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Pancreatic Neoplasms: HELP
Articles by Francesco Minni
Based on 41 articles published since 2010
(Why 41 articles?)
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Between 2010 and 2020, F. Minni wrote the following 41 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Sporadic Small (≤20 mm) Nonfunctioning Pancreatic Neuroendocrine Neoplasm: is the Risk of Malignancy Negligible When Adopting a More Conservative Strategy? A Systematic Review and Meta-analysis. 2017

Ricci, Claudio / Casadei, Riccardo / Taffurelli, Giovanni / Pacilio, Carlo Alberto / Campana, Davide / Ambrosini, Valentina / Donatella, Santini / Minni, Francesco. ·Department of Internal Medicine and Surgery (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università di Bologna, Bologna, Italy. claudio.ricci6@unibo.it. · Department of Internal Medicine and Surgery (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università di Bologna, Bologna, Italy. · Department of Specialized Diagnostic and Experimental Medicine (DIMES), Bologna, Italy. ·Ann Surg Oncol · Pubmed #28681158.

ABSTRACT: BACKGROUND: The management of small (≤20 mm), nonfunctioning pancreatic neuroendocrine neoplasms (pNENs) remains under debate. The European Neuroendocrine Tumor Society guidelines advocate the possibility of a conservative approach. METHODS: A systematic literature search was conducted to identify all studies comparing the risk of malignancy in small pNENs with respect to large ones (>20 mm). Malignancy was defined based on the presence of nodal metastases. Distant metastases, tumor grading (G2-3), vascular microscopic invasion, stage III-IV, and overall and disease-free survival also were evaluated. The data were reported in two ways: using the risk difference (RD) and the likelihood of being helped or harmed (LHH). RESULTS: The search identified only 6 eligible studies with an overall population of 1697 resected pNENs: 382 (22.5%) small and 1315 (77.5%) large. The RD of lymph nodal metastases was -0.26 (95% confidence interval (CI): -0.31 to -0.22; P < 0.001). The LHH was 0.34, suggesting that the risk of leaving a malignancy during follow-up due to the adoption of a conservative strategy was three times higher than the benefits. The risk difference of distant metastases, G3 lesions, G2-G3 lesions, stage III/IV, microscopic vascular invasion, death, and recurrence of the disease were lower in small NF-PNETs than large ones. The related LHH values suggested that a watch-and-wait policy never provided a benefit. CONCLUSIONS: Even if the malignancy rate in sporadic, small pancreatic neuroendocrine neoplasms was lower than in large ones, this difference did not justify a watch-and-wait policy.

2 Review Risk Factors for Malignancy of Branch-Duct Intraductal Papillary Mucinous Neoplasms: A Critical Evaluation of the Fukuoka Guidelines With a Systematic Review and Meta-analysis. 2016

Ricci, Claudio / Casadei, Riccardo / Taffurelli, Giovanni / Zani, Elia / Pagano, Nico / Pacilio, Carlo Alberto / Ingaldi, Carlo / Bogoni, Selene / Santini, Donatella / Migliori, Marina / Di Marco, Mariacristina / Serra, Carla / Calculli, Lucia / De Giorgio, Roberto / Minni, Francesco. ·From the Departments of *Medical and Surgical Sciences, and †Specialist, Diagnostic and Experimental Medicine, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. ·Pancreas · Pubmed #27776043.

ABSTRACT: OBJECTIVES: This study aimed to evaluate the accuracy of the risk factors proposed by Fukuoka guidelines in detecting malignancy of branch-duct intraductal papillary mucinous neoplasms. METHOD: Diagnostic meta-analysis of cohort studies. A systematic literature search was conducted using MEDLINE, the Cochrane Library, Scopus, and the ISI-Web of Science databases to identify all studies published up to 2014. RESULTS: Twenty-five studies (2025 patients) were suitable for the meta-analysis. The "high risk stigmata" showed the highest pooled diagnostic odds ratio (jaundice, 6.3; positive citology, 5.5; mural nodules, 4.8) together with 2 "worrisome features" (thickened/enhancing walls, 4.2; duct dilatation, 4.0) and 1 "other parameters" (carbohydrate antigen 19-9 serum levels, 4.6). CONCLUSIONS: An "ideal risk factor" capable of recognizing all malignant branch-duct intraductal papillary mucinous neoplasms was not identified and some "dismal areas" remain. However, "high risk stigmata" were strongly related to malignancy, mainly enhancing mural nodules. Among the "worrisome features," duct dilatation and thickened/enhancing walls were underestimated, and their diagnostic performance was similar to those of "high risk stigmata." The carbohydrate antigen 19-9 serum level should be added to the Fukuoka algorithm because this value could help in carrying out correct management.

3 Review Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis. 2015

Ricci, Claudio / Casadei, Riccardo / Taffurelli, Giovanni / Toscano, Fabrizio / Pacilio, Carlo Alberto / Bogoni, Selene / D'Ambra, Marielda / Pagano, Nico / Di Marco, Maria Cristina / Minni, Francesco. ·Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università di Bologna, Policlinico S.Orsola-Malpighi Via Massarenti n, 9 40138, Bologna, Italy, claudiochir@gmail.com. ·J Gastrointest Surg · Pubmed #25560180.

ABSTRACT: BACKGROUND: Laparoscopic distal pancreatectomy was proposed as an oncologically safe approach for pancreatic ductal adenocarcinoma. METHODS: A systematic review of the studies comparing laparoscopic and open distal pancreatectomy was conducted. The primary endpoint was an R0 resection rate. The secondary endpoints were intra- and postoperative results, tumour size, mean harvested lymph node, number of patients eligible for adjuvant therapy and overall survival. RESULTS: Five comparative case control studies involving 261 patients (30.7% laparoscopic and 69.3% open) who underwent a distal pancreatectomy were included. The R0 resection rate was similar between the two groups (P = 0.53). The laparoscopic group had longer operative times (P = 0.04), lesser blood loss (P = 0.01), a shorter hospital stay (P < 0.001) and smaller tumour size (P = 0.04) as compared with the laparotomic group. Overall morbidity, postoperative pancreatic fistula, reoperation, mortality and number of patients eligible for adjuvant therapy were similar. The mean harvested lymph nodes were comparable in the two groups (P = 0.33). The laparoscopic approach did not affect the overall survival rate (P = 0.32). CONCLUSION: Even if the number of patients compared is underpowered, the laparoscopic approach in the treatment of PDAC seems to be safe and efficacious. However, additional prospective, randomised, multicentric trials are needed to correctly evaluate the laparoscopic approach in PDAC.

