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Pancreatic Neoplasms: HELP
Articles by Calvin H. L. Law
Based on 12 articles published since 2009
(Why 12 articles?)
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Between 2009 and 2019, C. H. L. Law wrote the following 12 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Consensus Recommendations for the Diagnosis and Management of Pancreatic Neuroendocrine Tumors: Guidelines from a Canadian National Expert Group. 2015

Singh, Simron / Dey, Chris / Kennecke, Hagen / Kocha, Walter / Maroun, Jean / Metrakos, Peter / Mukhtar, Tariq / Pasieka, Janice / Rayson, Daniel / Rowsell, Corwyn / Sideris, Lucas / Wong, Ralph / Law, Calvin. ·Department of Medicine, Odette Cancer Centre - Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada, simron.singh@sunnybrook.ca. ·Ann Surg Oncol · Pubmed #25366583.

ABSTRACT: Pancreatic neuroendocrine tumors (pNETs) are rare heterogeneous tumors that have been steadily increasing in both incidence and prevalence during the past few decades. Pancreatic NETs are categorized as functional (F) or nonfunctional (NF) based on their ability to secrete hormones that elicit clinically relevant symptoms. Specialized diagnostic tests are required for diagnosis. Treatment options are diverse and include surgical resection, intraarterial hepatic therapy, and peptide receptor radionuclide therapy (PRRT). Systemic therapy options include targeted agents as well as chemotherapy when indicated. Diagnosis and management should occur through a collaborative team of health care practitioners well-experienced in managing pNETs. Recent advances in pNET treatment options have led to the development of the Canadian consensus document described in this report. The discussion includes the epidemiology, classification, pathology, clinical presentation and prognosis, imaging and laboratory testing, medical and surgical management, and recommended treatment algorithms for pancreatic neuroendocrine cancers.

2 Review Principles of diagnosis and management of neuroendocrine tumours. 2017

Raphael, Michael J / Chan, David L / Law, Calvin / Singh, Simron. ·Departments of Medicine (Raphael, Chan, Singh) and Surgery (Law), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. · Departments of Medicine (Raphael, Chan, Singh) and Surgery (Law), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. simron.singh@sunnybrook.ca. ·CMAJ · Pubmed #28385820.

ABSTRACT: -- No abstract --

3 Review Chromogranin A: a sensitive biomarker for the detection and post-treatment monitoring of gastroenteropancreatic neuroendocrine tumors. 2012

Singh, Simron / Law, Calvin. ·Hepatobiliary, Pancreatic and Gastrointestinal Surgical Oncology, The Edmond Odette Cancer Center at Sunnybrook Health Sciences Centre, Toronto, ON, Canada. simron.singh@sunnybrook.ca ·Expert Rev Gastroenterol Hepatol · Pubmed #22646254.

ABSTRACT: Gastroenteropancreatic neuroendocrine tumors (GEP-NET) are a heterogeneous group of neoplasms that arise from neuroendocrine cells of the GI tract and pancreas. Due to the lack of symptoms in the early stage of the disease and the frequency of nonspecific gastrointestinal symptoms, GEP-NET are difficult to diagnose. This delay in diagnosis often results in patients presenting with advanced disease and thus a poor prognosis. There is an unmet medical need for earlier, more definitive GEP-NET diagnosis. Identification of effective biomarkers to improve GEP-NET diagnosis, as well as to assess treatment efficacy, relapse and prognosis, is important for improving outcomes in GEP-NET. Chromogranin A is currently the most useful general biomarker for the assessment of GEP-NET. This review summarizes the biochemical characteristics of chromogranin A, its specificity and sensitivity for GEP-NET diagnosis, and its use in monitoring treatment effectiveness, disease progression and prognosis.

4 Review Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer. 2012

Roberts, Patrick / Seevaratnam, Rajini / Cardoso, Roberta / Law, Calvin / Helyer, Lucy / Coburn, Natalie. ·Division of General Surgery, University of Toronto, Toronto, Canada. ·Gastric Cancer · Pubmed #21870150.

