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Pancreatic Neoplasms: HELP
Articles by Knut Jørgen Labori
Based on 24 articles published since 2010
(Why 24 articles?)
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Between 2010 and 2020, Knut Jørgen Labori wrote the following 24 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 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.

2 Review Laparoscopic Completion Pancreatectomy for Local Recurrence in the Pancreatic Remnant after Pancreaticoduodenectomy: Case Reports and Review of the Literature. 2016

Sahakyan, Mushegh A / Yaqub, Sheraz / Kazaryan, Airazat M / Villanger, Olaug / Berstad, Audun Elnæs / Labori, Knut Jørgen / Edwin, Bjørn / Røsok, Bård Ingvald. ·The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway. sahakyan.mushegh@gmail.com. · Institute for Clinical Research, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com. · Department of Hepato-Pancreato-Billiary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Department of Surgery, Finnmark Hospital, Kirkenes, Norway. · Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Institute for Clinical Research, Medical Faculty, University of Oslo, Oslo, Norway. ·J Gastrointest Cancer · Pubmed #26732389.

ABSTRACT: -- No abstract --

3 Review Pancreatic surgery with vascular reconstruction in patients with locally advanced pancreatic neuroendocrine tumors. 2013

Haugvik, Sven-Petter / Labori, Knut Jørgen / Waage, Anne / Line, Pål-Dag / Mathisen, Øystein / Gladhaug, Ivar Prydz. ·Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. svhaug@ous-hf.no ·J Gastrointest Surg · Pubmed #23670519.

ABSTRACT: INTRODUCTION: Pancreatic neuroendocrine tumors (PNET) are rare neoplasms with better prognosis than most pancreatic malignancies. Surgery of locally advanced PNET remains controversial, and the role of vascular reconstruction in this patient group has yet to be defined. The aim of this study was to evaluate the feasibility and outcome of pancreatic resections with vascular reconstruction in patients with locally advanced PNET. METHODS: Retrospective analysis of patients who underwent pancreatic surgery with vascular reconstruction for locally advanced PNET at a single institution. Furthermore, a review of the relevant literature on the topic was performed. RESULTS: Seven patients who had undergone vascular reconstruction for locally advanced PNET were identified. Four patients had liver metastases at time of surgery. Postoperative complications developed in four patients with no mortality. Median follow-up time of all patients was 21 (range, 3-58) months. Three patients had disease in remission after 58, 42 and 3 months, respectively. One patient died 35 months postoperatively due to progressive disease, whereas three patients had progression of disease after 21, 9, and 4 months postoperatively. CONCLUSION: Pancreatic surgery with vascular reconstruction in patients with locally advanced PNET is feasible with acceptable outcome.

4 Review Surgical treatment of sporadic pancreatic neuroendocrine tumors: a state of the art review. 2012

Haugvik, Sven-Petter / Labori, Knut Jørgen / Edwin, Bjørn / Mathisen, Øystein / Gladhaug, Ivar Prydz. ·Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway. svhaug@ous-hf.no ·ScientificWorldJournal · Pubmed #23304085.

ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor classification.

5 Clinical Trial Neoadjuvant chemotherapy versus surgery first for resectable pancreatic cancer (Norwegian Pancreatic Cancer Trial - 1 (NorPACT-1)) - study protocol for a national multicentre randomized controlled trial. 2017

Labori, Knut Jørgen / Lassen, Kristoffer / Hoem, Dag / Grønbech, Jon Erik / Søreide, Jon Arne / Mortensen, Kim / Smaaland, Rune / Sorbye, Halfdan / Verbeke, Caroline / Dueland, Svein. ·Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. uxknab@ous-hf.no. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. · Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway. · Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. · Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. · Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway. · Department of Clinical Medicine, University of Bergen, Bergen, Norway. · Department of Gastrointestinal and Hepatobiliary Surgery, University Hospital of Northern Norway, Tromsø, Norway. · Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway. · Department of Oncology, Haukeland University Hospital, Bergen, Norway. · Department of Clinical Science, Haukeland University Hospital, University of Bergen, Bergen, Norway. · Department of Pathology, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Department of Oncology, Oslo University Hospital, Oslo, Norway. ·BMC Surg · Pubmed #28841916.

ABSTRACT: BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer-related death. While surgical resection remains the foundation for potentially curative treatment, survival benefit is achieved with adjuvant oncological treatment. Thus, completion of multimodality treatment (surgical resection and (neo)adjuvant chemotherapy) to all patients and early treatment of micrometastatic disease is the ideal goal. NorPACT-1 aims to test the hypothesis that overall mortality at one year after allocation of treatment can be reduced with neoadjuvant chemotherapy in surgically treated patients with resectable pancreatic cancer. METHODS/DESIGN: The NorPACT- 1 is a multicentre, randomized controlled phase III trial organized by the Norwegian Gastrointestinal Cancer Group for Hepato-Pancreato-Biliary cancer. Patients with resectable adenocarcinoma of the pancreatic head are randomized to receive either surgery first (Group 1: SF/control) or neoadjuvant chemotherapy (Group 2: NT/intervention) with four cycles FOLFIRINOX followed by resection. Both groups receive adjuvant chemotherapy with gemicitabine and capecitabine (six cycles in Group 1, four cycles in Group 2). In total 90 patients will be randomized in all the five Norwegian university hospitals performing pancreatic surgery. Primary endpoint is overall mortality at one year following commencement of treatment for those who ultimately undergo resection. Secondary endpoints are overall survival after date of randomization (intention to treat), overall survival after resection, disease-free survival, histopathological response, complication rates after surgery, feasibility of neoadjuvant and adjuvant chemotherapy, completion rates of all parts of multimodal treatment, and quality-of-life. Bolt-on to the study is a translational research program that aims at identifying factors that are predictive of response to NT, the risk of distant cancer spread, and patient outcome. DISCUSSION: NorPACT- 1 is designed to investigate the additional benefit of NT compared to standard treatment only (surgery + adjuvant chemotherapy) for resectable cancer of the pancreatic head to decrease early mortality (within one year) in resected patients. TRIAL REGISTRATION: Trial open for accrual 01.02.2017. ClinicalTrials.gov Identifier: NCT02919787 . Date of registration: September 14, 2016.