4 Review Pancreatic resection in patients 80 years or older: a meta-analysis and systematic review. 2014

Casadei, Riccardo / Ricci, Claudio / Lazzarini, Enrico / Taffurelli, Giovanni / D'Ambra, Marielda / Mastroroberto, Marianna / Morselli-Labate, Antonio Maria / Minni, Francesco. ·From the Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ·Pancreas · Pubmed #25333405.

ABSTRACT: OBJECTIVE: The aim of this study was to evaluate the safety of pancreatic resections in patients 80 years or older. METHODS: A systematic search of the literature was carried out that compared perioperative outcomes after pancreatic resection in patients 80 years or older with patients younger than 80 years. The primary end points were postoperative mortality and morbidity. The secondary end points were incidence of postoperative pancreatic fistula, delayed gastric emptying, bile leak, pneumonia, postoperative infection, cardiologic complications, reoperation, and length of hospital stay. RESULTS: Nine studies were found to be suitable for the meta-analysis. The postoperative mortality and morbidity were significantly higher in the group 80 years or older (P < 0.00001 and P = 0.003, respectively) except for patients in whom there were no differences in preoperative comorbidities (P = 0.56 and P = 0.36, respectively). Postoperative cardiac complications were significantly more frequent in patients 80 years or older (P < 0.0001), and the length of hospital stay was significantly longer in octogenarian patients (P = 0.008). CONCLUSIONS: Patients 80 years or older have an increased incidence of postoperative mortality, morbidity, and cardiac complications and a longer length of hospital stay than do younger patients. Thus, pancreatic resection can be recommended only in a selected group of patients 80 years or older.

5 Review Laparoscopic distal pancreatectomy in Italy: a systematic review and meta-analysis. 2014

Ricci, Claudio / Casadei, Riccardo / Lazzarini, Enrico / D'Ambra, Marielda / Buscemi, Salvatore / Pacilio, Carlo Alberto / Taffurelli, Giovanni / Minni, Francesco. ·Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Universita di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. claudiochir@gmail.com. ·Hepatobiliary Pancreat Dis Int · Pubmed #25308355.

ABSTRACT: BACKGROUND: The use of laparoscopic distal pancreatectomy (LDP) increased in the past twenty years but the real diffusion of this technique is still unknown as well as the type of centers (high or low volume) in which this procedure is more frequently performed. DATA SOURCE: A systematic review was performed to evaluate the frequency of LDP in Italy and to compare indications and results in high volume centers (HVCs) and in low volume centers (LVCs). RESULTS: From 95 potentially relevant citations identified, only 5 studies were included. A total of 125 subjects were analyzed, of whom 95 (76.0%) were from HVCs and 30 (24.0%) from LVCs. The mean number of LDPs performed per year was 6.5. The mean number of patients who underwent LDP per year was 8.8 in HVCs and 3.0 in LVCs (P<0.001). The most frequent lesions operated on in HVCs were cystic tumors (62.1%, P<0.001) while, in LVCs, solid neoplasms (76.7%, P<0.001). In HVCs, malignant neoplasms were treated with LDP less frequently than in LVCs (17.9% vs 50.0%, P<0.001). Splenectomy was performed for non-oncologic reason frequenter in HVCs than in LVCs (70.2% vs 25.0%, P=0.004). The length of stay was shorter in HVCs than in LVCs (7.5 vs 11.3, P<0.001). No differences were found regarding age, gender, ductal adenocarcinoma treated, operative time, conversion, morbidity, postoperative pancreatic fistula, reoperation and margin status. CONCLUSIONS: LDPs were frequently performed in Italy. The "HVC approach" is characterized by a careful selection of patients undergoing LDP. The "LVC approach" is based on the hypothesis that LDPs are equivalent both in short-term and long-term results to laparotomic approach. These data are not conclusive and they point out the need for a national register of laparoscopic pancreatectomy.

6 Review Pancreatic mucinous cystic neoplasm in a male patient. 2012

Casadei, Riccardo / Pezzilli, Raffaele / Calculli, Lucia / Santini, Donatella / Taffurelli, Giovanni / Ricci, Claudio / D'Ambra, Marielda / Minni, Francesco. ·Department of Surgery, University of Bologna. Bologna, Italy. riccardo.casadei@unibo.it ·JOP · Pubmed #23183402.

ABSTRACT: CONTEXT: Mucinous cystic neoplasm (MCN) of the pancreas usually affects female patients and is characterized by an ovarian-type stroma. From literature review, only 9 cases of MCNs have been reported in male patients. CASE REPORT: We describe the 10th case of a MCN in a 65-year-old male patient who underwent a distal pancreatectomy with spleen resection and standard lymphadenectomy. CONCLUSIONS: MCN may rarely regard male patients, probably for embryological abnormalities.

7 Review Radiofrequency ablation for advanced ductal pancreatic carcinoma: is this approach beneficial for our patients? A systematic review. 2011

Pezzilli, Raffaele / Serra, Carla / Ricci, Claudio / Casadei, Riccardo / Monari, Francesco / D'Ambra, Marielda / Minni, Francesco. · ·Pancreas · Pubmed #21160378.

ABSTRACT: -- No abstract --

8 Review Total pancreatectomy: indications, operative technique, and results: a single centre experience and review of literature. 2010

Casadei, Riccardo / Monari, Francesco / Buscemi, Salvatore / Laterza, Marco / Ricci, Claudio / Rega, Daniela / D'Ambra, Marielda / Pezzilli, Raffaele / Calculli, Lucia / Santini, Donatella / Minni, Francesco. ·Dipartimento di Scienze Chirurgiche e Anestesiologiche, Chirurgia Generale-Minni, Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138 Bologna, Italy. riccardo.casadei@aosp.bo.it ·Updates Surg · Pubmed #20845100.