ABSTRACT: BACKGROUND: The purpose of this study was to identify and synthesize findings from all articles on surgical and long-term outcomes in patients with gastric cancer undergoing gastrectomy combined with pancreaticoduodenectomy (PD). METHODS: Electronic literature searches were conducted using Medline, EMBASE, and Cochrane databases from January 1, 1985, to December 31, 2009. RESULTS: Eight retrospective case series were included, with 132 patients having PD combined with gastrectomy. PD was combined with total gastrectomy in 27 patients, and subtotal gastrectomy in 81 patients; 24 patients had undocumented gastric resection type. Clinical stage was available for 92 patients (4 stage I, 7 stage II, 26 stage III, and 55 stage IV). Five studies (98 patients having PD combined with gastrectomy) compared PD and gastrectomy to gastrectomy alone. In the four studies reporting morbidity, PD had a higher morbidity. The pooled pancreatic anastomotic leak rate was 24.5% for the seven studies in which complications were reported; however, there were no peri-operative deaths. Long-term survival (37.3% at 5 years) in gastric cancer patients with PD combined with gastrectomy was described; however, survival was poor in the setting of incurable factors. Due to heterogeneity of patients and staging techniques in the case series no recommendations can be made on the appropriate selection criteria for patients undergoing PD and gastrectomy. CONCLUSION: PD for gastric cancer invading the pancreas is associated with a higher morbidity; given the heterogeneous data, defining exact selection criteria is difficult.

5 Clinical Trial Survival Following Resection of Intra- and Extra-Hepatic Metastases from Colorectal Cancer: A Phase II Trial. 2016

Wei, Alice C / Coburn, Natalie G / Devitt, Katharine S / Serrano, Pablo E / Moulton, Carol-Anne / Cleary, Sean P / Law, Calvin / Moore, Malcolm J / Gallinger, Steven. ·Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada. Alice.Wei@uhn.ca. · Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Alice.Wei@uhn.ca. · Department of Surgery, University of Toronto, Toronto, Canada. Alice.Wei@uhn.ca. · Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. · Department of Surgery, University of Toronto, Toronto, Canada. · Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Canada. · Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada. · Hepatobiliary & Pancreatic Surgical Oncology, Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada. · Department of Surgery, McMaster University, Hamilton, Ontario, Canada. · BC Cancer Agency, Vancouver, British Columbia, Canada. ·Ann Surg Oncol · Pubmed #27027312.

ABSTRACT: PURPOSE: Metastasectomy for intrahepatic metastases (IHM) from colorectal cancer (CRC) provides excellent 5-year overall survival (OS). Presence of extrahepatic metastases (EHM) has been a historic contraindication to surgery. Due to improved safety of hepatectomy, there is growing interest in multisite metastasectomy for IHM and EHM. The objective of this study was to evaluate the results of metastasectomy for patients with IHM and EHM from CRC. METHODS: A phase II study of metastasectomy for both IHM and EHM from CRC. Eligible patients with any number of IHM and up to three EHM foci, resectable with RO intent, were offered metastasectomy. Clinical, survival, and quality of life (QoL) data were analyzed using standard statistical methods. RESULTS: Twenty-six patients were enrolled with a median age of 58 (range 32-84) years; 14/26 (54 %) presented with synchronous disease. The lung was the most common EHM site (13/26, 50 %). Protocol surgery was completed in 20/26 (77 %), including 12/26 (46 %) planned sequential resections. Major morbidity and perioperative mortality were 5/26 (19 %) and 1/26 (4 %), respectively. The QoL decline appeared to be transient. All QoL domains returned to baseline by 1-year posttreatment. The median recurrence-free survival (RFS) was 5 months by intent-to-treat analysis. The median OS from the time of CRC diagnosis and metastasectomy were 50 and 38 months (3-year OS 80 and 53 %), respectively. CONCLUSIONS: Complete metastasectomy of multisite CRC is safe, but disease recurs in the majority of patients. Data suggest that aggressive multisite metastasectomy may provide OS benefit for selected patients.