6 Article Circulating Tumor Cells are an Independent Predictor of Shorter Survival in Patients Undergoing Resection for Pancreatic and Periampullary Adenocarcinoma. 2020

Hugenschmidt, Harald / Labori, Knut Jørgen / Brunborg, Cathrine / Verbeke, Caroline Sophie / Seeberg, Lars Thomas / Schirmer, Cecilie Bendigtsen / Renolen, Anne / Borgen, Elin Faye / Naume, Bjørn / Wiedswang, Gro. ·Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Department of Transplantation Surgery, Division of Transplantation Medicine, Oslo University Hospital, Oslo, Norway. · Department of GI-Surgery, Division of Surgery and Oncology, Oslo University Hospital, Oslo, Norway. · Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway. · Department of Pathology, Oslo University Hospital, Oslo, Norway. · Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway. · Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway. ·Ann Surg · Pubmed #30216219.

ABSTRACT: OBJECTIVE: We evaluated the prognostic impact of circulating tumor cells (CTCs) for patients with presumed resectable pancreatic and periampullary cancers. SUMMARY OF BACKGROUND DATA: Initial treatment decisions for this group are currently taken without a reliable prognostic marker. The CellSearch system allows standardized CTC-testing and has shown excellent specificity and prognostic value in other applications. METHODS: Preoperative blood samples from 242 patients between September 2009 and December 2014 were analyzed. One hundred seventy-nine patients underwent tumor resection, of whom 30 with stage-I tumors and duodenal cancer were assigned to the low-risk group, and the others to the high-risk group. Further 33 had advanced disease, 30 benign histology. Observation ended in December 2016. Cancer-specific survival (CSS) and disease-free survival (DFS) were calculated by log-rank and Cox regression. RESULTS: CTCs (CTC-positive; ≥1 CTC/7.5 mL) were detected in 6.8% (10/147) of the high-risk patients and 6.2% (2/33) with advanced disease. No CTCs (CTC-negative) were detected in the low-risk patients or benign disease. In high-risk patients, median CSS for CTC-positive versus CTC-negative was 8.1 versus 20.0 months (P < 0.0001), and DFS 4.0 versus 10.5 months (P < 0.001). Median CSS in advanced disease was 7.7 months. Univariate hazard ratio (HR) of CTC-positivity was 3.4 (P < 0.001). In multivariable analysis, CTC-status remained independent (HR: 2.4, P = 0.009) when corrected for histological type (HR: 2.7, P = 0.030), nodal status (HR: 1.7, P = 0.016), and vascular infiltration (HR: 1.7, P = 0.001). CONCLUSION: Patients testing CTC-positive preoperatively showed a detrimental outcome despite successful tumor resections. Although the low CTC-rate seems a limiting factor, results indicate high specificity. Thus, preoperative analysis of CTCs by this test may guide treatment decisions and warrants further testing in clinical trials.

7 Article Clinical relevance of pancreatobiliary and intestinal subtypes of ampullary and duodenal adenocarcinoma: Pattern of recurrence, chemotherapy, and survival after pancreatoduodenectomy. 2019

Bowitz Lothe, Inger Marie / Kleive, Dyre / Pomianowska, Ewa / Cvancarova, Milada / Kure, Elin / Dueland, Svein / Gladhaug, Ivar P / Labori, Knut Jørgen. ·Department of Pathology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway. · Department of Surgery, Baerum Hospital, Vestre Viken Hospital Trust, Norway. · Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway. · Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. · Department of Oncology, Oslo University Hospital, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway. Electronic address: uxknab@ous-hf.no. ·Pancreatology · Pubmed #30713128.

ABSTRACT: BACKGROUND: The clinical relevance of the classification of ampullary adenocarcinoma (AC) into pancreatobiliary (PB) or intestinal (Int) subtypes has not been resolved. METHODS: Clinicopathological factors, survival, and localization and treatment of recurrence were investigated for patients with AC and duodenal adenocarcinoma (DC) treated by pancreatoduodenectomy from 2000 to 2015. RESULTS: A total of 109 AC (45 PB, 64 Int) and 71 DC (all Int) were identified. Median overall survival (OS) for ACPB vs DC vs ACInt was 43.6 vs 51 vs 75 months, respectively. ACPB had significantly shorter OS than ACInt (p = 0.036). However, for AC stage (HR = 2.39; 95 %CI 1.23-4.64, p = 0.010) was the only factor associated with mortality risk in multivariate analysis. Localization of recurrence (n = 88) was predominantly distant (ACPB 81.5%; ACInt 92%; DC 91.7%, p = 0.371). Post-recurrence survival (PRS) for ACPB, ACInt and DC did not differ (6.9 vs 9.2 vs 7.5 months, p = 0.755). Best supportive care or palliative chemotherapy were offered for recurrent disease to 44.5%/48.1% for ACPB, 40%/56% for ACInt, and 41.7%/52.8% for DC (p = 0.947). The choice of chemotherapy regimen varied considerably. Five patients underwent surgical resection or ablation with curative intent. All deaths among ACPB were caused by recurrent disease, whereas 29.4% of ACInt and 23.1% of DC deaths was non-cancer related or caused by other specific cancer. CONCLUSION: ACPB, ACInt and DC have similar recurrence patterns and PRS. The difference in survival between ACPB and ACInt was not statistically significant when stratified by stage. The optimal chemotherapy in patients with recurrent AC remains undefined.

8 Article Extended laparoscopic distal pancreatectomy for adenocarcinoma in the body and tail of the pancreas: a single-center experience. 2018

Sahakyan, Mushegh A / Kleive, Dyre / Kazaryan, Airazat M / Aghayan, Davit L / Ignjatovic, Dejan / Labori, Knut Jørgen / Røsok, Bård Ingvald / Edwin, Bjørn. ·Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com. · The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. · The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway. · Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway. · Department of Faculty Surgery N2, I.M, Sechenov First Moscow State Medical University, Moscow, Russia. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. ·Langenbecks Arch Surg · Pubmed #30417281.

