy from January 1, 2000, to March 1, 2012. MAIN OUTCOMES AND MEASURES: Surgical indications, postoperative morbidity, mortality, and long-term outcomes regarding pancreatic function and recurrence. RESULTS: Central pancreatectomies were performed mainly for neuroendocrine tumors (35%), intraductal papillary mucinous neoplasms (33%), solid pseudopapillary neoplasms(12%), and mucinous cystadenomas (6%). The postoperative mortality rate was 3% (due to pulmonary embolisms in 2 patients and hemorrhage after pancreatic fistula in 1 patient). Clavien-Dindo III or IV complications occurred in 15%of patients and were due mainly to pancreatic fistula, requiring 10 radiologic drainage procedures, 7 endoscopic procedures, and 6 reoperations overall. After a median follow-up of 36 months, the rates of new-onset exocrine and endocrine insufficiency were 6%and 2%, respectively. Overall, 7 lesions could be considered undertreated, including 3 node-negative R0 microinvasive intraductal papillary mucinous neoplasms (without recurrence at 27, 29, and 34 months) and 4 node-positive neuroendocrine tumors (with 1 hepatic recurrence at 66 months). Among the 25 patients with a doubtful preoperative diagnosis, 9 could be considered over treated (ie, operated on for benign non evolutive asymptomatic lesions). CONCLUSIONS AND RELEVANCE: Central pancreatectomy is associated with an excellent pancreatic function at the expense of a significant morbidity and a non-nil mortality rate,underestimated by the published literature. The procedure is best indicated for benign or low-grade lesions in young and fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results.

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