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Pancreatic Neoplasms: HELP
Articles by Nico Pagano
Based on 17 articles published since 2010
(Why 17 articles?)
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Between 2010 and 2020, N. Pagano wrote the following 17 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 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.

2 Review Ki-67 prognostic and therapeutic decision driven marker for pancreatic neuroendocrine neoplasms (PNENs): A systematic review. 2016

Pezzilli, Raffaele / Partelli, Stefano / Cannizzaro, Renato / Pagano, Nico / Crippa, Stefano / Pagnanelli, Michele / Falconi, Massimo. ·Pancreas Unit, Department of Digestive System, Sant'Orsola-Malpighi Hospital, Bologna, Italy. · Pancreatic Surgery Unit, Department of Surgery, San Raffaele Hospital, Milan, Italy. · Department of Gastroenterology, National Cancer Institute, Aviano, Italy. · Pancreatic Surgery Unit, Department of Surgery, San Raffaele Hospital, Milan, Italy. Electronic address: falconi.massimo@hsr.it. ·Adv Med Sci · Pubmed #26774266.

ABSTRACT: BACKGROUND: We systematically evaluate the current evidence regarding Ki-67 as a prognostic factor in pancreatic neuroendocrine neoplasms to evaluate the differences of this marker in primary tumors and in distant metastases as well as the values of Ki-67 obtained by fine needle aspiration and by histology. METHODS: The literature search was carried out using the MEDLINE/PubMed database, and only papers published in the last 10 years were selected. RESULTS: The pancreatic tissue suitable for Ki-67 evaluation was obtained from surgical specimens in the majority of the studies. There was a concordance of 83% between preoperative and postoperative Ki-67 evaluation. Pooling the data of the studies which compared the Ki-67 values obtained in both cytological and surgical specimens, we found that they were not related. The assessment of Ki-67 was manual in the majority of the papers considered for this review. In order to eliminate manual counting, several imaging methods have been developed but none of them are routinely used at present. Twenty-two studies also explored the role of Ki-67 utilized as a prognostic marker for pancreatic neuroendocrine neoplasms and the majority of them showed that Ki-67 is a good prognostic marker of disease progression. Three studies explored the Ki-67 value in metastatic sites and one study demonstrated that, in metachronous and synchronous liver metastases, there was no significant variation in the index of proliferation. CONCLUSIONS: Ki-67 is a reliable prognostic marker for pancreatic neuroendocrine neoplasms.

3 Review Outcome of stenting in biliary and pancreatic benign and malignant diseases: A comprehensive review. 2015

Mangiavillano, Benedetto / Pagano, Nico / Baron, Todd H / Luigiano, Carmelo. ·Benedetto Mangiavillano, Unit of Gastroenterology and Digestive Endoscopy, General Hospital of Sanremo, 18038 Sanremo, Italy. ·World J Gastroenterol · Pubmed #26290631.

ABSTRACT: Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks, pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review, relevant literature search and expert opinions have been used to evaluate the outcome of stenting in biliary and pancreatic benign and malignant diseases.

4 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.

5 Review Pathophysiology of autoimmune pancreatitis. 2014

Pezzilli, Raffaele / Pagano, Nico. ·Raffaele Pezzilli, Nico Pagano, Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy. ·World J Gastrointest Pathophysiol · Pubmed #24891971.

ABSTRACT: Autoimmune pancreatitis (AIP) is a recently discovered form of pancreatitis and represents one of the diseases of the pancreas which can be cured and healed medically. International consensus diagnostic criteria have been developed, and the clinical phenotypes associated with the histopathologic patterns of lymphoplasmacytic sclerosing pancreatitis and idiopathic duct-centric pancreatitis should be referred to as type 1 and type 2 AIP, respectively. Most importantly, in type 1 AIP, the pancreatic manifestations are associated with other extrapancreatic disorders, resembling an immunoglobulin G4 (IgG4)-related disease. In addition, the pancreas of a patient with AIP is often infiltrated by various types of immune cells; the cluster of differentiation (CD) 4 or CD8 T lymphocytes and IgG4-bearing plasma cells have been found in the pancreatic parenchyma and other involved organs in AIP and factors regulating T-cell function may influence the development of AIP. From a genetic point of view, it has also been reported that DRB1*0405 and DQB1*0401 mutations are significantly more frequent in patients with AIP when compared to those with chronic calcifying pancreatitis, and that only DQB1*0302 had a significant association with the relapse of AIP. Finally, it has been found that the polymorphic genes encoding cytotoxic T lymphocyte-associated antigen 4, a key negative regulator of the T-cell immune response, are associated with AIP in a Chinese population. Even if these data are not concordant, it is possible that physiological IgG4 responses are induced by prolonged antigen exposure and controlled by type 2 helper T cells. We reviewed the current concepts regarding the pathophysiology of this intriguing disease, focusing on the importance of the humoral and cellular immune responses.