ABSTRACT: The aims of this study were to identify the indications to perform a total pancreatectomy and to evaluate the outcome and quality of life of the patient who underwent this operation. A retrospective analysis of a prospective database, regarding all the patients who underwent total pancreatectomy from January 2006 to June 2009, was carried out. Perioperative and outcome data were analyzed in two different groups: ductal adenocarcinoma (group 1) and non-ductal adenocarcinoma (group 2). Twenty (16.9%) total pancreatectomies out of 118 pancreatic resections were performed. Seven (35.0%) patients were affected by ductal adenocarcinoma (group 1) and the remaining 13 (65.0%) by pancreatic diseases different from ductal adenocarcinoma (group 2) [8 (61.5%) intraductal pancreatic mucinous neoplasms, 2 (15.4%) well-differentiated neuroendocrine carcinomas, 2 (15.4%) pancreatic metastases from renal cell cancer and, finally, 1 (7.7%) chronic pancreatitis]. Eleven patients (55%) underwent primary elective total pancreatectomy; nine (45%) had a completion pancreatectomy previous pancreaticoduodenectomy. Primary elective total pancreatectomy was significantly more frequent in group 2 than in group 1. Early and long-term postoperative results were good without significant difference between the two groups except for the disease-free survival that was significantly better in group 2. The follow-up examinations showed a good control of the apancreatic diabetes and of the exocrine insufficiency without differences between the two groups. In conclusion, currently, total pancreatectomy is a standardized and safe procedure that allows good early and late results. Its indications are increasing because of the more frequent diagnose of pancreatic disease that involved the whole gland as well as intraductal pancreatic mucinous neoplasm, neuroendocrine tumors and pancreatic metastases from renal cell cancer.

9 Clinical Trial Pancreatic endocrine tumors less than 4 cm in diameter: resect or enucleate? a single-center experience. 2010

Casadei, Riccardo / Ricci, Claudio / Rega, Daniela / D'Ambra, Marielda / Pezzilli, Raffaele / Tomassetti, Paola / Campana, Davide / Nori, Francesca / Minni, Francesco. ·Dipartimento di Scienze Chirurgiche e Anestesiologiche, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum Università di Bologna, Bologna, Italy. riccardo.casadei@aosp.bo.it ·Pancreas · Pubmed #20431423.

ABSTRACT: OBJECTIVE: Pancreatic endocrine tumors (PETs) are usually small, benign or low-grade malignant, and surgery should preserve the pancreatic parenchyma as much as possible. The aim of the study was to evaluate the postoperative and long-term survival of patients undergoing enucleation in small PETs. METHODS: Of 82 patients having PETs, 46 with tumor less than 4 cm in diameter, without distant metastases and with R0 resection by final pathologic examination, were included in this study. Enucleation was performed when the tumor did not involve the main pancreatic duct and in the absence of peripancreatic lymphadenopathy (group A); a typical resection was carried out in all other cases (group B). The 2 groups were compared regarding postoperative mortality and morbidity, pancreatic fistula, postoperative hospital stay, reoperation, World Health Organization classification, TNM stage, recurrence, and long-term survival. RESULTS: There were 15 patients (32.6%) in group A and 31 (67.4%) in group B. Postoperative and long-term results were similar in the 2 groups, whereas World Health Organization classification was significantly different; enucleation was performed more frequently than typical R0 resection in benign tumors (P = 0.009). CONCLUSIONS: Enucleation should be reserved for patients having benign PETs less than 4 cm in diameter and far from the main pancreatic duct.

10 Article Adjuvant chemoradiation in pancreatic cancer: impact of radiotherapy dose on survival. 2019

Morganti, Alessio G / Cellini, Francesco / Buwenge, Milly / Arcelli, Alessandra / Alfieri, Sergio / Calvo, Felipe A / Casadei, Riccardo / Cilla, Savino / Deodato, Francesco / Di Gioia, Giancarmine / Di Marco, Mariacristina / Fuccio, Lorenzo / Bertini, Federica / Guido, Alessandra / Herman, Joseph M / Macchia, Gabriella / Maidment, Bert W / Miller, Robert C / Minni, Francesco / Passoni, Paolo / Valentini, Chiara / Re, Alessia / Regine, William F / Reni, Michele / Falconi, Massimo / Valentini, Vincenzo / Mattiucci, Gian Carlo. ·Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, via Giuseppe Massarenti 9, 40138, Bologna, Italy. · UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Roma, Italy. · Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, via Giuseppe Massarenti 9, 40138, Bologna, Italy. mbuwenge@gmail.com. · Istituto di Clinica Chirurgica, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Roma, Italy. · Department of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain. · Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy. · Unit of Medical Physics, Fondazione Giovanni Paolo II, Campobasso, Italy. · Radiotherapy Unit, Fondazione Giovanni Paolo II, Campobasso, Italy. · Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA. · Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA. · IRCCS, Ospedale S. Raffaele, Milan, Italy. · Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. · Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA. · Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital, University "Vita e Salute", Milan, Italy. ·BMC Cancer · Pubmed #31185957.

ABSTRACT: BACKGROUND: To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC). METHODS: A multicenter retrospective analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: < 45 Gy, group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test. RESULTS: Median follow-up was 35 months (range: 3-120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p < 0.001), higher tumor grade (G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3-4, p = 0.002) and positive nodes (p < 0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis. CONCLUSIONS: Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to < 45 Gy dose generally used.

11 Article Evolution of pancreatectomy with en bloc venous resection for pancreatic cancer in Italy. Retrospective cohort study on 425 cases in 10 pancreatic referral units. 2018

Nigri, Giuseppe / Petrucciani, Niccolò / Pinna, Antonio Daniele / Ravaioli, Matteo / Jovine, Elio / Minni, Francesco / Grazi, Gian Luca / Chirletti, Piero / Balzano, Gianpaolo / Ferla, Fabio / De Carlis, Luciano / Tisone, Giuseppe / Napoli, Niccolò / Boggi, Ugo / Ramacciato, Giovanni. ·General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. Electronic address: giuseppe.nigri@uniroma1.it. · General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. · General Surgery and Transpantation Unit, University of Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy. · General Surgery Unit, Ospedale Maggiore di Bologna, Italy. · General Surgery Unit, Policlinico Sant'Orsola Malpighi, Bologna, Italy. · Hepato-pancreato-biliary Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy. · General Surgery Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. · Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy. · Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy. · Transplantation Unit, University of Tor Vergata, Policlinico Tor Vergata, Roma, Italy. · General Surgery and Transplantation Unit, University of Pisa, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. ·Int J Surg · Pubmed #29803770.

ABSTRACT: INTRODUCTION: The aim of this study is to analyze the evolution of pancreatectomy with venous resection in 10 referral Italian centers in the last 25 years. METHODS: A multicenter database of 425 patients submitted to pancreatectomy with venous resection between 1991 and 2015 was retrospectively analyzed. Patients were classified in 5 periods: 1 (1991-1995); 2 (1996-2000); 3 (2001-2005); 4 (2006-2010); 5 (2011-2015). Indications and outcomes were compared according to the period of surgery. RESULTS: Nineteen patients were operated in period 1, 28 in period 2, 91 in period 3, 140 in period 4, and 147 in period 5. Use of neoadjuvant therapy increased from 0% in period 1 and 2-12.1% in period 5. Postoperative complications ranged from 46.3% to 67.8%, and mortality from 5.3% to 9.2%. Median survival progressively increased, from 6 months in period 1-16 months in period 2, 24 months in period 3 and 4 and 35 months in period 5 (p = 0.004). Period, venous and nodal invasion were significant prognostic factors for survival. CONCLUSION: Management and outcomes of pancreatectomy with venous resection have evolved in the last 25 years in Italy. Improvement in patients' multidisciplinary management has lead to significant improvement of median survival.

