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Pancreatic Neoplasms: HELP
Articles by Jan Sven Mieog
Based on 23 articles published since 2010
(Why 23 articles?)
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Between 2010 and 2020, J. S. Mieog wrote the following 23 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Fluorescent-guided surgery for sentinel lymph node detection in gastric cancer and carcinoembryonic antigen targeted fluorescent-guided surgery in colorectal and pancreatic cancer. 2018

Vuijk, Floris A / Hilling, Denise E / Mieog, J Sven D / Vahrmeijer, Alexander L. ·Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. ·J Surg Oncol · Pubmed #30216455.

ABSTRACT: Sentinel lymph node procedures for gastric cancer resections using indocyanine green (ICG) linked to Nanocoll outperformed normal ICG but did not provide information on possible lymph node metastasis. Carcinoembryonic antigen targeted fluorescent imaging using SGM-101 was successful in both pancreatic and colorectal cancer. A large phase III multicentre trial will soon be initiated in colorectal cancer patients.

2 Review Current and future intraoperative imaging strategies to increase radical resection rates in pancreatic cancer surgery. 2014

Handgraaf, Henricus J M / Boonstra, Martin C / Van Erkel, Arian R / Bonsing, Bert A / Putter, Hein / Van De Velde, Cornelis J H / Vahrmeijer, Alexander L / Mieog, J Sven D. ·Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands. · Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands. ·Biomed Res Int · Pubmed #25157372.

ABSTRACT: Prognosis of patients with pancreatic cancer is poor. Even the small minority that undergoes resection with curative intent has low 5-year survival rates. This may partly be explained by the high number of irradical resections, which results in local recurrence and impaired overall survival. Currently, ultrasonography is used during surgery for resectability assessment and frozen-section analysis is used for assessment of resection margins in order to decrease the number of irradical resections. The introduction of minimal invasive techniques in pancreatic surgery has deprived surgeons from direct tactile information. To improve intraoperative assessment of pancreatic tumor extension, enhanced or novel intraoperative imaging technologies accurately visualizing and delineating cancer cells are necessary. Emerging modalities are intraoperative near-infrared fluorescence imaging and freehand nuclear imaging using tumor-specific targeted contrast agents. In this review, we performed a meta-analysis of the literature on laparoscopic ultrasonography and we summarized and discussed current and future intraoperative imaging modalities and their potential for improved tumor demarcation during pancreatic surgery.

3 Clinical Trial Image-Guided Surgery in Patients with Pancreatic Cancer: First Results of a Clinical Trial Using SGM-101, a Novel Carcinoembryonic Antigen-Targeting, Near-Infrared Fluorescent Agent. 2018

Hoogstins, Charlotte E S / Boogerd, Leonora S F / Sibinga Mulder, Babs G / Mieog, J Sven D / Swijnenburg, Rutger Jan / van de Velde, Cornelis J H / Farina Sarasqueta, Arantza / Bonsing, Bert A / Framery, Berenice / Pèlegrin, André / Gutowski, Marian / Cailler, Françoise / Burggraaf, Jacobus / Vahrmeijer, Alexander L. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Centre for Human Drug Research, Leiden, The Netherlands. · Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. · Surgimab, Montpellier, France. · Institut de Recherche en Cancérologie de Montpellier, Montpellier, France. · Institut Régional du Cancer de Montpellier, Montpellier, France. · Leiden Academic Center for Drug Research, Leiden, The Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. a.l.vahrmeijer@lumc.nl. ·Ann Surg Oncol · Pubmed #30051369.

ABSTRACT: BACKGROUND: Near-infrared (NIR) fluorescence is a promising novel imaging technique that can aid in intraoperative demarcation of pancreatic cancer (PDAC) and thus increase radical resection rates. This study investigated SGM-101, a novel, fluorescent-labeled anti-carcinoembryonic antigen (CEA) antibody. The phase 1 study aimed to assess the tolerability and feasibility of intraoperative fluorescence tumor imaging using SGM-101 in patients undergoing a surgical exploration for PDAC. METHODS: At least 48 h before undergoing surgery for PDAC, 12 patients were injected intravenously with 5, 7.5, or 10 mg of SGM-101. Tolerability assessments were performed at regular intervals after dosing. The surgical field was imaged using the Quest NIR imaging system. Concordance between fluorescence and tumor presence on histopathology was studied. RESULTS: In this study, SGM-101 specifically accumulated in CEA-expressing primary tumors and peritoneal and liver metastases, allowing real-time intraoperative fluorescence imaging. The mean tumor-to-background ratio (TBR) was 1.6 for primary tumors and 1.7 for metastatic lesions. One false-positive lesion was detected (CEA-expressing intraductal papillary mucinous neoplasm). False-negativity was seen twice as a consequence of overlying blood or tissue that blocked the fluorescent signal. CONCLUSION: The use of a fluorescent-labeled anti-CEA antibody was safe and feasible for the intraoperative detection of both primary PDAC and metastases. These results warrant further research to determine the impact of this technique on clinical decision making and overall survival.

4 Clinical Trial Near-infrared fluorescence imaging in patients undergoing pancreaticoduodenectomy. 2011

Hutteman, M / van der Vorst, J R / Mieog, J S D / Bonsing, B A / Hartgrink, H H / Kuppen, P J K / Löwik, C W G M / Frangioni, J V / van de Velde, C J H / Vahrmeijer, A L. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. ·Eur Surg Res · Pubmed #21720166.