ABSTRACT: PURPOSE: Extended resection is required for pancreatic adenocarcinoma infiltrating adjacent organs and structures. The role of laparoscopy in this setting is unclear. In this study, the outcomes of extended laparoscopic distal pancreatectomy (ELDP) for pancreatic body/tail adenocarcinoma were examined. METHODS: Perioperative and oncologic data were analyzed in patients undergoing laparoscopic distal pancreatectomy (LDP) for adenocarcinoma at Oslo University Hospital. ELDP was defined as suggested by the International Study Group for Pancreatic Surgery. The outcomes of ELDP were compared to those following standard LDP (SLDP). RESULTS: From August 2001 to June 2016, 460 consecutive patients underwent LDP for pancreatic neoplasms including 116 (25%) adenocarcinoma. SLDP and ELDP were applied in 78 and 31 patients, respectively. The adrenal gland (33%) and colon (21%) were the most frequently resected organs during ELDP. The latter was associated with larger tumor size (5.5 vs 4 cm, p = 0.03), longer operative time (236 vs 158 min, p = 0.001) and higher conversion rate (16 vs 3%, p = 0.019) compared with SLDP. Morbidity and 90-day mortality were similar. Median follow-up was 18 months. In patients with ductal adenocarcinoma, ELDP (n = 22) was associated with significantly shorter recurrence-free and overall survival than SLDP (n = 59) (6.2 vs 9.6 months, p = 0.047 and 12.9 vs 27 months, p < 0.01, respectively). CONCLUSION: Although technically challenging, ELDP is feasible in patients with adenocarcinoma providing acceptable surgical outcomes. ELDP for ductal adenocarcinoma is associated with worse prognosis than SLDP, while its potential benefits over palliative care deserve further scrutiny.

9 Article Risk for hemorrhage after pancreatoduodenectomy with venous resection. 2018

Kleive, Dyre / Sahakyan, Mushegh / Søreide, Kjetil / Brudvik, Kristoffer W / Line, Pål-Dag / Gladhaug, Ivar P / Labori, Knut Jørgen. ·Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Nydalen, 0424, Oslo, Norway. dyrkle@ous-hf.no. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. dyrkle@ous-hf.no. · Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. · The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway. · Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK. · Department of Clinical Medicine, University of Bergen, Bergen, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Nydalen, 0424, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Institute of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. ·Langenbecks Arch Surg · Pubmed #30397778.

ABSTRACT: PURPOSE: No consensus exists on the optimal anticoagulation therapy after pancreatoduodenectomy with venous resection (PDVR). The aim of the study was to analyze perioperative outcomes of patients receiving low- vs high-dose anticoagulation therapy and to identify risk factors for postpancreatectomy hemorrhage in patients undergoing PDVR. METHODS: Retrospective study of patients undergoing PDVR at a tertiary referral center between January 2006 and April 2017. Patients were investigated according to the dose of postoperative anticoagulation given (low- or high-dose low-molecular-weight heparin). Uni- and multivariate analysis were performed to assess risk factors for postpancreatectomy hemorrhage. RESULTS: A total of 141 patients underwent PDVR. Low-dose anticoagulation was given to 45 (31.9%) patients. Operative time (428 min vs 398 min, p = 0.025) and the use of interposition grafts (27% vs 11%, P = 0.033) were significantly higher in the high-dose group. There was no difference in the rate of early portal vein thrombosis (4.4% vs 4.2%, p = 0.939) or postpancreatectomy hemorrhage (13.3% vs 16.7%, p = 0.611) between the low- and high-dose groups. On multivariate analysis, serum bilirubin ≥ 200 μmol/L and clinically relevant postoperative fistula were the only factors associated with postpancreatectomy hemorrhage (OR 10.28, 95% CI 3.51-30.07, P < 0.001, and OR 6.39, 95% CI 1.59-25.74, P = 0.009). CONCLUSION: Preoperative hyperbilirubinemia and clinically relevant postoperative fistula are risk factors for postpancreatectomy hemorrhage after PDVR. Rates of postpancreatectomy hemorrhage did not differ between patients receiving high- vs low-dose low-molecular-weight heparin.

10 Article Incidence and management of arterial injuries during pancreatectomy. 2018

Kleive, Dyre / Sahakyan, Mushegh A / Khan, Ammar / Fosby, Bjarte / Line, Pål-Dag / Labori, Knut Jørgen. ·Institute of Clinical Medicine, University of Oslo, Oslo, Norway. dyrkle@ous-hf.no. · Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. dyrkle@ous-hf.no. · Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. · The Intervention Centre, Oslo University Hospital, Oslo, Norway. · Department of Transplantation Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. ·Langenbecks Arch Surg · Pubmed #29564544.

ABSTRACT: PURPOSE: The incidence of intraoperative arterial injury during pancreatectomy is not well described. This study aims to evaluate the incidence, management, and outcome of arterial injuries during pancreatectomy. METHODS: This is a retrospective study of 1535 consecutive patients undergoing pancreatectomy between 2006 and 2016 at Oslo University Hospital. The type of arterial injury and potential contributing factors were analyzed. Short-term outcomes were compared between patients with arterial injury and patients undergoing a planned arterial resection due to tumor involvement. RESULTS: Arterial injury was diagnosed in 14 patients (incidence 0.91%), while planned arterial resection was performed in 22 patients. The injuries were located in the superior mesenteric artery (n = 5), right hepatic artery (n = 5), common hepatic artery (n = 2), left hepatic artery (n = 1), and celiac trunk (n = 2). The artery was reconstructed in all except one patient. In 11 patients with injury, peripancreatic inflammation, aberrant arterial anatomy, close relationship between tumor and injured artery, or a combination of the three were found. Median estimated blood loss was 1100 ml in both groups. Rate of severe complications (≥ Clavien grade IIIa), comprehensive complication index, and 90-day mortality for patients with intraoperative arterial injury vs planned arterial resection were 43 vs 45% (p = 0.879), median 35.9 vs 21.8 (p = 0.287), and 14.3 vs 4.5% (p = 0.551), respectively. CONCLUSION: Arterial injury during pancreatectomy is an infrequent and manageable complication. Early recognition and primary repair in order to restore arterial liver perfusion may improve outcome. However, the morbidity is high and comparable to patients undergoing a planned arterial resection.