6 Article Follow-up Recommendations for Completely Resected Gastroenteropancreatic Neuroendocrine Tumors. 2018

Singh, Simron / Moody, Lesley / Chan, David L / Metz, David C / Strosberg, Jonathan / Asmis, Timothy / Bailey, Dale L / Bergsland, Emily / Brendtro, Kari / Carroll, Richard / Cleary, Sean / Kim, Michelle / Kong, Grace / Law, Calvin / Lawrence, Ben / McEwan, Alexander / McGregor, Caitlin / Michael, Michael / Pasieka, Janice / Pavlakis, Nick / Pommier, Rodney / Soulen, Michael / Wyld, David / Segelov, Eva / Anonymous361517. ·Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. · Perelman School of Medicine, Department of Gastroenterology, University of Pennsylvania, Philadelphia. · Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Centre, Tampa, Florida. · Department of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada. · Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia. · Department of Medical Oncology, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco. · North American Neuroendocrine Tumor Society, Albany, New York. · Department of Endocrinology, Wellington Regional Hospital, Wellington, New Zealand. · Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada. · Department of Gastroenterology, Mount Sinai Hospital, New York, New York. · Department of Nuclear Medicine, Peter MacCullum Cancer Centre, Melbourne, Australia. · Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Department of Medical Oncology, Auckland Hospital, Auckland, New Zealand. · Department of Oncology, University of Alberta, Edmonton, Alberta, Canada. · Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Department of Medical Oncology, Peter MacCullum Cancer Centre, Melbourne, Australia. · Department of Surgery, Tom Baker Cancer Centre, Calgary, Alberta, Canada. · Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia. · Department of Surgery, Oregon Health & Science University, Portland. · Perelman School of Medicine, Department of Medical Imaging, University of Pennsylvania, Philadelphia. · Department of Medical Oncology, Royal Brisbane and Women's Hospital, Queensland, Australia. · Department of Medical Oncology, Monash University, Clayton, Australia. ·JAMA Oncol · Pubmed #30054622.

ABSTRACT: There is no consensus on optimal follow-up for completely resected gastroenteropancreatic neuroendocrine tumors. Published guidelines for follow-up are complex and emphasize closer surveillance in the first 3 years after resection. Neuroendocrine tumors have a different pattern and timescale of recurrence, and thus require more practical and tailored follow-up. The Commonwealth Neuroendocrine Tumour Collaboration convened an international multidisciplinary expert panel, in collaboration with the North American Neuroendocrine Tumor Society, to create patient-centered follow-up recommendations for completely resected gastroenteropancreatic neuroendocrine tumors. This panel used the RAND/UCLA (University of California, Los Angeles) Appropriateness Method to generate recommendations. A large international survey was conducted outlining current the surveillance practice of neuroendocrine tumor practitioners and shortcomings of the current guidelines. A systematic review of available data to date was supplemented by recurrence data from 2 large patient series. The resultant guidelines suggest follow-up for at least 10 years for fully resected small-bowel and pancreatic neuroendocrine tumors and also identify clinical situations in which no follow-up is required. These recommendations stratify follow-up strategies based on evidence-based prognostic factors that allow for a more individualized patient-centered approach to this complex and heterogeneous malignant neoplasm.

7 Article Outcomes of Cytoreductive Surgery for Metastatic Low-Grade Neuroendocrine Tumors in the Setting of Extrahepatic Metastases. 2018

Chan, David L / Dixon, Matthew / Law, Calvin H L / Koujanian, Serge / Beyfuss, Kaitlyn A / Singh, Simron / Myrehaug, Sten / Hallet, Julie. ·Susan Leslie Multidisciplinary Clinic for Neuroendocrine Tumors, Odette Cancer Centre, Toronto, ON, Canada. · Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. · Department of Surgery, University of Toronto, Toronto, ON, Canada. · Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. · Sunnybrook Research Institute, Toronto, ON, Canada. · Division of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. · Susan Leslie Multidisciplinary Clinic for Neuroendocrine Tumors, Odette Cancer Centre, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. · Department of Surgery, University of Toronto, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. · Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. · Sunnybrook Research Institute, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. ·Ann Surg Oncol · Pubmed #29560571.