ABSTRACT: BACKGROUND: Intraoperative visualization of pancreatic tumors has the potential to improve radical resection rates. Intraoperative visualization of the common bile duct and bile duct anastomoses could be of added value. In this study, we explored the use of indocyanine green (ICG) for these applications and attempted to optimize injection timing and dose. METHODS: Eight patients undergoing a pancreaticoduodenectomy were injected intravenously with 5 or 10 mg ICG. During and after injection, the pancreas, tumor, common bile duct and surrounding organs were imaged in real time using the Mini-FLARE™ near-infrared (NIR) imaging system. RESULTS: No clear tumor-to-pancreas contrast was observed, except for incidental contrast in 1 patient. The common bile duct was clearly visualized using NIR fluorescence, within 10 min after injection, with a maximal contrast between 30 and 90 min after injection. Patency of biliary anastomoses could be visualized due to biliary excretion of ICG. CONCLUSION: No useful tumor demarcation could be visualized in pancreatic cancer patients after intravenous injection of ICG. However, the common bile duct and biliary anastomoses were clearly visualized during the observation period. Therefore, these imaging strategies could be beneficial during biliary surgery in cases where the surgical anatomy is aberrant or difficult to identify.

5 Article Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis. 2020

van Manen, Labrinus / Groen, Jesse V / Putter, Hein / Vahrmeijer, Alexander L / Swijnenburg, Rutger-Jan / Bonsing, Bert A / Mieog, J Sven D. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. · Department of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands. ·Biomarkers · Pubmed #32009482.

ABSTRACT:

6 Article International validation and update of the Amsterdam model for prediction of survival after pancreatoduodenectomy for pancreatic cancer. 2019

van Roessel, Stijn / Strijker, Marin / Steyerberg, Ewout W / Groen, Jesse V / Mieog, J Sven / Groot, Vincent P / He, Jin / De Pastena, Matteo / Marchegiani, Giovanni / Bassi, Claudio / Suhool, Amal / Jang, Jin-Young / Busch, Olivier R / Halimi, Asif / Zarantonello, Laura / Groot Koerkamp, Bas / Samra, Jaswinder S / Mittal, Anubhav / Gill, Anthony J / Bolm, Louisa / van Eijck, Casper H / Abu Hilal, Mohammed / Del Chiaro, Marco / Keck, Tobias / Alseidi, Adnan / Wolfgang, Christopher L / Malleo, Giuseppe / Besselink, Marc G. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. · Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. · Pancreatic Surgery Unit, Division of Surgery, Karolinska Institute at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. · Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands. · Department of Surgery, Royal North Shore Hospital, St Leonards, University of Sydney, Sydney, NSW, Australia. · Cancer Diagnosis and Pathology Group Kolling Institute of Medical Research and University of Sydney, Sydney, NSW, Australia. · Department of Surgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany. · Division of Surgical Oncology, Department of Surgery, University of Colorado at Denver-Anschutz Medical Campus, Aurora, CO, USA. · Section of Hepato-Pancreato-Biliary & Endocrine Surgery, Virginia Mason Medical Center, Seattle, WA, USA. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: m.g.besselink@amsterdamumc.nl. ·Eur J Surg Oncol · Pubmed #31924432.

ABSTRACT: BACKGROUND: The objective of this study was to validate and update the Amsterdam prediction model including tumor grade, lymph node ratio, margin status and adjuvant therapy, for prediction of overall survival (OS) after pancreatoduodenectomy for pancreatic cancer. METHODS: We included consecutive patients who underwent pancreatoduodenectomy for pancreatic cancer between 2000 and 2017 at 11 tertiary centers in 8 countries (USA, UK, Germany, Italy, Sweden, the Netherlands, Korea, Australia). Model performance for prediction of OS was evaluated by calibration statistics and Uno's C-statistic for discrimination. Validation followed the TRIPOD statement. RESULTS: Overall, 3081 patients (53% male, median age 66 years) were included with a median OS of 24 months, of whom 38% had N2 disease and 77% received adjuvant chemotherapy. Predictions of 3-year OS were fairly similar to observed OS with a calibration slope of 0.72. Statistical updating of the model resulted in an increase of the C-statistic from 0.63 to 0.65 (95% CI 0.64-0.65), ranging from 0.62 to 0.67 across different countries. The area under the curve for the prediction of 3-year OS was 0.71 after updating. Median OS was 36, 25 and 15 months for the low, intermediate and high risk group, respectively (P < 0.001). CONCLUSIONS: This large international study validated and updated the Amsterdam model for survival prediction after pancreatoduodenectomy for pancreatic cancer. The model incorporates readily available variables with a fairly accurate model performance and robustness across different countries, while novel markers may be added in the future. The risk groups and web-based calculator www.pancreascalculator.com may facilitate use in daily practice and future trials.

7 Article Efficacy and feasibility of stereotactic radiotherapy after folfirinox in patients with locally advanced pancreatic cancer (LAPC-1 trial). 2019

Suker, Mustafa / Nuyttens, Joost J / Eskens, Ferry A L M / Haberkorn, Brigitte C M / Coene, Peter-Paul L O / van der Harst, Erwin / Bonsing, Bert A / Vahrmeijer, Alexander L / Mieog, J Sven D / Jan Swijnenburg, Rutger / Roos, Daphne / Koerkamp, B Groot / van Eijck, Casper H J. ·Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Radiotherapy, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Oncology, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Oncology, Maasstad Hospital, Rotterdam, Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, Netherlands. · Department of Surgery, Reinier de Graaf Group, Delft, Netherlands. ·EClinicalMedicine · Pubmed #31891135.