11 Article Portal vein reconstruction using primary anastomosis or venous interposition allograft in pancreatic surgery. 2018

Kleive, Dyre / Berstad, Audun Elnaes / Sahakyan, Mushegh A / Verbeke, Caroline S / Naper, Christian / Haugvik, Sven Petter / Gladhaug, Ivar P / Line, Pål-Dag / Labori, Knut Jørgen. ·Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: dyrkle@ous-hf.no. · Department of Radiology, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pathology, Oslo University Hospital, Oslo, Norway. · Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. ·J Vasc Surg Venous Lymphat Disord · Pubmed #29128301.

ABSTRACT: OBJECTIVE: Superior mesenteric vein/portal vein (SMV/PV) resection and reconstruction during pancreatic surgery are increasingly common. Several reconstruction techniques exist. The aim of this study was to evaluate characteristics of patients and clinical outcomes for SMV/PV reconstruction using interposed cold-stored cadaveric venous allograft (AG+) or primary end-to-end anastomosis (AG-) after segmental vein resections during pancreatic surgery. METHODS: All patients undergoing pancreatic surgery with SMV/PV resection and reconstruction from 2006 to 2015 were identified. Clinical and histopathologic outcomes as well as preoperative and postoperative radiologic findings were assessed. RESULTS: A total of 171 patients were identified. The study included 42 and 71 patients reconstructed with AG+ and AG-, respectively. Patients in the AG+ group had longer mean operative time (506 minutes [standard deviation, 83 minutes] for AG+ vs 420 minutes [standard deviation, 91 minutes] for AG-; P < .01) and more intraoperative bleeding (median, 1000 mL [interquartile range (IQR), 650-2200 mL] for AG+ vs 600 mL [IQR, 300-1000 mL] for AG-; P < .01). Neoadjuvant therapy was administered more frequently for patients in the AG+ group (23.8% vs 8.5%; P = .02). Patients with AG+ had a longer length of tumor-vein involvement (median, 2.4 cm [IQR, 1.6-3.0 cm] for AG+ vs 1.8 cm [IQR, 1.2-2.4 cm] for AG-; P = .01), and a higher number of patients had a tumor-vein interface >180 degrees (35.7% for AG+ vs 21.1% for AG-; P = .02). There was no difference in number of patients with major complications (42.9% for AG+ vs 36.6% for AG-; P = .51) or early failure at the reconstruction site (9.5% for AG+ vs 8.5% for AG-; P = 1). A subgroup analysis of 10 patients in the AG+ group revealed the presence of donor-specific antibodies in all patients. CONCLUSIONS: The short-term outcome of SMV/PV reconstruction with interposed cold-stored cadaveric venous allografts is comparable to that of reconstruction with primary end-to-end anastomosis. Graft rejection could be a contributing factor to severe stenosis in patients reconstructed with allograft.

12 Article Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: Long-term oncologic outcomes after standard resection. 2017

Sahakyan, Mushegh A / Kim, Song Cheol / Kleive, Dyre / Kazaryan, Airazat M / Song, Ki Byung / Ignjatovic, Dejan / Buanes, Trond / Røsok, Bård I / Labori, Knut Jørgen / Edwin, Bjørn. ·The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. Electronic address: sahakyan.mushegh@gmail.com. · Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of HPB Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Department of HPB Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of HPB Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. ·Surgery · Pubmed #28756944.

ABSTRACT: BACKGROUND: Surgical resection is the only curative option in patients with pancreatic ductal adenocarcinoma. Little is known about the oncologic outcomes of laparoscopic distal pancreatectomy. This bi-institutional study aimed to examine the long-term oncologic results of standard laparoscopic distal pancreatectomy in a large cohort of patients with pancreatic ductal adenocarcinoma. METHODS: From January 2002 to March 2016, 207 patients underwent standard laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma at Oslo University Hospital-Rikshospitalet (Oslo, Norway) and Asan Medical Centre (Seoul, Republic of Korea). After the exclusion criteria were applied (distant metastases at operation, conversion to an open operation, loss to follow-up), 186 patients were eligible for the analysis. Perioperative and oncologic variables were analyzed for association with recurrence and survival. RESULTS: Median overall and recurrence-free survivals were 32 and 16 months, while 5-year overall and recurrence-free survival rates were estimated to be 38.2% and 35.9%, respectively. Ninety-six (52%) patients developed recurrence: 56 (30%) extrapancreatic, 27 (15%) locoregional, and 13 (7%) combined locoregional and extrapancreatic. Thirty-seven (19.9%) patients had early recurrence (within 6 months of operation). In the multivariable analysis, tumor size >3 cm and no adjuvant chemotherapy were associated with early recurrence (P = .017 and P = .015, respectively). The Cox regression model showed that tumor size >3 cm and lymphovascular invasion were independent predictors of decreased recurrence-free and overall survival. CONCLUSION: Standard laparoscopic distal pancreatectomy is associated with satisfactory long-term oncologic outcomes in patients with pancreatic ductal adenocarcinoma. Several risk factors, such as tumor size >3 cm, no adjuvant chemotherapy, and lymphovascular invasion, are linked to poor prognosis after standard laparoscopic distal pancreatectomy.

13 Article Follow-up After Surgery for Pancreatic Ductal Adenocarcinoma: Steps Toward an International Consensus. 2017

Labori, Knut Jørgen / Brudvik, Kristoffer Watten. ·Department of Hepato-Pancreato-Biliary Surgery Oslo University Hospital Oslo, Norway uxknab@ous-hf.no. ·Pancreas · Pubmed #27977631.

ABSTRACT: -- No abstract --

14 Article Perioperative outcomes and survival in elderly patients undergoing laparoscopic distal pancreatectomy. 2017

Sahakyan, Mushegh A / Edwin, Bjørn / Kazaryan, Airazat M / Barkhatov, Leonid / Buanes, Trond / Ignjatovic, Dejan / Labori, Knut Jørgen / Røsok, Bård Ingvald. ·The Interventional Centre, Oslo University Hospital, 0027, Oslo, Norway. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Surgery, Yerevan State Medical University, Yerevan, Armenia. · Department of HPB Surgery, Oslo University Hospital, Oslo, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. ·J Hepatobiliary Pancreat Sci · Pubmed #27794204.