ABSTRACT: BACKGROUND: Neuroendocrine tumors (NETs) have a uniquely indolent biology. Management focuses on tumor and hormonal burden reduction. Data on cytoreduction with extrahepatic disease remain limited. OBJECTIVE: We sought to define the outcomes of cytoreduction for metastatic NETs with extrahepatic metastases. METHODS: Patients undergoing cytoreductive surgery for grade 1 or 2 NETs with extrahepatic metastases (with or without intrahepatic disease) were identified from an institutional database (2003-2014). Primary outcomes included postoperative hormonal response (> 50% urinary 5HIAA decrease), progression-free survival (PFS) and overall survival (OS), while secondary outcomes were 30-day postoperative major morbidity (Clavien grade III-V), mortality, and length of stay. RESULTS: Fifty-five patients were identified (median age 59.3 years, 80% small bowel primaries, 56.4% grade 1); 87% of patients presented with combined intra- and extrahepatic metastases. Resection most commonly included the liver (87%), small bowel (22%), mesenteric (25%) and retroperitoneal (11%) lymph nodes, and peritoneum (7%). Thirty-day major morbidity (Clavien III-V) was 18%, with 3.6% mortality, and median length of stay was 7 days [interquartile range (IQR) 5-9]. Liver embolization was performed in 31% of patients after surgery, at a median of 23 months following surgery. Overall, postoperative hormonal response occurred in 70% of patients. At median follow-up of 37 months (IQR range 22-93), 42 (76%) patients were alive and 23 (41.8%) had progressed. Five-year OS was 77% and 5-year PFS was 51%. CONCLUSION: Patients undergoing cytoreduction of metastatic well-differentiated NET in the setting of extrahepatic metastatic disease experience good tumoral control with favorable PFS and OS. Cytoreductive surgery can be safely included in the therapeutic armamentarium for NET with extrahepatic metastases.

8 Article Patterns and Drivers of Costs for Neuroendocrine Tumor Care: A Comparative Population-Based Analysis. 2017

Hallet, Julie / Law, C H L / Cheung, M / Mittmann, N / Liu, N / Fischer, H D / Singh, S. ·Department of Surgery, University of Toronto, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. · Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. · Sunnybrook Research Institute, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. · Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. julie.hallet@sunnybrook.ca. · Department of Surgery, University of Toronto, Toronto, ON, Canada. · Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada. · Sunnybrook Research Institute, Toronto, ON, Canada. · Department of Medicine, University of Toronto, Toronto, ON, Canada. · Division of Medical Oncology, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada. · Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. ·Ann Surg Oncol · Pubmed #28695392.

ABSTRACT: BACKGROUND: Little is known about resource use in the care of neuroendocrine tumors (NETs). This study defined patterns of costs in NET management and compared them with those of a more common malignancy, colon cancer (CC). METHODS: Using a provincial cancer registry (2004-2012), NET patients were identified and matched at a ratio of 1-3 with CC patients. Four phases of care were examined: pre-diagnostic (PreDx: -2 years to -181 days), diagnostic (Dx: -180 days to +180 days), postdiagnostic (PostDx: +181 days to +3 years), and prolonged post-diagnostic (PPostDx: +181 days to +9 years). The mean costs per patient were compared, and cost predictors were analyzed with quintile regression. RESULTS: Of 3827 NETs, 3355 were matched with 9320 CCs. The PreDx mean NET costs were higher than the CC costs ($5877 vs $5368; p = 0.06), driven by nondrug costs. They were lower in the Dx and PostDx phases (both p < 0.01). For PPostDx, the drug costs were higher for NETs ($26,788 vs $7827; p < 0.01), representing 41% of the costs versus 16% of the costs for CC. Older age and comorbidities predicted higher NET costs in all phases. Lower socioeconomic status (SES) predicted higher costs in the initial phases and higher SES costs in the PPost-Dx phase. Gastroenteric NETs were associated with lower costs in the Dx phase [parameter estimate (PE), -$13,644] and pancreatic NETs with higher costs in PostDx phase (PE, $3348). CONCLUSION: Currently, NETs represent a potential important health care burden. The NET cost patterns differed from those for CC, with the highest costs during the PPostDx phase. The SES and primary NET site affected costs differently at different time points. These data can inform resource allocation tailored to the needs for NETs.