ABSTRACT: Background: We conducted a multicentre phase II trial to investigate feasibility and antitumor activity of sequential FOLFIRINOX and Stereotactic Body Radiotherapy (SBRT) in patients with locally advanced pancreatic cancer (LAPC), (LAPC-1 trial). Methods: Patients with biopsy-proven LAPC treated in four hospitals in the Netherlands between December 2014 and June 2017. Patients received 8 cycles of FOLFIRINOX followed by SBRT (5 fractions/8 Gy) if no tumour progression after the FOLFIRINOX treatment was observed. Primary outcome was 1-year overall survival (OS). Secondary outcomes were median OS, 1-year progression-free survival (PFS), treatment-related toxicity, and resection rate. The study is registered with ClinicalTrials.gov, NCT02292745, and is completed. Findings: Fifty patients were included. Nineteen (38%) patients did not receive all 8 cycles of FOLFIRINOX, due to toxicity ( Interpretation: FOLFIRINOX followed by SBRT in patients with LAPC is feasible and shows relevant antitumor activity. In 6 (12%) patients a potentially curative resection could be pursued following this combined treatment, with a complete histological response being observed in two patients.

8 Article Outcome and long-term quality of life after total pancreatectomy (PANORAMA): a nationwide cohort study. 2019

Scholten, Lianne / Latenstein, Anouk E J / van Eijck, Casper / Erdmann, Joris / van der Harst, Erwin / Mieog, J Sven D / Molenaar, I Quintus / van Santvoort, Hjalmar C / DeVries, J Hans / Besselink, Marc G / Anonymous3811095. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. · Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands. · Department of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein, Utrecht, the Netherlands. · Department of Endocrinology, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: m.g.besselink@amsterdamumc.nl. ·Surgery · Pubmed #31500907.

ABSTRACT: BACKGROUND: The threshold to perform total pancreatectomy is rather high, predominantly because of concerns for long-term consequences of brittle diabetes on patients' quality of life. Contemporary data on postoperative outcomes, diabetes management, and long-term quality of life after total pancreatectomy from large nationwide series are, however, lacking. METHODS: We performed a nationwide, retrospective cohort study among adults who underwent total pancreatectomy in 17 Dutch centers (2006-2016). Morbidity and mortality were analyzed, and long-term quality of life was assessed cross-sectionally using the following generic and disease-specific questionnaires: the 5-level version European quality of life 5-dimension and the European Organization for Research and Treatment in Cancer Quality of Life Questionnaire Cancer. Several questionnaires specifically addressing diabetic quality of life included the Problem Areas in Diabetes Scale 20, the Diabetes Treatment Satisfaction Questionnaire-status version, and the Hypoglycemia Fear Survey-II. Results were compared with the general population and patients with type 1 diabetes. RESULTS: Overall, 148 patients after total pancreatectomy were included. The annual nationwide volume of total pancreatectomy increased from 5 in 2006 to 32 in 2015 (P < .05). The 30-day and 90-day mortality were 5% and 8%, respectively. The major complication rate was 32%. Quality of life questionnaires were completed by 60 patients (85%, median follow-up of 36 months). Participants reported lower global (73 vs 78, P = .03) and daily health status (0.83 vs 0.87, P < .01) compared to the general population. Quality of life did not differ based on time after total pancreatectomy (<3, 3-5, or >5 years). In general, patients were satisfied with their diabetes therapy and experienced similar diabetes-related distress as patients with type 1 diabetes. CONCLUSION: This nationwide study found increased use of total pancreatectomy with a relatively high 90-day mortality. Long-term quality of life was lower compared to the general population, although differences were small. Diabetes-related distress and treatment satisfaction were similar to patients with type 1 diabetes.

9 Article Yield of staging laparoscopy before treatment of locally advanced pancreatic cancer to detect occult metastases. 2019

Suker, M / Koerkamp, B Groot / Coene, P P / van der Harst, E / Bonsing, B A / Vahrmeijer, A L / Mieog, J S D / Swijnenburg, R J / Dwarkasing, R S / Roos, D / van Eijck, C H J. ·Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. Electronic address: m.suker@erasmusmc.nl. · Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Radiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. · Department of Surgery, Reinier de Graaf Group, Delft, the Netherlands. ·Eur J Surg Oncol · Pubmed #31186205.

ABSTRACT: INTRODUCTION: Locally advanced pancreatic cancer (LAPC) is found in 35% of patients with pancreatic cancer. However, these patients often have occult metastatic disease. Patients with occult metastases are unlikely to benefit from locoregional treatments. This study evaluated the yield of occult metastases during staging laparoscopy in patients with LAPC. METHODS: Between January 2013 and January 2017 all patients with LAPC underwent a staging laparoscopy after a recent tri-phasic CT-scan of the chest and abdomen. Data were retrospectively reviewed from a prospectively maintained database. Univariate and multivariable logistic regression analysis was conducted to predict metastasis found at laparoscopy. RESULTS: A total of 91 (41% male, median age 64 years) LAPC patients were included. The median time between CT-scan and staging laparoscopy was 21 days. During staging laparoscopy metastases were found in 17 patients (19%, 95% CI: 12%-28%). Seven (8%) patients had liver-only, 9 (10%) patients peritoneal-only, and 1 (1%) patient both liver and peritoneal metastases. Univariate logistic regression analysis showed that CEA (OR 1.056, 95% CI 1.007-1.107, p = 0.02) was the only preoperative predictor for occult metastases. In a multivariable logistic regression analysis of the preoperative risk factors again only CEA was an independent predictor for occult metastatic disease (p = 0.03). Patients with a CEA above 5 μg/L had a risk of occult metastasis of 91%. FOLFIRINOX was given to 69 (76%) of the patients with a median number of cycles of 8. Subsequent radiotherapy was given to 44 (48%) patients after the FOLFIRINOX treatment. Six (14%) patients underwent a resection after FOLFIRINOX and radiotherapy. The overall 1-year survival was 53% in patients without occult metastasis versus 29% with occult metastasis (p = 0.11). The 1-year OS for patients that completed FOLFIRINOX and radiotherapy was 84%. CONCLUSION: The yield of staging laparoscopy for occult intrahepatic or peritoneal metastases in patients with locally advanced pancreatic cancer was 19%. Staging laparoscopy is recomended for patients with LAPC for accurate staging to determine optimal treatment.