ABSTRACT: BACKGROUND: The outcomes following laparoscopic distal pancreatectomy (LDP) in elderly patients have not been widely reported to date. This study aimed to analyze perioperative and oncologic outcomes in patients aged ≥70 years (elderly group) and compare with those <70 years (non-elderly group). METHODS: From April 1997 to September 2015, 402 consecutive patients with lesions in the body and tail of the pancreas underwent LDP at Rikshospitalet, Oslo University Hospital. RESULTS: Of these, 118 (29.4%) were elderly, whereas 284 (70.6%) were non-elderly. Despite higher rate of comorbidities and American Society of Anesthesiologists score (P = 0.001 and 0.001, respectively), elderly patients had lower postoperative morbidity, pancreatic fistula (PF) and readmission rates, compared with non-elderly (P = 0.032, 0.001 and 0.025, respectively). Spleen-preserving LDP (SPLDP) resulted in similar postoperative outcomes in the two groups. Elderly patients with pancreatic ductal adenocarcinoma (PDAC) were comparable to non-elderly in terms of median and 3-year survival (20.2 vs. 19 months (P = 0.94, log-rank) and 26.7% vs. 34.3%, respectively). CONCLUSIONS: Both LDP and SPLDP are safe in patients aged ≥70 years, providing outcomes similar to those in younger group. Elderly patients with PDAC can benefit from LDP, since age itself is not associated with decreased survival after surgery.

15 Article Role of laparoscopic enucleation in the treatment of pancreatic lesions: case series and case-matched analysis. 2017

Sahakyan, Mushegh A / Røsok, Bård Ingvald / Kazaryan, Airazat M / Barkhatov, Leonid / Haugvik, Sven-Petter / Fretland, Åsmund Avdem / Ignjatovic, Dejan / Labori, Knut Jørgen / Edwin, Bjørn. ·The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com. · Department of Surgery No 1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com. · Department of HPB Sugery, Oslo University Hospital - Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. ·Surg Endosc · Pubmed #27620912.

ABSTRACT: BACKGROUND: Previous studies report successful application of laparoscopic pancreatic enucleation (LPE). However, the evidence is limited to small series. This study aimed to evaluate the indications, technique and outcome of LPE at a tertiary care institution. METHODS: Between February 1998 and April 2016, 45 consecutive LPEs were performed at Oslo University Hospital-Rikshospitalet. Twenty-four (53.3 %) patients subjected to right-sided LPE (RLPE) were compared with 21 (46.7 %) patients who had undergone left-sided LPE (LLPE). A case-matched analysis (1:2) was performed to compare the outcomes following LLPE and laparoscopic distal pancreatectomy (LDP). RESULTS: Patient demographics, BMI, ASA score and pathological characteristics were similar between the RLPE and LLPE groups. Operative time was slightly longer for RLPE [123 (53-320) vs 102 (50-373) min, P = 0.09]. The rates of severe morbidity (≥Accordion grade III) and clinically relevant pancreatic fistula (grades B/C) were comparable, although with a trend for higher rate of complications following LLPE (16.7 vs 33.3 %; P = 0.19 and 20.8 vs 33.3 %, P = 0.34, respectively). The hospital stay was similar between RLPE and LLPE [5 (2-80) vs 7 (2-52), P = 0.49]. A case-matched analysis demonstrated shorter operating time [145 (90-350) vs 103 (50-233) min, P = 0.02], but higher readmission rate following LLPE (25 vs 3.1 %, P = 0.037). CONCLUSION: LLPE seems to be associated with a higher risk of postoperative morbidity and readmission rates than LDP. RLPE is a feasible, safe approach and a reasonable alternative to pancreatoduodenectomy in selected patients with pancreatic lesions.

16 Article Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. 2017

Pozzi-Mucelli, Raffaella Maria / Rinta-Kiikka, Irina / Wünsche, Katharina / Laukkarinen, Johanna / Labori, Knut Jørgen / Ånonsen, Kim / Verbeke, Caroline / Del Chiaro, Marco / Kartalis, Nikolaos. ·Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Radiology, C1-46 Karolinska University Hospital, 14186, Stockholm, Sweden. · Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland. · Department of Radiology, St.Olavs University Hospital, Trondheim, Norway. · Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. · Department of Gastroenterology, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway. · Department of Pathology, Karolinska University Hospital, Stockholm, Sweden. · Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. · Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Radiology, C1-46 Karolinska University Hospital, 14186, Stockholm, Sweden. nikolaos.kartalis@karolinska.se. ·Eur Radiol · Pubmed #27246720.

ABSTRACT: OBJECTIVES: The study aims were to evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance. METHODS: This retrospective study included 154 consecutive patients (median age: 66, 52 % men) with working-diagnosis of PCN and available contrast-enhanced MRI/MRCP. Three radiologists evaluated independently two imaging sets (SP/CP) per patient. The CP included: T2-weighted (HASTE/MRCP), DWI and T1-weighted (chemical-shift/pre-/post-contrast) images [acquisition time (AT) ≈ 35 min], whereas the SP included: T2-weighted HASTE and T1-weighted pre-contrast images (AT ≈ 8 min). Mean values of largest cyst/main pancreatic duct diameter (D RESULTS: For D CONCLUSIONS: For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol. KEY POINTS: • Pancreatic cystic neoplasms (PCN) are increasingly diagnosed in the general population. • Multiple imaging controls are recommended for the surveillance of patients with PCN. • Short and comprehensive MRI-protocols are equivalent for decision-making in PCN under surveillance. • Evaluation of imaging risk factors in PCNs is comparable with both MRI-protocols. • Use of the short MRI-protocol may rationalise healthcare resources.

17 Article Impact of obesity on surgical outcomes of laparoscopic distal pancreatectomy: A Norwegian single-center study. 2016

Sahakyan, Mushegh A / Røsok, Bård Ingvald / Kazaryan, Airazat M / Barkhatov, Leonid / Lai, Xiaoran / Kleive, Dyre / Ignjatovic, Dejan / Labori, Knut Jørgen / Edwin, Bjørn. ·Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of Surgery No1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia. Electronic address: sahakyan.mushegh@gmail.com. · Department of HPB Sugery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Biostatistics, Oslo Center for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of HPB Sugery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. ·Surgery · Pubmed #27498300.