6 Review Is diabetes mellitus a risk factor for pancreatic cancer? 2013

Pezzilli, Raffaele / Pagano, Nico. ·Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy. raffaele.pezzilli@aosp.bo.it ·World J Gastroenterol · Pubmed #23946590.

ABSTRACT: The relationship between diabetes mellitus and the risk of pancreatic cancer has been a matter of study for a long period of time. The importance of this topic is due to two main causes: the possible use of recent onset diabetes as a marker of the disease and, in particular, as a specific marker of pancreatic cancer, and the selection of a population at risk for pancreatic cancer. Thus, we decided to make an in-depth study of this topic; thus, we carried out an extensive literature search in order to re-assess the current knowledge on this topic. Even if diabetes is found a decade before the appearance of pancreatic cancer as reported in meta-analytic studies, we cannot select those patients already having non detectable pancreatic cancer, at least with the imaging and biological techniques available today. We believe that more studies are necessary in order to definitively identify diabetes mellitus as a risk factor for pancreatic cancer taking into consideration that approximately 10 years are needed to diagnose symptomatic pancreatic cancer. At present, the answer to the as to whether diabetes and pancreatic cancer comes first similar to the adage of the chicken and the egg is that diabetes is the egg.

7 Article The Great View Forward: The Use of a Colonoscope for Distal Duodenal Stent Placement. 2019

Minervini, A / Lauro, A / Pagano, N / Vaccari, S / D'Andrea, V / Marino, I R / Cervellera, M / Tonini, V. ·Department of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy. · Department of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy. augustola@yahoo.com. · Department of Surgical Sciences, Umberto I Hospital, La Sapienza University, Rome, Italy. · Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA. ·Dig Dis Sci · Pubmed #31410750.

ABSTRACT: INTRODUCTION: Stent placement in the distal duodenum can be difficult. We describe a case report of a 94-year-old man with metastatic pancreatic head cancer compressing the third and fourth portions of the duodenum, treated by endoscopic stent placement using a colonoscope. AREAS COVERED: A literature review highlighted two possible procedures for stent placement in the distal duodenum, namely forward-viewing and side-viewing endoscopies. Gastroscopes, duodenoscopes, enteroscopes, and colonoscopes have all been suggested for the purpose. For distal lesions, especially when the duodenal wall is stiffened due to compression or infiltration by neoplastic lesions, a conventional upper endoscope can be too short to reach the narrowed site in "push mode," necessitating the use of a longer endoscope. EXPERT COMMENTARY: A colonoscope can be safely and effectively used to accomplish distal duodenal stent placement.

8 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.

9 Article Pre-operative Diagnosis of Pancreatic Neuroendocrine Tumors with Endoscopic Ultrasonography and Computed Tomography in a Large Series. 2016

Manta, Raffaele / Nardi, Elisabetta / Pagano, Nico / Ricci, Claudio / Sica, Mariano / Castellani, Danilo / Bertani, Helga / Piccoli, Micaela / Mullineris, Barbara / Tringali, Alberto / Marini, Francesco / Germani, Ugo / Villanacci, Vincenzo / Casadei, Riccardo / Mutignani, Massimiliano / Conigliaro, Rita / Bassotti, Gabrio / Zullo, Angelo. ·Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy. r.manta@libero.it. · Gastroenterology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy. · Department of Internal Medicine and Surgery (DIMEC), University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy. · Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy. · Department of General Surgery, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy. · Endoscopy Unit, Niguarda Ca-Granda Hospital, Milan, Italy. · Gastroenterology Unit, Ospedali Riuniti Ancona, Italy. · Pathology Unit Spedali Civili, Brescia, Italy. · Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. ·J Gastrointestin Liver Dis · Pubmed #27689195.