9 Article A renewed model of pancreatic cancer evolution based on genomic rearrangement patterns. 2016

Notta, Faiyaz / Chan-Seng-Yue, Michelle / Lemire, Mathieu / Li, Yilong / Wilson, Gavin W / Connor, Ashton A / Denroche, Robert E / Liang, Sheng-Ben / Brown, Andrew M K / Kim, Jaeseung C / Wang, Tao / Simpson, Jared T / Beck, Timothy / Borgida, Ayelet / Buchner, Nicholas / Chadwick, Dianne / Hafezi-Bakhtiari, Sara / Dick, John E / Heisler, Lawrence / Hollingsworth, Michael A / Ibrahimov, Emin / Jang, Gun Ho / Johns, Jeremy / Jorgensen, Lars G T / Law, Calvin / Ludkovski, Olga / Lungu, Ilinca / Ng, Karen / Pasternack, Danielle / Petersen, Gloria M / Shlush, Liran I / Timms, Lee / Tsao, Ming-Sound / Wilson, Julie M / Yung, Christina K / Zogopoulos, George / Bartlett, John M S / Alexandrov, Ludmil B / Real, Francisco X / Cleary, Sean P / Roehrl, Michael H / McPherson, John D / Stein, Lincoln D / Hudson, Thomas J / Campbell, Peter J / Gallinger, Steven. ·Ontario Institute for Cancer Research, Toronto, Ontario M5G 0A3, Canada. · Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK. · UHN Program in BioSpecimen Sciences, Department of Pathology, University Health Network, Toronto, Ontario M5G 2C4, Canada. · Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 1L7, Canada. · Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada. · Department of Computer Science, University of Toronto, Toronto, Ontario M5S 3G4, Canada. · Eppley Institute for Research in Cancer, Nebraska Medical Center, Omaha, Nebraska 68198, USA. · Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 1A8, Canada. · Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario M5G 2M9, Canada. · Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario M4N 3M5, Canada. · Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA. · Research Institute of the McGill University Health Centre, Montreal, Québec, Canada, H3H 2L9. · Theoretical Biology and Biophysics (T-6) and Center for Nonlinear Studies, Los Alamos National Laboratory, Los Alamos, New Mexico, USA, 87545. · Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain. · Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada. · Department of Surgery, University Health Network, Toronto, Ontario M5G 2C4, Canada. · Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK. ·Nature · Pubmed #27732578.

ABSTRACT: Pancreatic cancer, a highly aggressive tumour type with uniformly poor prognosis, exemplifies the classically held view of stepwise cancer development. The current model of tumorigenesis, based on analyses of precursor lesions, termed pancreatic intraepithelial neoplasm (PanINs) lesions, makes two predictions: first, that pancreatic cancer develops through a particular sequence of genetic alterations (KRAS, followed by CDKN2A, then TP53 and SMAD4); and second, that the evolutionary trajectory of pancreatic cancer progression is gradual because each alteration is acquired independently. A shortcoming of this model is that clonally expanded precursor lesions do not always belong to the tumour lineage, indicating that the evolutionary trajectory of the tumour lineage and precursor lesions can be divergent. This prevailing model of tumorigenesis has contributed to the clinical notion that pancreatic cancer evolves slowly and presents at a late stage. However, the propensity for this disease to rapidly metastasize and the inability to improve patient outcomes, despite efforts aimed at early detection, suggest that pancreatic cancer progression is not gradual. Here, using newly developed informatics tools, we tracked changes in DNA copy number and their associated rearrangements in tumour-enriched genomes and found that pancreatic cancer tumorigenesis is neither gradual nor follows the accepted mutation order. Two-thirds of tumours harbour complex rearrangement patterns associated with mitotic errors, consistent with punctuated equilibrium as the principal evolutionary trajectory. In a subset of cases, the consequence of such errors is the simultaneous, rather than sequential, knockout of canonical preneoplastic genetic drivers that are likely to set-off invasive cancer growth. These findings challenge the current progression model of pancreatic cancer and provide insights into the mutational processes that give rise to these aggressive tumours.

10 Article Patient Adherence and Experience with Extended Use of Prophylactic Low-Molecular-Weight Heparin Following Pancreas and Liver Resection. 2016

Lemke, Madeline / Beyfuss, Kaitlyn / Hallet, Julie / Coburn, Natalie G / Law, Calvin H L / Karanicolas, Paul J. ·Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. · Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, T2-016, Toronto, ON, M4N 3M5, Canada. · Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. paul.karanicolas@sunnybrook.ca. · Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, T2-016, Toronto, ON, M4N 3M5, Canada. paul.karanicolas@sunnybrook.ca. ·J Gastrointest Surg · Pubmed #27688212.