ABSTRACT: BACKGROUND: Obesity is known as a risk factor for intra- and postoperative complications in pancreatic operation. However, the operative outcomes in obese patients undergoing laparoscopic distal pancreatectomy remain unclear. METHODS: A total number of 423 patients underwent laparoscopic distal pancreatectomy at Oslo University Hospital-Rikshospitalet from April 1997 to December 2015. Patients were categorized into 3 groups based on the body mass index: normal weight (18.5-24.9 kg/m RESULTS: Obese patients had significantly longer operative time and increased blood loss compared with overweight and normal weight patients (190 [61-480] minutes vs 158 [56-520] minutes vs 153 [29-374] minutes, P = .009 and 200 [0-2,800] mL vs 50 [0-6250] mL vs 90 [0-2,000] mL, P = .01, respectively). A multiple linear regression analysis identified obesity as predictive of prolonged operative time and increased blood loss during laparoscopic distal pancreatectomy. The rates of clinically relevant pancreatic fistula and severe complications (≥grade III by Accordion classification) were comparable in the 3 groups (P = .23 and P = .37, respectively). A multivariate logistic regression model did not demonstrate an association between obesity and postoperative morbidity (P = .09). The duration of hospital stay was comparable in the 3 groups (P = .13). CONCLUSION: In spite of longer operative time and greater blood loss, laparoscopic distal pancreatectomy in obese patients is associated with satisfactory postoperative outcomes, similar to those in normal weight and overweight patients. Hence, laparoscopic distal pancreatectomy should be equally considered both in obese and nonobese patients.

18 Article The Genomic Landscape of Pancreatic and Periampullary Adenocarcinoma. 2016

Sandhu, Vandana / Wedge, David C / Bowitz Lothe, Inger Marie / Labori, Knut Jørgen / Dentro, Stefan C / Buanes, Trond / Skrede, Martina L / Dalsgaard, Astrid M / Munthe, Else / Myklebost, Ola / Lingjærde, Ole Christian / Børresen-Dale, Anne-Lise / Ikdahl, Tone / Van Loo, Peter / Nord, Silje / Kure, Elin H. ·Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. Department for Environmental Health and Science, University College of Southeast Norway, Bø, Norway. · Wellcome Trust Sanger Institute, Hinxton, United Kingdom. Department of Cancer Genomics, Big Data Institute, University of Oxford, Oxford, United Kingdom. · Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. Department of Pathology, Oslo University Hospital, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, 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. · Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. · Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. · Department of Computer Science, University of Oslo, Oslo, Norway. · Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Department of Oncology, Oslo University Hospital, Oslo, Norway. Akershus University Hospital, Nordbyhagen, Norway. · The Francis Crick Institute, London, United Kingdom. Department of Human Genetics, University of Leuven, Leuven, Belgium. · Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. Department for Environmental Health and Science, University College of Southeast Norway, Bø, Norway. Elin.Kure@rr-research.no. ·Cancer Res · Pubmed #27488532.

ABSTRACT: Despite advances in diagnostics, less than 5% of patients with periampullary tumors experience an overall survival of five years or more. Periampullary tumors are neoplasms that arise in the vicinity of the ampulla of Vater, an enlargement of liver and pancreas ducts where they join and enter the small intestine. In this study, we analyzed copy number aberrations using Affymetrix SNP 6.0 arrays in 60 periampullary adenocarcinomas from Oslo University Hospital to identify genome-wide copy number aberrations, putative driver genes, deregulated pathways, and potential prognostic markers. Results were validated in a separate cohort derived from The Cancer Genome Atlas Consortium (n = 127). In contrast to many other solid tumors, periampullary adenocarcinomas exhibited more frequent genomic deletions than gains. Genes in the frequently codeleted region 17p13 and 18q21/22 were associated with cell cycle, apoptosis, and p53 and Wnt signaling. By integrating genomics and transcriptomics data from the same patients, we identified CCNE1 and ERBB2 as candidate driver genes. Morphologic subtypes of periampullary adenocarcinomas (i.e., pancreatobiliary or intestinal) harbor many common genomic aberrations. However, gain of 13q and 3q, and deletions of 5q were found specific to the intestinal subtype. Our study also implicated the use of the PAM50 classifier in identifying a subgroup of patients with a high proliferation rate, which had impaired survival. Furthermore, gain of 18p11 (18p11.21-23, 18p11.31-32) and 19q13 (19q13.2, 19q13.31-32) and subsequent overexpression of the genes in these loci were associated with impaired survival. Our work identifies potential prognostic markers for periampullary tumors, the genetic characterization of which has lagged. Cancer Res; 76(17); 5092-102. ©2016 AACR.

19 Article Surgical Treatment as a Principle for Patients with High-Grade Pancreatic Neuroendocrine Carcinoma: A Nordic Multicenter Comparative Study. 2016

Haugvik, Sven-Petter / Janson, Eva Tiensuu / Österlund, Pia / Langer, Seppo W / Falk, Ragnhild Sørum / Labori, Knut Jørgen / Vestermark, Lene Weber / Grønbæk, Henning / Gladhaug, Ivar Prydz / Sorbye, Halfdan. ·Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway. sphaugvik@yahoo.de. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. sphaugvik@yahoo.de. · Department of Medical Sciences, Uppsala University, Uppsala, Sweden. · Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland. · Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway. · Department of Oncology, Odense University Hospital, Odense C, Denmark. · Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Department of Oncology, Haukeland University Hospital, Bergen, Norway. ·Ann Surg Oncol · Pubmed #26678407.

ABSTRACT: BACKGROUND: This study aimed to evaluate the role of surgery for patients with high-grade pancreatic neuroendocrine carcinoma (hgPNEC) in a large Nordic multicenter cohort study. Prior studies evaluating the role of surgery for patients with hgPNEC are limited, and the benefit of the surgery is uncertain. METHODS: Data from patients with a diagnosis of hgPNEC determined between 1998 and 2012 were retrospectively registered at 10 Nordic university hospitals. Kaplan-Meier curves were used to compare the overall survival of different treatment groups, and Cox-regression analysis was used to evaluate factors potentially influencing survival. RESULTS: The study registered 119 patients. The median survival period from the time of metastasis was 23 months for patients undergoing initial resection of localized nonmetastatic disease and chemotherapy at the time of recurrence (n = 14), 29 months for patients undergoing resection of the primary tumor and resection/radiofrequency ablation of synchronous metastatic liver disease (n = 12), and 13 months for patients with synchronous metastatic disease given systemic chemotherapy alone (n = 78). The 3-year survival rate after surgery of the primary tumor and metastatic disease was 69 %. Resection of the primary tumor was an independent factor for improved survival after occurrence of metastatic disease. CONCLUSIONS: Patients with resected localized nonmetastatic hgPNEC and later metastatic disease seemed to benefit from initial resection of the primary tumor. Patients selected for resection of the primary tumor and synchronous liver metastases had a high 3-year survival rate. Selected patients with both localized hgPNEC and metastatic hgPNEC should be considered for radical surgical treatment.