ABSTRACT: BACKGROUND AND AIMS: Diagnosis of pancreatic neuroendocrine tumors (p-NETs) is frequently challenging. We describe a large series of patients with p-NETs in whom both pre-operative Computed Tomography (CT) and Endoscopic Ultrasonography (EUS) were performed. METHODS: This was a retrospective analysis of prospectively collected sporadic p-NET cases. All patients underwent both standard multidetector CT study and EUS with fine-needle aspiration (FNA). The final histological diagnosis was achieved on a post-surgical specimen. Chromogranin A (CgA) levels were measured. RESULTS: A total of 80 patients (mean age: 58 +/- 14.2 years; males: 42) were enrolled. The diameter of functioning was significantly lower than that of non-functioning p-NETs (11.2 +/- 8.5 mm vs 19.8 +/- 12.2 mm; P = 0.0004). The CgA levels were more frequently elevated in non-functioning than functioning pNET patients (71.4% vs 46.9%; P = 0.049). Overall, the CT study detected the lesion in 51 (63.7%) cases, being negative in 26 (68.4%) patients with a tumor Data of this large case series would suggest that the EUS should be included in the diagnostic work-up in all patients with a suspected p-NET, even when the CT study was negative for a primary lesion in the pancreas.

10 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.

11 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.

12 Article Laparoscopic Distal Pancreatectomy in Benign or Premalignant Pancreatic Lesions: Is It Really More Cost-Effective than Open Approach? 2015

Ricci, Claudio / Casadei, Riccardo / Taffurelli, Giovanni / Bogoni, Selene / D'Ambra, Marielda / Ingaldi, Carlo / Pagano, Nico / Pacilio, Carlo Alberto / 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, claudiochir@gmail.com. ·J Gastrointest Surg · Pubmed #26001367.

ABSTRACT: BACKGROUND: Data regarding the quality of life in patients undergoing laparoscopic distal pancreatectomy are lacking and no studies have reported a real cost-effectiveness analysis of this surgical procedure. The aim of this study was to evaluate and compare the quality of life and the cost-effectiveness of a laparoscopic distal pancreatectomy with respect to an open distal pancreatectomy. METHODS: Forty-one patients who underwent a laparoscopic distal pancreatectomy and 40 patients who underwent an open distal pancreatectomy were retrospectively studied as regards postoperative results, quality of life and cost-effectiveness analysis. The Italian neutral version of the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C-30, version 3.0, was used to rate the quality of life. RESULTS: Postoperative results were similar in the two groups; the only difference was that the first oral intake took place significantly earlier in the laparoscopic group than in the open group (P < 0.001). Regarding quality of life, the laparoscopic approach was able to ameliorate physical functioning (P = 0.049), role functioning (P = 0.044) and cognitive functioning (P = 0.030) and reduce the sleep disturbance scale (P = 0.050). The cost-effectiveness analysis showed that the acceptability curve for a laparoscopic distal pancreatectomy had a higher probability of being more cost-effective than an open distal pancreatectomy when a willingness to pay above 5400 Euros/quality-adjusted life years (QALY) was accepted. CONCLUSION: Despite the limitations of the study, laparoscopic distal pancreatectomy can be considered not only safe and feasible but also permits a better quality of life and is acceptable in terms of cost-effectiveness to Italian and European health care services.

13 Article Natural history of branch-duct intraductal papillary mucinous neoplasms of the pancreas: a case report. 2014

Casadei, Riccardo / Ricci, Claudio / D'Ambra, Marielda / Taffurelli, Giovanni / Zingaretti, Caterina C / Pacilio, Carlo A / Calculli, Lucia / Pagano, Nico / Minni, Francesco. ·Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital. Bologna, Italy. riccardo.casadei@aosp.bo.it. ·JOP · Pubmed #25076351.

ABSTRACT: CONTEXT: The natural history of incidental branch-duct intraductal papillary mucinous neoplasm of the pancreas is still unknown. CASE REPORT: The case of a 74-year-old man who had been diagnosed 14 years previously with an incidental branch-duct intraductal papillary mucinous neoplasm of the pancreatic head, 30 mm in size, without mural nodules and dilatation of the main pancreatic duct is herein reported. After an exploratory laparotomy at the time of diagnosis (when he was 60 year-old), the patient was enrolled in a surveillance program. Fourteen years after the diagnosis, the cystic lesion showed an increase in size, Wirsung duct dilatation and the presence of several mural nodules. A total pancreatectomy was performed and a diagnosis of mixed-intraductal papillary mucinous neoplasm diffused throughout the entire pancreas with high grade dysplasia, and a micro-invasive carcinoma (<1 mm) of the pancreatic head was reached. CONCLUSION: The present case confirmed that the natural history of branch-duct intraductal papillary mucinous neoplasms is unpredictable. Thus, an appropriate surveillance program is required for prompt identification of the signs predictive of a malignant transformation of branch-duct intraductal papillary mucinous neoplasms. In high-volume centers, surgery should seriously be considered in young patients who are fit for surgery.