10 Article A Prospective Clinical Trial to Determine the Effect of Intraoperative Ultrasound on Surgical Strategy and Resection Outcome in Patients with Pancreatic Cancer. 2019

Sibinga Mulder, Babs G / Feshtali, Shirin / Fariña Sarasqueta, Arantza / Vahrmeijer, Alexander L / Swijnenburg, Rutger-Jan / Bonsing, Bert A / Mieog, J Sven D. ·Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. · Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.s.d.mieog@lumc.nl. ·Ultrasound Med Biol · Pubmed #31130412.

ABSTRACT: Surgical exploration in patients with pancreatic or periampullary cancer is often performed without intraoperative image guidance. Although intraoperative ultrasound (IOUS) may enhance visualization during resection, this tool has not been investigated in detail until now. Here, we performed a prospective cohort study to evaluate the effect of IOUS on surgical strategy and to evaluate whether vascular involvement and radicality of the resection could be correctly assessed with IOUS. IOUS was performed by an experienced abdominal radiologist during surgical exploration in 31 consecutive procedures. IOUS affected surgical strategy by either (i) having no effect, (ii) determining tumor localization, (iii) evaluating vascular involvement or (iv) waiving surgery. Radicality of the resections and vascular contact were determined during pathologic analysis and compared with preoperative imaging and IOUS findings. Overall, IOUS influenced surgical strategy in 61% of procedures. In 21 out of 27 malignant tumors, a radical resection was achieved (78%). Vascular contact was assessed correctly using IOUS in 89% compared with 74% of patients using preoperative imaging. IOUS can help the surgical team to assess the resectability and to visualize the tumor and possible vascular contact in real time during resection. IOUS may therefore increase the likelihood of achieving a radical resection.

11 Article Impact of resection margin status on recurrence and survival in pancreatic cancer surgery. 2019

Tummers, W S / Groen, J V / Sibinga Mulder, B G / Farina-Sarasqueta, A / Morreau, J / Putter, H / van de Velde, C J / Vahrmeijer, A L / Bonsing, B A / Mieog, J S / Swijnenburg, R J. ·Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands. · Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands. · Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands. · Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. ·Br J Surg · Pubmed #30883699.

ABSTRACT: BACKGROUND: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) is poor and selection of patients for surgery is challenging. This study examined the impact of a positive resection margin (R1) on locoregional recurrence (LRR) and overall survival (OS); and also aimed to identified tumour characteristics and/or technical factors associated with a positive resection margin in patients with PDAC. METHODS: Patients scheduled for pancreatic resection for PDAC between 2006 and 2016 were identified from an institutional database. The effect of resection margin status, patient characteristics and tumour characteristics on LRR, distant metastasis and OS was assessed. RESULTS: A total of 322 patients underwent pancreatectomy for PDAC. A positive resection (R1) margin was found in 129 patients (40·1 per cent); this was associated with decreased OS compared with that in patients with an R0 margin (median 15 (95 per cent c.i. 13 to 17) versus 22 months; P < 0·001). R1 status was associated with reduced time to LRR (median 16 versus 36 (not estimated, n.e.) months; P = 0·002). Disease recurrence patterns were similar in the R1 and R0 groups. Risk factors for early recurrence were tumour stage, positive lymph nodes (N1) and perineural invasion. Among 100 patients with N0 disease, R1 status was associated with shorter OS compared with R0 resection (median 17 (10 to 24) versus 45 (n.e.) months; P = 0·002), whereas R status was not related to OS in 222 patients with N1 disease (median 14 (12 to 16) versus 17 (15 to 19) months after R1 and R0 resection respectively; P = 0·068). CONCLUSION: Although pancreatic resection with a positive margin was associated with poor survival and early recurrence, particularly in patients with N1 disease, disease recurrence patterns were similar between R1 and R0 groups.

12 Article The Systemic-immune-inflammation Index Independently Predicts Survival and Recurrence in Resectable Pancreatic Cancer and its Prognostic Value Depends on Bilirubin Levels: A Retrospective Multicenter Cohort Study. 2019

Aziz, Mohammad Hosein / Sideras, Kostandinos / Aziz, Nasir Ahmad / Mauff, Katya / Haen, Roel / Roos, Daphne / Saida, Lawlaw / Suker, Mustafa / van der Harst, Erwin / Mieog, Jan Sven / Bonsing, Bert A / Klaver, Yarne / Koerkamp, Bas Groot / van Eijck, Casper H. ·Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands. · Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands. · Department of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Medical Oncology, Laboratory of Tumor Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands. ·Ann Surg · Pubmed #29334554.

ABSTRACT: OBJECTIVE: Our aim was to determine the prognostic significance of the systemic-immune-inflammation index (SIII) in patients with resectable pancreatic cancer, using cancer-specific survival as the primary outcome. BACKGROUND: Pancreatic cancer is associated with a dysfunctional immune system and poor prognosis. We examined the prognostic significance of the SIII in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and the effects of bilirubin on this index. METHODS: We retrospectively assessed all pancreatic resections performed between 2004 and 2015 at 4 tertiary referral centers to identify pathologically confirmed PDAC patients. Baseline clinicopathologic characteristics, preoperative laboratory values such as absolute neutrophil, lymphocyte, and platelet counts, C-reactive protein, albumin, bilirubin, and CA19-9 levels, and also follow-up information, were collected. The associations of the calculated inflammatory indices with outcome were both internally and externally validated. RESULTS: In all, 590 patients with resectable PDAC were included. The discovery and validation cohort included 170 and 420 patients, respectively. SIII >900 [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.55-3.48], lymph node ratio (HR 3.75, 95% CI 2.08-6.76), and CA19.9 >200 kU/L (HR 1.62, 95% CI 1.07-2.46) were identified as independent predictors of cancer-specific survival. Separate model analysis confirmed that preoperative SIII contributed significantly to prognostication. However, SIII appeared to lose its prognostic significance in patients with bilirubin levels above 200 μmol/L. CONCLUSIONS: SIII is an independent predictor of cancer-specific survival and recurrence in patients with resectable PDAC. SIII may lose its prognostic significance in patients with high bilirubin levels. Properly designed prospective studies are needed to further confirm this hypothesis.