12 Article Mutational burden of resectable pancreatic cancer, as determined by whole transcriptome and whole exome sequencing, predicts a poor prognosis. 2018

Grassi, Elisa / Durante, Sandra / Astolfi, Annalisa / Tarantino, Giuseppe / Indio, Valentina / Freier, Eva / Vecchiarelli, Silvia / Ricci, Claudio / Casadei, Riccardo / Formica, Francesca / Filippini, Daria / Comito, Francesca / Serra, Carla / Santini, Donatella / D' Errico, Antonietta / Minni, Francesco / Biasco, Guido / Di Marco, Mariacristina. ·Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant' Orsola-Malpighi Hospital, I-40138 Bologna, Italy. · Interdepartmental Center of Cancer Research University of Bologna, Sant' Orsola-Malpighi Hospital, I-40138 Bologna, Italy. · Department of Medical and Surgical Sciences, University of Bologna, Sant' Orsola-Malpighi Hospital, I-40138 Bologna, Italy. · Department of Internal Medicine, University of Bologna, Sant' Orsola-Malpighi Hospital, I-40138 Bologna, Italy. · Department of Pathology, University of Bologna, Sant' Orsola-Malpighi Hospital, I-40138 Bologna, Italy. ·Int J Oncol · Pubmed #29620163.

ABSTRACT: Despite the genomic characterization of pancreatic cancer (PC), marked advances in the development of prognosis classification and novel therapeutic strategies have yet to come. The present study aimed to better understand the genomic alterations associated with the invasive phenotype of PC, in order to improve patient selection for treatment options. A total of 30 PC samples were analysed by either whole transcriptome (9 samples) or exome sequencing (21 samples) on an Illumina platform (75X2 or 100X2 bp), and the results were matched with normal DNA to identify somatic events. Single nucleotide variants and insertions and deletions were annotated using public databases, and the pathogenicity of the identified variants was defined according to prior knowledge and mutation-prediction tools. A total of 43 recurrently altered genes were identified, which were involved in numerous pathways, including chromatin remodelling and DNA damage repair. In addition, an analysis limited to a subgroup of early stage patients (50% of samples) demonstrated that poor prognosis was significantly associated with a higher number of known PC mutations (P=0.047). Samples from patients with a better overall survival (>25 months) harboured an average of 24 events, whereas samples from patients with an overall survival of <25 months presented an average of 40 mutations. These findings indicated that a complex genetic profile in the early stage of disease may be associated with increased aggressiveness, thus suggesting an urgent requirement for an innovative approach to classify this disease.

13 Article Is radical surgery always curative in pancreatic neuroendocrine tumors? A cure model survival analysis. 2018

Ricci, Claudio / Casadei, Riccardo / Taffurelli, Giovanni / Campana, Davide / Ambrosini, Valentina / Pacilio, Carlo Alberto / Santini, Donatella / Brighi, Nicole / Minni, Francesco. ·Department of Internal Medicine and Surgery (DIMEC), Italy. Electronic address: claudiochir@gmail.com. · Department of Internal Medicine and Surgery (DIMEC), Italy. · Department of Haematology and Oncology (DIMES), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy. ·Pancreatology · Pubmed #29487026.

ABSTRACT: BACKGROUND: Adjuvant therapy after curative surgery for sporadic pancreatic neuroendocrine tumor (pNETs) is not currently recommended, assuming that all patients could be cured by a radical resection. The aim of our study is to establish how many and which kind of patients remained uncured after radical resection of pNET. METHODS: Retrospective study involving 143 resected sporadic pNETs. The survival analysis was carried out using the cure model, describing the cure fraction and the excess of risk recurrence. Multivariate analyses were made in order to evaluate the non negligible effect of demographics, clinical and pathological factors on survival parameters. The results were reported as percentages, fractions, ORs and HRs with 95% confidence interval (95 CI %). RESULTS: The cure fraction and the excess of hazard rate of the whole population were 57.1% (37.4-74.6, 95% CI) and 0.06 (0.03-0.07, 95% CI), respectively. Two independent factors were related to the cure fraction: TNM stage (OR 0.27 ± 0.17; P = 0.002) and grading (OR 0.11 ± 0.18; P = 0.004). Considering the excess of hazard rate, only two independent factors were related to an increased risk of recurrence: TNM stage (HR 3.49 ± 1.12; P = 0.004) and grading (HR 4.93 ± 1.82; P < 0.001). CONCLUSION: The radical surgery has a high probability of cure in stages I-II or in grading 1 while, in stages III-IV or in grading 3 tumors, surgery alone failed to achieve a "cure". A multimodal treatment should be employed in order to avoid a recurrence of the disease.

14 Article Laparoscopic distal pancreatectomy: which factors are related to open conversion? Lessons learned from 68 consecutive procedures in a high-volume pancreatic center. 2018

Casadei, Riccardo / Ricci, Claudio / Pacilio, Carlo Alberto / Ingaldi, Carlo / Taffurelli, Giovanni / Minni, Francesco. ·Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. riccardo.casadei@unibo.it. · Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Prof. Minni, Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. riccardo.casadei@unibo.it. · Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. ·Surg Endosc · Pubmed #29435756.

ABSTRACT: BACKGROUND: Laparoscopic distal pancreatectomy represents a difficult surgical procedure with an high conversion rate to open procedure. The factors related to its difficulty and conversion to open distal pancreatectomy were rarely reported. The aim of the present study was to identify which factors are related to conversion from laparoscopic to open distal pancreatectomy. METHODS: A retrospective study of a prospective database of 68 patients who underwent laparoscopic distal pancreatectomy was conducted at a high-volume center by pancreatic surgeons experienced with laparoscopic surgery. Pre-intra and postoperative data were collected. Patients who completed a laparoscopic distal pancreatectomy were compared with those who needed a conversion to the open approach as regard demographic, clinical, radiological, and surgical data. Univariate and multivariate analyses were carried out. RESULTS: Univariate analysis suggested that the site of the lesion, the extension of pancreatic resection, and the requirement for an extended procedure to adjacent organs were significantly associated with the risk of conversion to the open approach. Multivariate analysis showed that only the extension of the pancreatic resection (subtotal pancreatectomy) was significantly related to the odds of conversion [odds ratio (OR) 19.5; 95% confidence interval (CI) 1.1-32.3; P = 0.038]. Preoperative suspicion of malignancy differed between the two groups; however, this difference did not reach statistical significance (P = 0.078). CONCLUSIONS: Despite the limitations of the study, only the extension of pancreatic resection seemed to be the main factor related to conversion during laparoscopic distal pancreatectomy.