14 Article Ki-67 cytological index can distinguish well-differentiated from poorly differentiated pancreatic neuroendocrine tumors: a comparative cytohistological study of 53 cases. 2014

Carlinfante, Gabriele / Baccarini, Paola / Berretti, Debora / Cassetti, Tiziana / Cavina, Maurizio / Conigliaro, Rita / De Pellegrin, Alessandro / Di Tommaso, Luca / Fabbri, Carlo / Fornelli, Adele / Frasoldati, Andrea / Gardini, Giorgio / Losi, Luisa / Maccio, Livia / Manta, Raffaele / Pagano, Nico / Sassatelli, Romano / Serra, Silvia / Camellini, Lorenzo. ·Department of Pathology, Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy, carlinfante.gabriele@asmn.re.it. ·Virchows Arch · Pubmed #24807732.

ABSTRACT: The Ki-67 labeling index has been found to bear prognostic significance in gastrointestinal neuroendocrine tumors (NETs), and it was recently incorporated in NET histological grading. Nevertheless, a reliable preoperative determination of NET grading could be useful in clinical practice. The aim of this study is to compare the results of Ki-67 labeling index, as measured on cytological samples and on surgical specimens of patients with pancreatic NETs (P-NETs). We also investigated whether concordance might be improved, using a 5 % (instead of 2 %) cutoff value for defining G2 tumors. We retrospectively identified 48 consecutive patients with 53 P-NETs, from our five institutions, and we measured Ki-67 labeling index on their cytological samples and surgical specimens. The traditional 2 % and the alternative 5 % cutoff values were used to classify G2 tumors. The concordance rate between cytological and histological grading was 46/53 (86.8 %; weighted κ statistic 0.77; 95 % confidence interval (95 % CI) 0.60-0.94). No cases of cytological G1-G2 NETs were upgraded to G3 neuroendocrine carcinoma (NEC) at histological grading. Cytology was found to be highly specific in the diagnosis of both G2 (94.1 %; 95 % CI 80.3-99.3) and G3 tumors (100.0 %; 95 % CI 92.8-100), but the sensitivity was poor for G2 NETs (66.7 %; 95 % CI 38.4-88.2) and high for the prediction of G3 NECs (100 %; 95 % CI 39.8-100.0). When the 5 % cutoff value was adopted, concordance rate was 49/53 (92.4 %; weighted κ 0.82; 95 % CI 0.64-1.00). In conclusion, Ki-67 cytological expression can distinguish well-differentiated (both G1 and G2) from poorly differentiated P-NETs, and it may be useful for their preoperative classification.

15 Article Is diagnostic accuracy of fine needle aspiration on solid pancreatic lesions aspiration-related? A multicentre randomised trial. 2014

Tarantino, Ilaria / Di Mitri, Roberto / Fabbri, Carlo / Pagano, Nico / Barresi, Luca / Granata, Antonino / Liotta, Rosa / Mocciaro, Filippo / Maimone, Antonella / Baccarini, Paola / Fabio, Tuzzolino / Curcio, Gabriele / Repici, Alessandro / Traina, Mario. ·Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. Electronic address: itarantino@ismett.edu. · Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy. · Gastroenterology Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Gastroenterology Department, Humanitas Irccs, Rozzano, Milano, Italy. · Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. · Pathology Unit, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Italy. · Gastroenterology Department Ferrara University, Ferrara, Italy. · Pathology Unit, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Office of Research, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Italy. ·Dig Liver Dis · Pubmed #24704290.

ABSTRACT: BACKGROUND: Endoscopic ultrasound fine needle aspiration has a central role in the diagnostic algorithm of solid pancreatic masses. Data comparing the fine needle aspiration performed with different aspiration volume and without aspiration are lacking. We compared endoscopic ultrasound fine needle aspiration performed with the 22 gauge needle with different aspiration volumes (10, 20 and 0 ml), for adequacy, diagnostic accuracy and complications. METHODS: Prospective clinical study at four referral centres. Endoscopic ultrasound fine needle aspiration was performed with a 22G needle with both volume aspiration (10 and 20 cc) and without syringe, in randomly assigned sequence. The cyto-pathologist was blinded as to which aspiration was used for each specimen. RESULTS: 100 patients met the inclusion criteria, 88 completed the study. The masses had a mean size of 32.21±11.24 mm. Sample adequacy evaluated on site was 87.5% with 20 ml aspiration vs. 76.1% with 10 ml (p=0.051), and 45.4% without aspiration (20 ml vs. 0 ml p<0.001; 10 ml vs. 0 ml p<0.001). The diagnostic accuracy was significantly better with 20 ml than with 10 ml and 0 ml (86.2% vs. 69.0% vs. 49.4% p<0.001). CONCLUSIONS: A significantly higher adequacy and accuracy were observed with the 20 ml aspiration puncture, therefore performing all passes with this volume aspiration may improve the diagnostic power of fine needle aspiration.