20 Article Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. 2016

Sahakyan, Mushegh A / Kazaryan, Airazat M / Rawashdeh, Majd / Fuks, David / Shmavonyan, Mark / Haugvik, Sven-Petter / Labori, Knut Jørgen / Buanes, Trond / Røsok, Bård Ingvald / Ignjatovic, Dejan / Abu Hilal, Mohammad / Gayet, Brice / Kim, Song Cheol / Edwin, Bjørn. ·The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com. · Department of Surgery No 1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com. · The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. · Department of Surgery, Finnmark Hospital, Kirkenes, Norway. · University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. · Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. · Department of Surgery, Vestre Viken Hospital Trust, Drammen, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. ·Surg Endosc · Pubmed #26514135.

ABSTRACT: BACKGROUND: Laparoscopy is widely accepted as a feasible option for distal pancreatectomy. However, the experience in laparoscopic distal pancreatectomy (LDP) for pancreatic ductal adenocarcinoma (PDAC) is limited to a small number of studies, reported by expert centers. The present study aimed to evaluate perioperative and oncological outcomes after LDP for PDAC in a large, multicenter cohort of patients. METHODS: A retrospective analysis of the data on 196 patients with histologically verified PDAC, operated at Oslo University Hospital-Rikshospitalet (Oslo, Norway), Asan Medical Center (Seoul, Republic of Korea), Institut Mutualiste Montsouris (Paris, France) and University Hospital Southampton (Southampton, UK) between January 2002 and April 2015 was conducted. The patients with standard (SLDP) and extended (i.e., en bloc with adjacent organ, ELDP) resections were compared in terms of perioperative and oncological outcomes. RESULTS: Out of 196 LDP procedures, 191 (97.4 %) were completed through laparoscopy, while five (2.6 %) were converted to open surgery. ELDP was performed in 30 (15.7 %) cases. Sixty-one (31.9 %) patients experienced postoperative complications, including 48 (25.1 %) with pancreatic fistula. The rate of clinically relevant fistula (grade B/C) was 15.7 %. Median postoperative hospital stay was 8 (2-63) days. Median follow-up was 16 months. Median survival was 31.3 months (95 % CI 22.9-39.6). Three- and 5-year actuarial survival rates were 42.4 and 30 %, respectively. SLDP was associated with significantly higher survival compared with ELDP (p = 0.032). CONCLUSIONS: LDP seems to be a feasible and safe procedure, providing satisfactory oncological outcomes in patients with PDAC.

21 Article Serum N-Glycome Characterization in Patients with Resectable Periampullary Adenocarcinoma. 2015

Hamfjord, Julian / Saldova, Radka / Stöckmann, Henning / Sandhu, Vandana / Bowitz Lothe, Inger Marie / Buanes, Trond / Lingjærde, Ole Christian / Labori, Knut Jørgen / Rudd, Pauline M / Kure, Elin H. ·NIBRT GlycoScience Group, The National Institute for Bioprocessing Research and Training , Dublin, Ireland. · Department of Environmental and Health Studies, Faculty of Arts and Sciences, Telemark University College , 3800 Bo in Telemark, Norway. ·J Proteome Res · Pubmed #26515733.

ABSTRACT: Serum N-glycans are promising biomarkers for systemic disease states. Better understanding of the serum N-glycome of patients with resectable periampullary adenocarcinoma may identify novel prognostic markers for this disease. Serum N-glycans in 70 patients with resectable periampullary adenocarcinoma, 15 patients with benign periampullary tumor, and 129 healthy individuals were quantified using ultra performance liquid chromatography. High-sensitivity C-reactive protein (hsCRP) was analyzed for all samples using an immunoturbidimetric method. The N-glycome was compared to clinical and histopathological data, and to the acute phase response as measured by hsCRP. Whole-genome tumor tissue mRNA expression data were used for correlation and enrichment analysis to investigate underlying biological processes giving rise to changes in the serum N-glycome. Significant changes were found in the serum N-glycome of patients with periampullary adenocarcinoma (n = 70) compared to healthy individuals (n = 129). No significant differences were found between patients with benign (n = 15) and malignant periampullary tumors (n = 70). Many alterations in the N-glycome correlated with systemic acute phase response as measured by hsCRP. Enrichment analysis indicated that immunologic pathways of the cancer microenvironment correlate with specific features of the serum N-glycome. Certain glycans were associated with poor overall and disease free survival in patients with pancreatobiliary type of periampullary adenocarcinoma. Our study supports the hypothesis that certain factors secreted by the tumor affect liver and plasma cells to orchestrate the changes in the serum N-glycome observed. The serum N-glycome could potentially reflect modified phenotypes of the host and/or tumor microenvironment. The prognostic impact of the serum N-glycome should be evaluated in larger, prospective studies.