15 Article Multicolour versus monocolour inking specimens after pancreaticoduodenectomy for periampullary cancer: A single centre prospective randomised clinical trial. 2018

Casadei, Riccardo / Ricci, Claudio / Taffurelli, Giovanni / Pacilio, Carlo Alberto / Santini, Donatella / Di Marco, Mariacristina / Minni, Francesco. ·Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Italy. Electronic address: riccardo.casadei@unibo.it. · Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Italy. · Department of Specialist, Diagnostic and Experimental Medicine (DIMES), S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Italy. ·Int J Surg · Pubmed #29367035.

ABSTRACT: BACKGROUND: R status represents an important prognostic factors in periampullary cancers. Thus, it is useful to verify if it can be influenced by different techniques of margination. METHODS: Single-centre, randomised clinical trial of patients affected by periampullary cancer who underwent pancreaticoduodenectomies which included two different types of margination: arm A (multicolour inking) and arm B (monocolour inking). The primary endpoint was the overall R1 resection rate and its difference between the two arms. The secondary endpoints were the R1 resection rate in each margin and its difference between the two arms, and the impact of margin status on survival. RESULTS: Fifty patients were randomised, 41 analysed: 22 in arm A, 19 arm B. The overall R1 status was 61%, without significant differences between the two arms. The margin most commonly involved was the superior mesenteric artery (SMA) (36.6%). A trend in favour of arm B was shown for the superior mesenteric artery margin (arm A = 22.7% versus arm B = 52.6%; P = 0.060). The anterior surface (P = 0.015), SMA (P = 0.047) and pancreatic remnant (P = 0.018) margins significantly influenced disease-free survival. CONCLUSIONS: The R status was not influenced by different techniques of margination using a standardised pathological protocol. The SMA margin seemed to be the most important margin for evaluating both R status and disease-free survival.

16 Article Impact of surgery and surveillance in the management of branch duct intraductal papillary mucinous neoplasms of the pancreas according to Fukuoka guidelines: the Bologna experience. 2018

Casadei, Riccardo / Ricci, Claudio / Taffurelli, Giovanni / Pacilio, Carlo Alberto / Migliori, Marina / Minni, Francesco. ·Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, Malpighi Hospital, University of Bologna, Via Massarenti n.9, 40138, Bologna, Italy. riccardo.casadei@unibo.it. · Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, Malpighi Hospital, University of Bologna, Via Massarenti n.9, 40138, Bologna, Italy. ·Updates Surg · Pubmed #28593459.

ABSTRACT: The objective of the study was to evaluate the Fukuoka guidelines in indicating the proper management for recognising the risk factors of malignancy. Data of patients with branch duct intraductal papillary mucinous neoplasms who underwent pancreatic resection or surveillance according to the Fukuoka risk parameters were collected in a prospective database. The clinical outcome (development of pancreatic cancer, overall and disease-specific survival) and pathological results were evaluated in all patients and in resected cases, respectively. The data of 197 patients were collected: 23 primarily resected and 174 primarily followed. Of the latter, 16 were secondarily resected. Among the patients resected, 21 (53.9%) showed diagnosis of in situ or invasive carcinoma and only contrast-enhancing mural nodules were significantly related to malignancy (P = 0.002), with a DOR of 3.3 and an LH+ of 2.2. Development of pancreatic cancer was shown in ten (5.7%) of the patients primarily followed. The overall survival and disease-specific survival were similar between patients primarily followed and primarily resected. It seems reasonable to suggest that a branch duct intraductal papillary mucinous neoplasm should be treated as a benign and indolent disease that is rarely malignant. Enhancing mural nodules represent the best indicator for surgery.

17 Article Prognostic role of nodal ratio, LODDS, pN in patients with pancreatic cancer with venous involvement. 2017

Ramacciato, Giovanni / Nigri, Giuseppe / Petrucciani, Niccolo' / Pinna, Antonio Daniele / Ravaioli, Matteo / Jovine, Elio / Minni, Francesco / Grazi, Gian Luca / Chirletti, Piero / Tisone, Giuseppe / Ferla, Fabio / Napoli, Niccolo' / Boggi, Ugo. ·Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, General Surgery Unit, Via di Grottarossa 1037, 00189, Rome, Italy. · Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, General Surgery Unit, Via di Grottarossa 1037, 00189, Rome, Italy. giuseppe.nigri@uniroma1.it. · Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, General Surgery and Transplantation Unit, Bologna, Italy. · General Surgery Unit, 'Maggiore' Hospital, Bologna, Italy. · Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, S. Orsola-Malpighi Hospital, University of Bologna, General Surgery Unit, Bologna, Italy. · Regina Elena National Cancer Institute IFO, Hepato-pancreato-biliary Surgery Unit, Rome, Italy. · Department of Surgical Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, General Surgery Unit, Rome, Italy. · Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy. · Division of General Surgery and Transplantation Surgery, Niguarda Hospital, Milan, Italy. · Division of General Surgery and Transplantation Surgery, Pisa University Hospital, Pisa, Italy. ·BMC Surg · Pubmed #29169392.

ABSTRACT: BACKGROUND: The UICC/AJCC TNM staging system classifies lymph nodes as N0 and N1 in pancreatic cancer. Aim of the study is to determine whether the number of examine nodes, the nodal ratio (NR) and the logarithm odds of positive lymph nodes (LODDS) may better stratify the prognosis of patients undergoing pancreatectomy combined with venous resection for pancreatic cancer with venous involvement. METHODS: A multicenter database of 303 patients undergoing pancreatectomy in 9 Italian referral centers was analyzed. The prognostic impact of number of retrieved and examined nodes, NR, LODDS was analyzed and compared with ROC curves analysis, Pearson test, univariate and multivariate analysis. RESULTS: The number of metastatic nodes, pN, the NR and LODDS was significantly correlated with survival at multivariate analyses. The corresponding AUC for the number of metastatic nodes, pN, the NR and LODDS were 0.66, 0.69, 0.63 and 0.65, respectively. The Pearson test showed a significant correlation between the number of retrieved lymph nodes and number of metastatic nodes, pN and the NR. LODDS had the lower coefficient correlation. Concerning N1 patients, the NR, the LODDS and the number of metastatic nodes were able to significantly further stratify survival (p = 0.040; p = 0.046; p = 0.038, respectively). CONCLUSIONS: The number of examined lymph nodes, the NR and LODDS are useful for further prognostic stratification of N1 patients in the setting of pancreatectomy combined with PV/SMV resection. No superiority of one over the others methods was detected.