ABSTRACT: BACKGROUND: Guidelines recommend 28 days venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) following major abdominal surgery for cancer. Overall adherence with these recommendations is poor, but little is known about feasibility and tolerability from a patient perspective. METHODS: An institution-wide policy for routine administration of 28 days of post-operative LMWH following major hepatic or pancreatic resection for cancer was implemented in April 2013. Patients having surgery from July 2013 to June 2015 were approached to participate in an interview examining adherence and experience with extended duration LMWH. RESULTS: There were 100 patients included, with 81.4 % reporting perfect adherence with the regimen. The most frequent reasons for non-adherence were that a healthcare provider stopped the regimen or because of poor experience with injections. Most patients were able to correctly recall the reason for being prescribed LMWH (82.6 %), and 78.4 % of patients performed all injections themselves. Over half the patients (55.7 %) did not find the injections bothersome. CONCLUSION: Patients reported high adherence and a manageable experience with post-operative extended-duration LMWH in an ambulatory setting following liver or pancreas resection. These findings suggest that patient adherence is not a major contributor to poor compliance with VTE prophylaxis guidelines.

11 Article Impact of fluid resuscitation on major adverse events following pancreaticoduodenectomy. 2015

Behman, Ramy / Hanna, Sherif / Coburn, Natalie / Law, Calvin / Cyr, David P / Truong, Jessica / Lam-McCulloch, Jenny / McHardy, Paul / Sawyer, Jason / Idestrup, Chris / Karanicolas, Paul J. ·Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. · Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. · Department of Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. · Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: paul.karanicolas@sunnybrook.ca. ·Am J Surg · Pubmed #26255229.

ABSTRACT: BACKGROUND: Pancreaticoduodenectomy remains a major undertaking with substantial perioperative morbidity and mortality. Previous studies in the colorectal population have noted a correlation between excessive postoperative fluid resuscitation and anastomotic complications. This study sought to assess the relationship between perioperative fluid management and clinical outcomes in patients undergoing pancreaticoduodenectomy. METHODS: Data from a single institution, prospective database over a 10-year period (2002 to 2012) were reviewed. Patients were compared for perioperative fluid balance and postoperative outcomes. Multivariable analysis was performed to assess the relationship between perioperative fluid administration and incidence of major adverse events. RESULTS: Higher positive fluid balance on postoperative day 0, postoperative day 1, and postoperative day 2 was associated with increased incidence of major adverse events, increased postoperative intensive care unit admission, and longer hospital stay. Higher positive fluid balance on postoperative day 0 was most strongly associated with postoperative morbidity (odds ratio 1.39, confidence interval 1.16 to 1.66, P = .0003). Fluid balance on postoperative day 3 was not associated with adverse events. CONCLUSIONS: Increased early perioperative fluid resuscitation is associated with major adverse events in patients undergoing pancreaticoduodenectomy. More restrictive fluid administration may improve postoperative outcomes; further prospective clinical trials focused on fluid resuscitation and goal-directed therapy are needed.

12 Article Variability of Ki67 labeling index in multiple neuroendocrine tumors specimens over the course of the disease. 2014

Singh, S / Hallet, J / Rowsell, C / Law, C H L. ·Department of Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada. Electronic address: Simron.singh@sunnybrook.ca. · Division of General Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada. · Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada. ·Eur J Surg Oncol · Pubmed #25088936.

ABSTRACT: BACKGROUND: The Ki67-LI is a valid surrogate for biologic behavior of neuroendocrine tumors (NETs), with higher levels associated with aggressive behavior. The World Health Organization (WHO) classifies NETs according to Ki67-LI (G1: <3%; G2 : 3-20%; G3: >20%). Little is known about the evolution of NETs histologic characteristics over the disease course. We sought to evaluate variations in Ki67-LI throughout NETs disease course. METHODS: We retrospectively reviewed the Sunnybrook Odette Cancer Center NET database for patients with multiple pathology specimens. Primary outcome was the WHO NET class based on Ki67-LI for each specimen. We assessed change in WHO class between specimens. RESULTS: Forty-three patients were retrieved, of which 39 had specimens from the primary tumor and a metastatic focus, and 4 had specimens from multiple metastatic foci. Sixteen (37.0%) were identified with Ki67-LI falling in different WHO classes on distinct biopsies. For 12 (75.0%) of those 16 patients, Ki67-LI showed enough variability for WHO class to be upstaged: 5 (31%) from G1 to G2, 2 (13%) from G2 to G3, and 5 (31%) from G1 to G3. CONCLUSION: When multiple pathology specimens were available, Ki67-LI varied throughout NETs disease course, with a majority of cases upgraded to a higher WHO class. If confirmed, this finding may have implications in how neuroendocrine tumors are monitored and treated. Further research is warranted to confirm these findings, understand better the underlying mechanisms of Ki67 variability, and define its relationship to prognosis.