13 Article Staging laparoscopy with ultrasound and near-infrared fluorescence imaging to detect occult metastases of pancreatic and periampullary cancer. 2018

Handgraaf, H J M / Sibinga Mulder, B G / Shahbazi Feshtali, S / Boogerd, L S F / van der Valk, M J M / Fariña Sarasqueta, A / Swijnenburg, R J / Bonsing, B A / Vahrmeijer, A L / Mieog, J S D. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. ·PLoS One · Pubmed #30383818.

ABSTRACT: INTRODUCTION: Up to 38% of pancreatic and periampullary cancer patients undergoing curative intended surgery turn out to have incurable disease. Therefore, staging laparoscopy (SL) prior to laparotomy is advised to spare patients the morbidity, inconvenience and expense of futile major surgery. The aim of this study was to assess the added value of SL with laparoscopic ultrasonography (LUS) and laparoscopic near-infrared fluorescence imaging (LFI). METHODS: All patients undergoing curative intended surgery of pancreatic or periampullary cancer were included prospectively in this single arm study. Patients received an intravenous infusion of 10 mg indocyanine green (ICG) one or two days prior to surgery to allow LFI. Suspect lesions were analyzed via biopsy or resection. Follow-up visits after surgery occurred every three months. RESULTS: A total of 25 patients were included. Suspect lesions were identified in 7 patients: liver metastases (n = 2; identified by inspection, LUS, and LFI), peritoneal metastases (n = 1; identified by inspection only), and benign lesions (n = 4; identified by inspection or LUS). Quality of LFI was good in 67% (10/15) of patients dosed one day and 89% (8/9) dosed two days prior to surgery. A futile laparotomy was averted in 3 patients (12%). Following SL the primary tumor was resected in 20 patients. Two patients (10%) developed metastases within 3 months after resection. CONCLUSIONS: Despite current preoperative imaging modalities metastases are still identified during surgery. This study shows limited added value of LUS during SL in patients with pancreatic or periampullary cancer. LFI was of added value due to its high negative predictive value in case of suspect hepatic lesions identified by inspection.

14 Article Differences in Treatment and Outcome of Pancreatic Adenocarcinoma Stage I and II in the EURECCA Pancreas Consortium. 2018

Groen, J V / Sibinga Mulder, B G / van Eycken, E / Valerianova, Z / Borras, J M / van der Geest, L G M / Capretti, G / Schlesinger-Raab, A / Primic-Zakelj, M / Ryzhov, A / van de Velde, C J H / Bonsing, B A / Bastiaannet, E / Mieog, J S D. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Belgian Cancer Registry, Brussels, Belgium. · Bulgarian National Cancer Registry/National Oncological Hospital, Sofia, Bulgaria. · Department of Clinical Sciences, University of Barcelona, Barcelona, Spain. · Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands. · Pancreatic Surgery Unit, Department of Surgery, Humanitas University, Milan, Italy. · Munich Cancer Registry, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany. · Epidemiology and Cancer Registry/Institute of Oncology Ljubljana, Ljubljana, Slovenia. · Taras Shevchenko National University of Kyiv and Ukrainian National Cancer Institute, Kiev, Ukraine. · Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. J.S.D.Mieog@lumc.nl. ·Ann Surg Oncol · Pubmed #30151560.

ABSTRACT: BACKGROUND: The EUropean REgistration of Cancer CAre (EURECCA) consortium aims to investigate differences in treatment and to improve cancer care through Europe. The purpose of this study was to compare neo- and adjuvant chemotherapy (ACT) and outcome after tumor resection for pancreatic adenocarcinoma stage I and II in the EURECCA Pancreas consortium. METHODS: The eight, collaborating national, regional, and single-center partners shared their anonymized dataset. Patients diagnosed in 2012-2013 who underwent tumor resection for pancreatic adenocarcinoma stage I and II were investigated with respect to treatment and survival and compared using uni- and multivariable logistic and Cox regression analyses. All comparisons were performed separately per registry type: national, regional, and single-center registries. RESULTS: In total, 2052 patients were included. Stage II was present in the majority of patients. The use of neo-ACT was limited in most registries (range 2.8-15.5%) and was only different between Belgium and The Netherlands after adjustment for potential confounders. The use of ACT was different between the registries (range 40.5-70.0%), even after adjustment for potential confounders. Ninety-day mortality was also different between the registries (range 0.9-13.6%). In multivariable analyses for overall survival, differences were observed between the national and regional registries. Furthermore, patients in ascending age groups and patients with stage II showed a significant worse overall survival. CONCLUSIONS: This study provides a clear insight in clinical practice in the EURECCA Pancreas consortium. The differences observed in (neo-)ACT and outcome give us the chance to further investigate the best practices and improve outcome of pancreatic adenocarcinoma.