18 Article Is surgery the best treatment for sporadic small (≤2 cm) non-functioning pancreatic neuroendocrine tumours? A single centre experience. 2017

Ricci, Claudio / Taffurelli, Giovanni / Campana, Davide / Ambrosini, Valentina / Pacilio, Carlo Alberto / Pagano, Nico / Santini, Donatella / Brighi, Nicole / Minni, Francesco / Casadei, Riccardo. ·Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy. · Department of Haematology and Oncology (DIMES), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy. · Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy. Electronic address: riccardo.casadei@unibo.it. ·Pancreatology · Pubmed #28320587.

ABSTRACT: BACKGOUND: There is currently there is substantial controversy regarding the best management of non-functioning pancreatic neuroendocrine tumours ≤2 cm. METHODS: Retrospective study involving 102 surgically treated patients affected by non-functioning pancreatic neuroendocrine tumours. Patients having small tumours (≤2 cm) (Group A) and those having large tumours (>2 cm) (Group B) were compared regarding demographics, clinical and pathological factors with the aim of evaluating the risk of malignancy and survival times. RESULTS: The small tumours were T3-4 in 11% and G2-3 in 36.6% of cases; lymph node and distant metastases were present in 31% and 8% of the cases, respectively. When small and large tumours were compared, significant differences were found in relation to the presence of symptoms (P = 0.012), tumour status (P > 0.001), grading (P > 0.001) and years lost due to disability (P = 0.002). Multivariate analysis of the factors predicting malignancy and survival times showed that tumour size was related only to grading (P < 0.001). The years of life lost and disability adjusted life years were influenced by age at of diagnosis, the presence of symptoms and years lost due to disability only by grading. CONCLUSIONS: Tumour size alone did not seem to be reliable in predicting malignancy because, first, small tumours (≤2 cm) could present lymph node or distant metastases, and could be G2-3 in a non-negligible percentage of cases and second, their risk of malignancy and survival time are similar to large tumours. Additional parameters have to be considered in order to establish the proper management of small tumours, such as age at diagnosis, presence of symptoms and grading.

19 Article Copy number gain of chromosome 3q is a recurrent event in patients with intraductal papillary mucinous neoplasm (IPMN) associated with disease progression. 2016

Durante, Sandra / Vecchiarelli, Silvia / Astolfi, Annalisa / Grassi, Elisa / Casadei, Riccardo / Santini, Donatella / Panzacchi, Riccardo / Ricci, Claudio / Serravalle, Salvatore / Tarantino, Giuseppe / Falconi, Mirella / Teti, Gabriella / Indio, Valentina / Pession, Andrea / Minni, Francesco / Biasco, Guido / Di Marco, Mariacristina. ·Giorgio Prodi Cancer Research Centre, University of Bologna, Bologna, Italy. · Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy. · Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy. · Pathology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy. · Department of Medical and Surgical Sciences, "Lalla Seràgnoli" Hematology-Oncology Unit, University of Bologna, Bologna, Italy. · DIBINEM-Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. ·Oncotarget · Pubmed #27566563.

ABSTRACT: BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN) is the most common cystic preneoplastic lesion of pancreatic cancer. We used an approach coupling high resolution cytogenetic analysis (Affymetrix Oncoscan FFPE Array) with clinically-oriented bioinformatic interpretation of data to understand the most relevant alterations of precursor lesions at different stages to identify new diagnostic markers. RESULTS: We identified multiple copy number alterations, particularly in lesions with severe dysplasia, with 7 IPMN with low-intermediate dysplasia carrying a nearly normal karyotype and 13 IPMN with complex Karyotype (> 4 alterations), showing high grade dysplasia. A specific gain of chromosome arm 3q was found in IPMN with complex Karyotype (92%). This gain of 3q is particularly interesting for the presence of oncogenes such as PIK3CA, GATA2 and TERC that are part of pathways that deregulate cell growth and promote disease progression. Quantitative PCR and FISH analysis confirmed the data . Further demonstration of the overexpression of the PIK3CA gene supports the identification of this alteration as a possible biomarker in the early identification of patients with IPMN at higher risk for disease progression. MATERIALS AND METHODS: High resolution cytogenetic analysis was performed in 20 formalin fixed paraffin embedded samples of IPMN by Oncoscan FFPE assay. Results were validated by qPCR and FISH analysis. CONCLUSIONS: The identification of these markers at an early stage of disease onset could help to identify patients at risk for cancer progression and new candidates for a more specific targeted therapy.

20 Article Is total pancreatectomy as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy? A single center, prospective, observational study. 2016

Casadei, Riccardo / Ricci, Claudio / Taffurelli, Giovanni / Guariniello, Anna / Di Gioia, Anthony / Di Marco, Mariacristina / Pagano, Nico / Serra, Carla / Calculli, Lucia / Santini, Donatella / Minni, Francesco. ·Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Via Massarenti n.9, 40138, Bologna, Italy. riccardo.casadei@unibo.it. · Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Via Massarenti n.9, 40138, Bologna, Italy. · Department of Specialist, Diagnostic and Experimental Medicine (DIMES), S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. ·J Gastrointest Surg · Pubmed #27418262.

ABSTRACT: BACKGROUND: Total pancreatectomy is actually considered a viable option in selected patients even if large comparative studies between partial versus total pancreatectomy are not currently available. Our aim was to evaluate whether total pancreatectomy can be considered as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy. METHODS: A single center, prospective, observational trial, regarding postoperative outcomes, long-term results, and cost-effectiveness, in a tertiary referral center was conducted, comparing consecutive patients who underwent elective total pancreatectomy and/or pancreaticoduodenectomy. RESULTS: Seventy-three consecutive elective total pancreatectomies and 184 pancreaticoduodenectomies were compared. There were no significant differences regarding postoperative outcomes and overall survival. The quality of life, evaluated in 119 patients according to the EQ-5D-5L questionnaire, showed that there were no significant differences regarding the five items considered. The mean EQ-5D-5L score was similar in the two procedures (total pancreatectomy = 0.872, range 0.345-1.000; pancreaticoduodenectomy = 0.832, range 0.393-1.000; P = 0.320). The impact of diabetes according to the Problem Areas in Diabetes (PAID) questionnaire did not show any significant differences except for question 13 (total pancreatectomy = 0.60; pancreaticoduodenectomy = 0.19; P = 0.022). The cost-effectiveness analysis suggested that the quality-adjusted life year was not significantly different between the two procedures (total pancreatectomy = 0.910, range 0.345-1.000; pancreaticoduodenectomy = 0.910, range -0.393-1.000; P = 0.320). CONCLUSIONS: From this study, it seems reasonable to suggest that total pancreatectomy can be considered as safe, feasible, and efficacious as PD and acceptable in terms of cost-effectiveness.