16 Article Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study. 2014

Tarantino, Ilaria / Fabbri, Carlo / Di Mitri, Roberto / Pagano, Nico / Barresi, Luca / Mocciaro, Filippo / Maimone, Antonella / Curcio, Gabriele / Repici, Alessandro / Traina, Mario. ·Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. Electronic address: itarantino@ismett.edu. · Gastroenterology Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy. · Gastroenterology Department, Humanitas Irccs, Rozzano, Milan, Italy. · Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. · Gastroenterology Department Ferrara University, Ferrara, Italy. ·Dig Liver Dis · Pubmed #24054767.

ABSTRACT: BACKGROUND: Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been reported to have a higher complication rate than that of solid lesions, but the real complication rate is unknown. Aim of the study was to identify the complication rate of endoscopic ultrasound-guided fine needle aspiration and related risk factors. METHODS: Prospective multicenter study at four referral centres. Data were collected from January 2010 to July 2012, searching for all adverse events related to guided fine needle aspiration. All complications occurring up to day 90 were recorded. RESULTS: 298 patients (43.9% male, mean age 63.2 ± 15.4 years) underwent endoscopic ultrasound-guided needle aspiration of pancreatic cystic lesions. Mean size was 34.1 ± 9 mm. Adverse events occurred in 18 patients (6%): mild complications in 12/18 (66.6%), and moderate complications in 6/18 (33.3%). Seven were immediate, 6 early, and 5 late. All resolved with medical therapy. CONCLUSIONS: Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been found to be associated with a higher complication rate than for solid lesions; however, the risk rate is acceptable considering the complication grade and the important diagnostic role of the technique in the management of pancreatic cystic lesions.

17 Article The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses: a meta-analysis of prospective studies. 2013

Fuccio, Lorenzo / Hassan, Cesare / Laterza, Liboria / Correale, Loredana / Pagano, Nico / Bocus, Paolo / Fabbri, Carlo / Maimone, Antonella / Cennamo, Vincenzo / Repici, Alessandro / Costamagna, Guido / Bazzoli, Franco / Larghi, Alberto. ·Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. ·Gastrointest Endosc · Pubmed #23660563.

ABSTRACT: BACKGROUND: Differential diagnosis of pancreatic solid masses with EUS-guided FNA (EUS-FNA) is still challenging in about 15% of cases. Mutation of the K-ras gene is present in over 75% of pancreatic adenocarcinomas (PADC). OBJECTIVE: To assess the accuracy of K-ras gene mutation analysis for diagnosing PADC. DESIGN: We systematically searched the electronic databases for relevant studies published. Data from selected studies underwent meta-analysis by use of a bivariate model providing a pooled value for sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve. SETTING: Meta-analysis of 8 prospective studies. PATIENTS: Total of 931 patients undergoing EUS-FNA for diagnosis of pancreatic solid masses. INTERVENTION: K-ras mutation analysis. MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy of K-ras mutation analysis and of combined diagnostic strategy by using EUS-FNA and K-ras mutation analysis in the diagnosis of PADC. RESULTS: The pooled sensitivity of EUS-FNA for the differential diagnosis of PADC was 80.6%, and the specificity was 97%. Estimated sensitivity and specificity were 76.8% and 93.3% for K-ras gene analysis, respectively, and 88.7% and 92% for combined EUS-FNA plus K-ras mutation analysis. Overall, K-ras mutation testing applied to cases that were inconclusive by EUS-FNA reduced the false-negative rate by 55.6%, with a false-positive rate of 10.7%. Not repeating EUS-FNA in cases in which mutation testing of the K-ras gene is inconclusive would reduce the repeat-biopsy rate from 12.5% to 6.8%. LIMITATIONS: Small number of studies and between-study heterogeneity. CONCLUSION: K-ras mutation analysis can be useful in the diagnostic work-up of pancreatic masses, in particular when tissue obtained by EUS-FNA is insufficient, and the diagnosis inconclusive.