15 Article Intraoperative Near-Infrared Fluorescence Imaging of Multiple Pancreatic Neuroendocrine Tumors: A Case Report. 2018

Handgraaf, Henricus J M / Boogerd, Leonora S F / Shahbazi Feshtali, Shirin / Fariña Sarasqueta, Arantza / Snel, Marieke / Swijnenburg, Rutger-Jan / Vahrmeijer, Alexander L / Bonsing, Bert A / Mieog, J Sven D. · ·Pancreas · Pubmed #29232342.

ABSTRACT: Multiple endocrine neoplasia type 1 syndrome can feature pancreatic neuroendocrine lesions that have the potential to degenerate into malignancies (pancreatic neuroendocrine tumors [PNETs]). Resection is required in selected cases and aims to cure patients and to prevent metastasis. Preoperative imaging is important to assess the number, size, and location of PNETs. However, sensitivity of preoperative imaging modalities to detect small lesions can be rather disappointing. This makes intraoperative reassessment of the pancreas crucial. Methylene blue (MB) accumulates in neuroendocrine lesions after intravenous administration. Methylene blue emits fluorescence of approximately 700 nm and can be visualized using a dedicated near-infrared (NIR) fluorescence imaging system. We present a 58-year-old male patient with multiple endocrine neoplasia type 1 syndrome and 2 lesions suspected as PNETs identified during regular follow-up. Intraoperative administration of MB allowed successful NIR fluorescence imaging of multiple lesions missed by preoperative imaging. After confirmation by intraoperative ultrasound, this new finding led to a major change in treatment: from enucleations to total pancreatectomy. Histopathologic examination confirmed that the fluorescent lesions were indeed neuroendocrine lesions ranging from microadenomas to PNETs. This case demonstrates that intraoperative assessment of neuroendocrine lesions can be improved by intraoperative NIR fluorescence imaging using MB, a safe and relatively easy technique.

16 Article Diagnostic value of targeted next-generation sequencing in patients with suspected pancreatic or periampullary cancer. 2018

Sibinga Mulder, Babs G / Mieog, J Sven D / Farina Sarasqueta, Arantza / Handgraaf, Henricus Jm / Vasen, Hans F A / Swijnenburg, Rutger-Jan / Luelmo, Saskia A C / Feshtali, Shirin / Inderson, Akin / Vahrmeijer, Alexander L / Bonsing, Bert A / Wezel, Tom van / Morreau, Hans. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. ·J Clin Pathol · Pubmed #28775172.

ABSTRACT: AIMS: Radiological imaging and morphological assessment of cytology material have limitations for preoperative classification of pancreatic or periampullary lesions, often resulting in surgical resection without definitive diagnosis. Our prospective study aims to define the diagnostic value of targeted next-generation sequencing (NGS) of DNA from cytology material. METHODS: Patients with a suspect pancreatic or periampullary lesion underwent standard diagnostic evaluation including preoperative morphological cytology assessment. Treatment options for suspect lesions were surgical exploration with possible resection, follow-up or palliation. The cytology samples were analysed with NGS, in which 50 genes were sequenced for the presence of pathogenic variants. The NGS results were integrated with the clinical information during multidisciplinary team meetings, and changes in the treatment plan were scored. Diagnostic accuracy of NGS analysis (malignancy vs benign disease) was calculated. RESULTS: NGS results of the cytology samples were confirmed in the resection specimens of the first 10 included patients. The integration of the NGS results led to a change in treatment plan in 7 out of 70 patients (from exploration to follow-up, n=4; from follow-up to exploration and resection, n=2; from palliation to resection, n=1). In four patients, the NGS results were contradictory, but did not affect the treatment plan. In the remaining 59 patients, NGS analysis supported the initial treatment plan. The diagnostic accuracy of NGS analysis was 94% (sensitivity=93%; specificity=100%). CONCLUSIONS: NGS can change the treatment plan in a significant portion of patients with suspect pancreatic or periampullary lesions. Application of NGS can optimise treatment selection and diminish unnecessary surgeries.

17 Article Selection of optimal molecular targets for tumor-specific imaging in pancreatic ductal adenocarcinoma. 2017

Tummers, Willemieke S / Farina-Sarasqueta, Arantza / Boonstra, Martin C / Prevoo, Hendrica A / Sier, Cornelis F / Mieog, Jan S / Morreau, Johannes / van Eijck, Casper H / Kuppen, Peter J / van de Velde, Cornelis J / Bonsing, Bert A / Vahrmeijer, Alexander L / Swijnenburg, Rutger-Jan. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. ·Oncotarget · Pubmed #28915633.

ABSTRACT: Discrimination of pancreatic ductal adenocarcinoma (PDAC) from chronic pancreatitis (CP) or peritumoral inflammation is challenging, both at preoperative imaging and during surgery, but it is crucial for proper therapy selection. Tumor-specific molecular imaging aims to enhance this discrimination and to help select and stratify patients for resection. We evaluated various biomarkers for the specific identification of PDAC and associated lymph node metastases. Using immunohistochemistry (IHC), expression levels and patterns were investigated of integrin αvβ6, carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5), Cathepsin E (Cath E), epidermal growth factor receptor (EGFR), hepatocyte growth factor receptor (c-MET), thymocyte differentiation antigen 1 (Thy1), and urokinase-type plasminogen activator receptor (uPAR). In a first cohort, multiple types of pancreatic tissue were evaluated (n=62); normal pancreatic tissue (n=8), CP (n=7), PDAC (n=9), tumor associated lymph nodes (n=32), and PDAC after neoadjuvant radiochemotherapy (n=6). In a second cohort, tissues were investigated (n=55) with IHC and immunofluorescence (IF) for concordance of biomarker expression in all tissue types, obtained from an individual patient. Integrin αvβ6 and CEACAM5 showed significantly higher expression levels in PDAC versus normal pancreatic tissue (P=0.001 and P<0.001, respectively) and CP (P=0.003 and P<0.001, respectively). Avβ6 and CEACAM5 expression identified tumor-positive lymph nodes correctly in 84% and 68%, respectively, and in 100% of tumor-negative nodes for both biomarkers. In conclusion, αvβ6 and CEACAM5 are excellent biomarkers to differentiate PDAC from surrounding tissue and to identify lymph node metastases. Individually or combined, these biomarkers are promising targets for tumor-specific molecular imaging of PDAC.