21 Article Validation of the 2010 WHO classification and a new prognostic proposal: A single centre retrospective study of well-differentiated pancreatic neuroendocrine tumours. 2016

Ricci, Claudio / Casadei, Riccardo / Taffurelli, Giovanni / Campana, Davide / Ambrosini, Valentina / Pagano, Nico / Santini, Donatella / De Giorgio, Roberto / Ingaldi, Carlo / Tomassetti, Paola / Zani, Elia / Minni, Francesco. ·Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy. Electronic address: claudiochir@gmail.com. · Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy. · Department of Haematology and Oncology (DIMES), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy. ·Pancreatology · Pubmed #26924664.

ABSTRACT: BACKGOUND: In 2010, the World Health Organization (WHO) modified the classification for pancreatic neuroendocrine tumours (NETs). Recently, some modifications were proposed to improve its prognostic value. The aim of this study was to test the prognostic value of both the original and the modified 2010 WHO grading systems. METHODS: One hundred and twenty consecutive patients surgically resected for well-differentiated NETs were evaluated in multivariate Cox regression models. Age, sex, hormonal status, size, lymph node ratio, stage, margin status and grading were evaluated in order to predict disease-free survival (DFS). Four models were evaluated: model 1: grading according to the 2010 WHO; model 2: modified grading with cut-off at 5% of the Ki-67 index; model 3: modified grading in which the G2 category was divided into two subgroups (2-5% and 5-20%) and model 4: the Ki-67 index as a continuous variable. Decision curve analysis (DCA) was carried out to evaluate the clinical utility of the various cut-offs. RESULTS: All the grading systems remained independent factors in predicting DFS. Model 2 (c index = 0.814 and P = 0.012) and model 3 (c index = 0.865 and P = 0.015) showed higher predictive powers with respect to model 1 (c index = 0.799). Model 4 had a high predictive value (c index 0.848, P = 0.013). Decision curve analysis confirmed that biological behaviour represented the best prognostic parameter. CONCLUSION: This study presented some limitations: single centre, retrospective design and a long period of enrolment. The result showed that, by increasing the cut-off of the G2 category to 5% or by creating two subgroups in the G2 category, it was possible to obtain a better stratification of patients.

22 Article Pancreatectomy with Mesenteric and Portal Vein Resection for Borderline Resectable Pancreatic Cancer: Multicenter Study of 406 Patients. 2016

Ramacciato, Giovanni / Nigri, Giuseppe / Petrucciani, Niccolò / Pinna, Antonio Daniele / Ravaioli, Matteo / Jovine, Elio / Minni, Francesco / Grazi, Gian Luca / Chirletti, Piero / Tisone, Giuseppe / Napoli, Niccolò / Boggi, Ugo. ·Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, General Surgery Unit, Rome, Italy. · Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, General Surgery Unit, Rome, Italy. giuseppe.nigri@uniroma1.it. · Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, General Surgery and Transplantation Unit, Bologna, Italy. · General Surgery Unit, 'Maggiore' Hospital, Bologna, Italy. · Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, S. Orsola-Malpighi Hospital, University of Bologna, General Surgery Unit, Bologna, Italy. · Regina Elena National Cancer Institute IFO, Hepato-pancreato-biliary Surgery Unit, Rome, Italy. · Department of Surgical Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, General Surgery Unit, Rome, Italy. · Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Rome, Italy. · Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy. ·Ann Surg Oncol · Pubmed #26893222.

ABSTRACT: PURPOSE: The role of pancreatectomy with en bloc venous resection and the prognostic impact of pathological venous invasion are still debated. The authors analyzed perioperative, survival results, and prognostic factors of pancreatectomy with en bloc portal (PV) or superior mesenteric vein (SMV) resection for borderline resectable pancreatic carcinoma, focusing on predictive factors of histological venous invasion and its prognostic role. METHODS: A multicenter database of 406 patients submitted to pancreatectomy with en bloc SMV and/or PV resection for pancreatic adenocarcinoma was analyzed retrospectively. Univariate and multivariate analysis of factors related to histological venous invasion were performed using logistic regression model. Prognostic factors were analyzed with log-rank test and multivariate proportional hazard regression analysis. RESULTS: Complications occurred in 51.9 % of patients and postoperative death in 7.1 %. Histological invasion of the resected vein was confirmed in 56.7 % of specimens. Five-year survival was 24.4 % with median survival of 24 months. Vein invasion at preoperative computed tomography (CT), N status, number of metastatic lymph nodes, preoperative serum albumin were related to pathological venous invasion at univariate analysis, and vein invasion at CT was independently related to venous invasion at multivariate analysis. Use of preoperative biliary drain was significantly associated with postoperative complications. Multivariate proportional hazard regression analysis demonstrated a significant correlation between overall survival and histological venous invasion and administration of adjuvant therapy. CONCLUSIONS: This study identifies predictive factors of pathological venous invasion and prognostic factors for overall survival, including pathological venous invasion, which may help with patients' selection for different treatment protocols.

23 Article Characterization of pancreatic ductal adenocarcinoma using whole transcriptome sequencing and copy number analysis by single-nucleotide polymorphism array. 2015

Di Marco, Mariacristina / Astolfi, Annalisa / Grassi, Elisa / Vecchiarelli, Silvia / Macchini, Marina / Indio, Valentina / Casadei, Riccardo / Ricci, Claudio / D'Ambra, Marielda / Taffurelli, Giovanni / Serra, Carla / Ercolani, Giorgio / Santini, Donatella / D'Errico, Antonia / Pinna, Antonio Daniele / Minni, Francesco / Durante, Sandra / Martella, Laura Raffaella / Biasco, Guido. ·Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola‑Malpighi Hospital, Bologna I‑40100, Italy. · Interdepartmental Center of Cancer Research, Sant'Orsola‑Malpighi Hospital, Bologna I‑40100, Italy. · Department of Medical and Surgical Sciences, Sant'Orsola‑Malpighi Hospital, Bologna I‑40100, Italy. · Department of Digestive Diseases and Internal Medicine, Sant'Orsola‑Malpighi Hospital, Bologna I‑40100, Italy. · Liver and Multiorgan Transplant Unit, Sant'Orsola‑Malpighi Hospital, Bologna I‑40100, Italy. · Pathology Unit, Sant'Orsola‑Malpighi Hospital, Bologna I‑40100, Italy. ·Mol Med Rep · Pubmed #26397140.