22 Article Pancreatic cancer exosomes initiate pre-metastatic niche formation in the liver. 2015

Costa-Silva, Bruno / Aiello, Nicole M / Ocean, Allyson J / Singh, Swarnima / Zhang, Haiying / Thakur, Basant Kumar / Becker, Annette / Hoshino, Ayuko / Mark, Milica Tešić / Molina, Henrik / Xiang, Jenny / Zhang, Tuo / Theilen, Till-Martin / García-Santos, Guillermo / Williams, Caitlin / Ararso, Yonathan / Huang, Yujie / Rodrigues, Gonçalo / Shen, Tang-Long / Labori, Knut Jørgen / Lothe, Inger Marie Bowitz / Kure, Elin H / Hernandez, Jonathan / Doussot, Alexandre / Ebbesen, Saya H / Grandgenett, Paul M / Hollingsworth, Michael A / Jain, Maneesh / Mallya, Kavita / Batra, Surinder K / Jarnagin, William R / Schwartz, Robert E / Matei, Irina / Peinado, Héctor / Stanger, Ben Z / Bromberg, Jacqueline / Lyden, David. ·Children's Cancer and Blood Foundation Laboratories, Departments of Pediatrics, and Cell and Developmental Biology, Drukier Institute for Children's Health, Meyer Cancer Center, Weill Cornell Medical College, New York, New York 10021, USA. · Gastroenterology Division, Department of Medicine, Abramson Family Cancer Research Institute, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. · Department of Medicine, Division of Hematology and Medical Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10021, USA. · 1] Children's Cancer and Blood Foundation Laboratories, Departments of Pediatrics, and Cell and Developmental Biology, Drukier Institute for Children's Health, Meyer Cancer Center, Weill Cornell Medical College, New York, New York 10021, USA [2] Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover 30625, Germany. · Proteomics Resource Center, The Rockefeller University, New York, New York 10065, USA. · Genomics Resources Core Facility, Weill Cornell Medical College, New York, New York 10021, USA. · 1] Children's Cancer and Blood Foundation Laboratories, Departments of Pediatrics, and Cell and Developmental Biology, Drukier Institute for Children's Health, Meyer Cancer Center, Weill Cornell Medical College, New York, New York 10021, USA [2] Graduate Program in Areas of Basic and Applied Biology, Abel Salazar Biomedical Sciences Institute, University of Porto, 4099-003 Porto, Portugal. · Department of Plant Pathology and Microbiology, National Taiwan University, Taipei 10617, Taiwan. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Nydalen, Oslo 0424, Norway. · 1] Department of Pathology, Oslo University Hospital, Nydalen, Oslo 0424, Norway [2] Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Nydalen, Oslo 0424, Norway. · Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Nydalen, Oslo 0424, Norway. · Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA. · Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA. · Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA. · Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, New York 10021, USA. · 1] Children's Cancer and Blood Foundation Laboratories, Departments of Pediatrics, and Cell and Developmental Biology, Drukier Institute for Children's Health, Meyer Cancer Center, Weill Cornell Medical College, New York, New York 10021, USA [2] Microenvironment and Metastasis Laboratory, Department of Molecular Oncology, Spanish National Cancer Research Center (CNIO), Madrid 28029, Spain. · Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York 10065, USA. · 1] Children's Cancer and Blood Foundation Laboratories, Departments of Pediatrics, and Cell and Developmental Biology, Drukier Institute for Children's Health, Meyer Cancer Center, Weill Cornell Medical College, New York, New York 10021, USA [2] Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065, USA. ·Nat Cell Biol · Pubmed #25985394.

ABSTRACT: Pancreatic ductal adenocarcinomas (PDACs) are highly metastatic with poor prognosis, mainly due to delayed detection. We hypothesized that intercellular communication is critical for metastatic progression. Here, we show that PDAC-derived exosomes induce liver pre-metastatic niche formation in naive mice and consequently increase liver metastatic burden. Uptake of PDAC-derived exosomes by Kupffer cells caused transforming growth factor β secretion and upregulation of fibronectin production by hepatic stellate cells. This fibrotic microenvironment enhanced recruitment of bone marrow-derived macrophages. We found that macrophage migration inhibitory factor (MIF) was highly expressed in PDAC-derived exosomes, and its blockade prevented liver pre-metastatic niche formation and metastasis. Compared with patients whose pancreatic tumours did not progress, MIF was markedly higher in exosomes from stage I PDAC patients who later developed liver metastasis. These findings suggest that exosomal MIF primes the liver for metastasis and may be a prognostic marker for the development of PDAC liver metastasis.

23 Article Opportunities of improvement in the management of pancreatic and periampullary tumors. 2013

Nordby, Tom / Ikdahl, Tone / Lothe, Inger Marie Bowitz / Ånonsen, Kim / Hauge, Truls / Edwin, Bjørn / Line, Pål-Dag / Labori, Knut Jørgen / Buanes, Trond. ·Department of Gastroenterological Surgery, Division of Cancer, Surgery and Transplantation, Oslo University Hospital (OuS), Oslo, Norway. ·Scand J Gastroenterol · Pubmed #23597153.

ABSTRACT: Abstract Objective. The first objective of the present study was to identify opportunities of improvement for clinical practice, assessed by local quality indicators, then to analyze possible reasons why we did not reach defined treatment quality measures. The second objective was to characterize patients, considered unresectable according to present criteria, for future arrangement of interventional studies with improved patient selection. Material and methods. Prospective observational cohort study from October 2008 to December 2010 of patients referred to the authors' institution with suspected pancreatic or periampullary neoplasm. Results. Of 330 patients, 135 underwent surgery, 195 did not, 129 due to unresectable malignancies. The rest had benign lesions. Perioperative morbidity rate was 32.6%, mortality 0.7%. Radical resection (R0) was obtained in 23 (41.8%) of 55 patients operated for pancreatic adenocarcinoma and 6.3% underwent reconstructive vascular surgery. Diagnostic failure/delay resulted in unresectable carcinoma, primarily misconceived as serous cystic adenoma in two patients. One resected lesion turned out to be focal autoimmune pancreatitis. One case with misdiagnosed cancer was revised to be a pseudoaneurysm. Palliative treatment was offered to 144 patients with malignant tumors, 62 due to locally advanced disease and all pancreatic adenocarcinomas. Conclusions. Quality improvement opportunities were identified for patient selection and surgical technique: Too few patients underwent reconstructive vascular surgery. The most important quality indicators are those securing resectional, radical (R0) surgery. Altogether 143 patients (57.9%) of those with malignant tumors were found unresectable, most of these patients are eligible for inclusion in future interventional studies with curative and/or palliative intention.

24 Minor Letter to the editor: Multidisciplinary management of pancreatic neuroendocrine tumors--the importance of an aggressive surgical approach. 2016

Labori, Knut Jørgen / Haugvik, Sven-Petter / Line, Pål-Dag. ·a Department of Hepato-Pancreato-Biliary Surgery , Oslo University Hospital , Oslo , Norway . · b Department of Transplantation Medicine , Oslo University Hospital , Oslo , Norway. ·Scand J Gastroenterol · Pubmed #26458136.

ABSTRACT: -- No abstract --