18 Article Validation of full-field optical coherence tomography in distinguishing malignant and benign tissue in resected pancreatic cancer specimens. 2017

van Manen, Labrinus / Stegehuis, Paulien L / Fariña-Sarasqueta, Arantza / de Haan, Lorraine M / Eggermont, Jeroen / Bonsing, Bert A / Morreau, Hans / Lelieveldt, Boudewijn P F / van de Velde, Cornelis J H / Vahrmeijer, Alexander L / Dijkstra, Jouke / Mieog, J Sven D. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. ·PLoS One · Pubmed #28414765.

ABSTRACT: BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer-related mortality in the United States. The minority of patients can undergo curative-intended surgical therapy due to progressive disease stage at time of diagnosis. Nonetheless, tumor involvement of surgical margins is seen in up to 70% of resections, being a strong negative prognostic factor. Real-time intraoperative imaging modalities may aid surgeons to obtain tumor-free resection margins. Full-field optical coherence tomography (FF-OCT) is a promising diagnostic tool using high-resolution white-light interference microscopy without tissue processing. Therefore, we composed an atlas of FF-OCT images of malignant and benign pancreatic tissue, and investigated the accuracy with which the pathologists could distinguish these. MATERIALS AND METHODS: One hundred FF-OCT images were collected from specimens of 29 patients who underwent pancreatic resection for various indications between 2014 and 2016. One experienced gastrointestinal pathologist and one pathologist in training scored independently the FF-OCT images as malignant or benign blinded to the final pathology conclusion. Results were compared to those obtained with standard hematoxylin and eosin (H&E) slides. RESULTS: Overall, combined test characteristics of both pathologists showed a sensitivity of 72%, specificity of 74%, positive predictive value of 69%, negative predictive value of 79% and an overall accuracy of 73%. In the subset of pancreatic ductal adenocarcinoma patients, 97% of the FF-OCT images (n = 35) were interpreted as tumor by at least one pathologist. Moreover, normal pancreatic tissue was recognised in all cases by at least one pathologist. However, atrophy and fibrosis, serous cystadenoma and neuroendocrine tumors were more often wrongly scored, in 63%, 100% and 25% respectively. CONCLUSION: FF-OCT could distinguish normal pancreatic tissue from pathologic pancreatic tissue in both processed as non-processed specimens using architectural features. The accuracy in pancreatic ductal adenocarcinoma is promising and warrants further evaluation using improved assessment criteria.

19 Article No association between metformin use and survival in patients with pancreatic cancer: An observational cohort study. 2017

Frouws, Martine A / Sibinga Mulder, Babs G / Bastiaannet, Esther / Zanders, Marjolein M J / van Herk-Sukel, Myrthe P P / de Leede, Eleonora M / Bonsing, Bert A / Mieog, J Sven D / Van de Velde, Cornelis J H / Liefers, Gerrit-Jan. ·aDepartment of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands, P.O. Box 9600, 2300 RC, The Netherlands bComprehensive Cancer Organisation The Netherlands, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands cPHARMO Institute for Drug Outcomes Research, van Deventerlaan 30/40, Utrecht, 3528 AE, The Netherlands. ·Medicine (Baltimore) · Pubmed #28272215.

ABSTRACT: Several studies have suggested an association between use of metformin and an increased overall survival in patients diagnosed with pancreatic cancer, however with several important methodological limitations. The aim of the study was to assess the association between overall survival, pancreatic cancer, and metformin use.A retrospective cohort study of 1111 patients with pancreatic cancer was conducted using data from The Netherlands Comprehensive Cancer Organization (1998-2011). Data were linked to the PHARMO Database Network containing drug-dispensing records from community pharmacies. Patients were classified as metformin user or sulfonylurea derivatives user from the moment of first dispensing until the end of follow up. The difference in overall survival between metformin users and nonusers was assessed, and additionally between metformin users and sulfonylurea derivatives users. Univariable and multivariable parametric survival models were used and use of metformin and sulfonylurea derivatives was included as time-varying covariates.Of the 1111 patients, 91 patients were excluded because of differences in morphology, 48 patients because of using merely metformin before diagnosis, and 57 metformin-users ever used contemporary sulfonylurea derivatives and were therefore excluded. Lastly, 8 patients with a survival of zero months were excluded. This resulted in 907 patients for the analysis. Overall, 77 users of metformin, 43 users of sulfonylurea derivatives, and 787 nonusers were identified. The adjusted rate ratio for overall survival for metformin users versus nonusers was 0.86 (95% CI: 0.66-1.11; P = 0.25). The difference in overall survival between metformin users and sulfonylurea derivatives users showed an adjusted rate ratio of 0.90 (95% CI: 0.59-1.40; P = 0.67).No association was found between overall survival, pancreatic cancer, and metformin use. This was in concordance with 2 recently published randomized controlled trials. Future research should focus on the use of adjuvant metformin in other cancer types and the development or repurposing of other drugs for pancreatic cancer.