ABSTRACT: The aim of the current study was to implement whole transcriptome massively parallel sequencing (RNASeq) and copy number analysis to investigate the molecular biology of pancreatic ductal adenocarcinoma (PDAC). Samples from 16 patients with PDAC were collected by ultrasound‑guided biopsy or from surgical specimens for DNA and RNA extraction. All samples were analyzed by RNASeq performed at 75x2 base pairs on a HiScanSQ Illumina platform. Single‑nucleotide variants (SNVs) were detected with SNVMix and filtered on dbSNP, 1000 Genomes and Cosmic. Non‑synonymous SNVs were analyzed with SNPs&GO and PROVEAN. A total of 13 samples were analyzed by high resolution copy number analysis on an Affymetrix SNP array 6.0. RNAseq resulted in an average of 264 coding non‑synonymous novel SNVs (ranging from 146‑374) and 16 novel insertions or deletions (In/Dels) (ranging from 6‑24) for each sample, of which a mean of 11.2% were disease‑associated and somatic events, while 34.7% were frameshift somatic In/Dels. From this analysis, alterations in the known oncogenes associated with PDAC were observed, including Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations (93.7%) and inactivation of cyclin‑dependent kinase inhibitor 2A (CDKN2A) (50%), mothers against decapentaplegic homolog 4 (SMAD4) (50%), and tumor protein 53 (TP53) (56%). One case that was negative for KRAS exhibited a G13D neuroblastoma RAS viral oncogene homolog mutation. In addition, gene fusions were detected in 10 samples for a total of 23 different intra‑ or inter‑chromosomal rearrangements, however, a recurrent fusion transcript remains to be identified. SNP arrays identified macroscopic and cryptic cytogenetic alterations in 85% of patients. Gains were observed in the chromosome arms 6p, 12p, 18q and 19q which contain KRAS, GATA binding protein 6, protein kinase B and cyclin D3. Deletions were identified on chromosome arms 1p, 9p, 6p, 18q, 10q, 15q, 17p, 21q and 19q which involve TP53, CDKN2A/B, SMAD4, runt‑related transcription factor 2, AT‑rich interactive domain‑containing protein 1A, phosphatase and tensin homolog and serine/threonine kinase 11. In conclusion, genetic alterations in PDCA were observed to involve numerous pathways including cell migration, transforming growth factor‑β signaling, apoptosis, cell proliferation and DNA damage repair. However, signaling alterations were not observed in all tumors and key mutations appeared to differ between PDAC cases.

24 Article Neoadjuvant Chemoradiotherapy and Surgery Versus Surgery Alone in Resectable Pancreatic Cancer: A Single-Center Prospective, Randomized, Controlled Trial Which Failed to Achieve Accrual Targets. 2015

Casadei, Riccardo / Di Marco, Mariacristina / Ricci, Claudio / Santini, Donatella / Serra, Carla / Calculli, Lucia / D'Ambra, Marielda / Guido, Alessandra / Morselli-Labate, Antonio Maria / Minni, Francesco. ·Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum - University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. riccardo.casadei@aosp.bo.it. · Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), Oncologia Medica-Biasco, Alma Mater Studiorum - University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. · Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum - University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. · Anatomia Patologica-Grigioni, Alma Mater Studiorum - University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. · Medicina Interna-Morelli, Alma Mater Studiorum - University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. · Radiologia-Zompatori, Alma Mater Studiorum - University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. · Radioterapia-Zompatori, Alma Mater Studiorum - University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy. ·J Gastrointest Surg · Pubmed #26224039.

ABSTRACT: OBJECTIVE: The objective of the study is to evaluate the usefulness of neoadjuvant chemoradiotherapy in resectable pancreatic cancer. METHODS: A single-center RCT of patients affected by resectable pancreatic adenocarcinoma which included arm A (surgery alone) and arm B (neoadjuvant chemoradiation and surgery). The primary endpoint was R0 resection; the secondary endpoints were toxicity; number of patients who completed the neoadjuvant therapy; radiological and pathological response after chemoradiation; and pTNM stage, postoperative morbidity, mortality, and overall and disease-free survival. A sample size of 32 patients was required for each group. RESULTS: The study was terminated early, and 38 patients were randomized: 20 in arm A and 18 in arm B. There was no significant difference regarding R0 resection rate in the two groups (intention-to-treat, OR = 1.91, P = 0.489). Neoadjuvant chemoradiotherapy was completed in 14 out of 18 cases (77.8 %) and the radiological and pathological response was efficacious in 72.3 and 90.9 % of cases, respectively. CONCLUSIONS: Neoadjuvant chemoradiation was feasible, safe, and efficacious, although non-significant results were obtained as a result of the underpowered data due to the difficulty in recruiting patients. Additional multicenter RCTs are needed in the future.

25 Article Portal/Superior Mesenteric Vein Reconstruction during Pancreatic Resection Using a Cryopreserved Arterial Homograft. 2015

Mascoli, Chiara / D'Ambra, Marielda / Casadei, Riccardo / Ricci, Claudio / Taffurelli, Giovanni / Ancetti, Stefano / Stella, Andrea / Minni, Francesco / Freyrie, Antonio. ·Departments of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ·Dig Surg · Pubmed #26113314.

ABSTRACT: BACKGROUND: Portal-superior mesenteric vein (PV/SMV) resection during pancreatic resection has been widely applied in clinical practice. METHODS: From a prospective data base of pancreatic resections, patients undergoing PV/SMV resection and reconstruction with a cryopreserved arterial homograft were extracted with the aim of evaluating the safety, feasibility and reproducibility of the procedure. Data regarding patient demographics, preoperative staging, surgery, histopathology and postoperative outcomes were analyzed. RESULTS: Five patients were extracted in the last year. Indications for this technique were type IV-V degree of vein involvement and a 3.5 cm median length of vein infiltration. Median operative and clamping times were satisfactory (385 and 27 min, respectively), postoperative outcomes were good and there was no graft infection, thrombosis or stenosis occurred postoperatively and during the follow-up period. CONCLUSION: The use of a cryopreserved arterial homograft for PV/SMV reconstruction after pancreatic resection seems to be a feasible, safe and easily reproducible surgical technique in high-volume specialized centers and can be added to the pool of surgical solutions in selected patients.

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