20 Article Targeted next-generation sequencing of FNA-derived DNA in pancreatic cancer. 2017

Sibinga Mulder, Babs G / Mieog, J Sven D / Handgraaf, Henricus J M / Farina Sarasqueta, Arantza / Vasen, Hans F A / Potjer, Thomas P / Swijnenburg, Rutger-Jan / Luelmo, Saskia A C / Feshtali, Shirin / Inderson, Akin / Vahrmeijer, Alexander L / Bonsing, Bert A / van Wezel, Tom / Morreau, Hans. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands. · Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. ·J Clin Pathol · Pubmed #27672215.

ABSTRACT: To improve the diagnostic value of fine-needle aspiration (FNA)-derived material, we perform targeted next-generation sequencing (NGS) in patients with a suspect lesion of the pancreas. The NGS analysis can lead to a change in the treatment plan or supports inconclusive or uncertain cytology results. We describe the advantages of NGS using one particular patient with a recurrent pancreatic lesion 7 years after resection of a pancreatic ductal adenocarcinoma (PDAC). Our NGS analysis revealed the presence of a presumed second primary cancer in the pancreatic remnant, which led to a change in treatment: resection with curative intend instead of palliation. Additionally, NGS identified an unexpected germline CDKN2A 19-base pair deletion, which predisposed the patient to developing PDAC. Preoperative NGS analysis of FNA-derived DNA can help identify patients at risk for developing PDAC and define future therapeutic options.

21 Article Selecting Tumor-Specific Molecular Targets in Pancreatic Adenocarcinoma: Paving the Way for Image-Guided Pancreatic Surgery. 2016

de Geus, Susanna W L / Boogerd, Leonora S F / Swijnenburg, Rutger-Jan / Mieog, J Sven D / Tummers, Willemieke S F J / Prevoo, Hendrica A J M / Sier, Cornelis F M / Morreau, Hans / Bonsing, Bert A / van de Velde, Cornelis J H / Vahrmeijer, Alexander L / Kuppen, Peter J K. ·Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. · Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. p.j.k.kuppen@lumc.nl. ·Mol Imaging Biol · Pubmed #27130234.

ABSTRACT: PURPOSE: The purpose of this study was to identify suitable molecular targets for tumor-specific imaging of pancreatic adenocarcinoma. PROCEDURES: The expression of eight potential imaging targets was assessed by the target selection criteria (TASC)-score and immunohistochemical analysis in normal pancreatic tissue (n = 9), pancreatic (n = 137), and periampullary (n = 28) adenocarcinoma. RESULTS: Integrin α CONCLUSIONS: The results of this study show that integrin α

22 Article Common variables in European pancreatic cancer registries: The introduction of the EURECCA pancreatic cancer project. 2016

de Leede, E M / Sibinga Mulder, B G / Bastiaannet, E / Poston, G J / Sahora, K / Van Eycken, E / Valerianova, Z / Mortensen, M B / Dralle, H / Primic-Žakelj, M / Borràs, J M / Gasslander, T / Ryzhov, A / Lemmens, V E / Mieog, J S D / Boelens, P G / van de Velde, C J H / Bonsing, B A. ·Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. · Department of Surgery, University Hospital Aintree, Liverpool, United Kingdom. · Department of Surgery and Comprehensive Cancer Centre, Medical University of Vienna/ABCSG Pancreatic Cancer Registry, Austria. · Belgian Cancer Registry, Brussels, Belgium. · Bulgarian National Cancer Registry/National Oncological Hospital, Sofia, Bulgaria. · Department of Surgery, Odense University Hospital/Danish Pancreas Cancer Group, Denmark. · Department of Surgery, University of Halle-Wittenberg/Pancreatic Cancer Register, Halle, Germany. · Epidemiology and Cancer Registry/Institute of Oncology, Ljubljana, Slovenia. · Department of Clinical Sciences, University of Barcelona, Barcelona, Spain. · Department of Surgery, Linköping University/Swedish Registry for Pancreatic Tumors, Sweden. · National Cancer Registry of Ukraine/National Institute of Cancer, Kiev, Ukraine. · Department of Research, Netherlands Cancer Registry/Comprehensive Cancer Centre The Netherlands (IKNL), Eindhoven, The Netherlands. · Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: c.j.h.van_de_velde@lumc.nl. ·Eur J Surg Oncol · Pubmed #27061790.

ABSTRACT: BACKGROUND: Quality assurance of cancer care is of utmost importance to detect and avoid under and over treatment. Most cancer data are collected by different procedures in different countries, and are poorly comparable at an international level. EURECCA, acronym for European Registration of Cancer Care, is a platform aiming to harmonize cancer data collection and improve cancer care by feedback. After the prior launch of the projects on colorectal, breast and upper GI cancer, EURECCA's newest project is collecting data on pancreatic cancer in several European countries. METHODS: National cancer registries, as well as specific pancreatic cancer audits/registries, were invited to participate in EURECCA Pancreas. Participating countries were requested to share an overview of their collected data items. Of the received datasets, a shared items list was made which creates insight in similarities between different national registries and will enable data comparison on a larger scale. Additionally, first data was requested from the participating countries. RESULTS: Over 24 countries have been approached and 11 confirmed participation: Austria, Belgium, Bulgaria, Denmark, Germany, The Netherlands, Slovenia, Spain, Sweden, Ukraine and United Kingdom. The number of collected data items varied between 16 and 285. This led to a shared items list of 25 variables divided into five categories: patient characteristics, preoperative diagnostics, treatment, staging and survival. Eight countries shared their first data. CONCLUSIONS: A list of 25 shared items on pancreatic cancer coming from eleven participating registries was created, providing a basis for future prospective data collection in pancreatic cancer treatment internationally.

23 Minor Author response to: Resection margin status in pancreatic cancer surgery: is it really less important than the N status? 2019

Groen, J V / Tummers, W S / Mieog, J S / Swijnenburg, R J. ·Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. · Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. ·Br J Surg · Pubmed #31577053.

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