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Pancreatic Neoplasms: HELP
Articles by Stefano Partelli
Based on 85 articles published since 2010
(Why 85 articles?)
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Between 2010 and 2020, S. Partelli wrote the following 85 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
51 Article Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? 2016

Crippa, S / Bittoni, A / Sebastiani, E / Partelli, S / Zanon, S / Lanese, A / Andrikou, K / Muffatti, F / Balzano, G / Reni, M / Cascinu, S / Falconi, M. ·Department of Surgery, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy. · Department of Oncology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy. · Department of Surgery, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy. · Department of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy. · Department of Surgery, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy. Electronic address: falconi.massimo@hsr.it. ·Eur J Surg Oncol · Pubmed #27423449.

ABSTRACT: BACKGROUND: New chemotherapeutic regimens have improved survival for stage IV pancreatic ductal adenocarcinoma and occasionally major response of liver metastases can be observed. Aim of this work is to analyze the outcomes of patients undergoing primary chemotherapy for liver metastases from pancreatic cancer and to evaluate the results of surgical resection. METHODS: Retrospective analysis. EXCLUSION CRITERIA: patients with extra-hepatic metastases, patients with Eastern Cooperative Oncology Group performance status ≥3, patients undergoing supportive care alone. RESULTS: 127 patients were identified. Liver metastases were unilobar in 28.5% of patients. Chemotherapy regimens included gemcitabine alone or in association with other agents (44%), oxaliplatin, irinotecan, fluorouracil and leucovorin (FOLFIRINOX 8%), and cisplatin, gemcitabine plus capecitabine and epirubicin (PEXG) or capecitabine and docetaxel (PDXG) or epirubicin and fluorouracil (PEFG) (48%). 56 patients (44%) had a complete (7%) or partial response (37%). surgical resection was carried out in 11 patients (8.5%). Median overall survival was 11 months for the entire cohort and 15 months for those with partial/complete response. In this sub-group median survival was significantly longer (46 versus 11 months) for patients undergoing resection (P < 0.0001). Independent predictors of overall survival were chemotherapy with multiple agents (HR: 0.512), surgical resection (HR: 0.360), >5 liver metastases at diagnosis (HR: 3.515), and CA 19.9 reduction < 50% of baseline value (HR: 2.708). CONCLUSIONS: Surgical resection of primary pancreatic tumor with or without residual liver disease can be considered in selected cases after primary chemotherapy and it is associated with improved survival.

52 Article [Pancreatic cancer]. 2016

Falconi, Massimo / Tamburrino, Domenico / Buzzetti, Elena / Partelli, Stefano. ·Chirurgia del Pancreas, Pancreas Translational & Clinical Research Center, Ospedale San Raffaele, Università "Vita e Salute", Milano. · HPB and Liver Transplant Surgery, Royal Free Hospital, NHS Foundation Trust, London (UK). · UCL Institute for Liver and Digestive Health, Royal Free Hospital, NHS Foundation Trust, London (UK). ·Recenti Prog Med · Pubmed #27362726.

ABSTRACT: Pancreatic cancer is the fourth leading cause of death for neoplasm in western countries. Surgery still remains the treatment of choice although almost 80% of patients are not resectable at diagnosis because of liver metastases and the 5-year overall survival of patients treated with surgery is only (20%). During the last two decades we have witnessed an overall improvement in terms of survival, mostly due to the advances in therapy and strategies for a more accurate patient selection for surgery. Specific preoperative criteria, mostly linked to the biological features of the tumour, have been proposed to better identify those patients who will benefit from surgical resection, such as duration of symptoms and serum level of CA19-9 in resectable disease. Oncological therapy plays a central role in the management of pancreatic cancer. In patients undergone surgical resection, adjuvant therapy might increase the overall survival and reduce the rate of early relapse. Patients with locally advanced pancreatic cancer can be treated with neoadjuvant treatment. Chemotherapy or chemoradiotherapy are usually used with the aim to downstage the disease but whether one specific strategy or drug is the treatment of choice is still under debate.

53 Article Active Surveillance versus Surgery of Nonfunctioning Pancreatic Neuroendocrine Neoplasms ≤2 cm in MEN1 Patients. 2016

Partelli, Stefano / Tamburrino, Domenico / Lopez, Caroline / Albers, Max / Milanetto, Anna Caterina / Pasquali, Claudio / Manzoni, Marco / Toumpanakis, Christos / Fusai, Giuseppe / Bartsch, Detlef / Falconi, Massimo. ·Pancreatic Surgery Unit, Department of Internal Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy. ·Neuroendocrinology · Pubmed #26731608.

ABSTRACT: BACKGROUND: The aim of this study was to evaluate the efficacy of conservative treatment for nonfunctioning pancreatic neuroendocrine neoplasms (NF-PNEN) ≤2 cm in multiple endocrine neoplasia type 1 (MEN1)-affected patients compared with surgical treatment. METHODS: The databases of 4 tertiary referral institutions (San Raffaele Scientific Institute, Milan; Philipps-Universität Marburg, Marburg; University of Padua, Padua; Royal Free Hospital, London) were analyzed. A comparison of conservative management and surgery at initial diagnosis of NF-PNEN ≤2 cm between 1997 and 2013 was performed. RESULTS: Overall, 27 patients (45%) underwent up-front surgery and 33 patients (55%) were followed up after the initial diagnosis. A higher proportion of patients in the surgery group were female (70 vs. 33%, p = 0.004). Patients were mainly operated on in the period 1997-2007 as compared with the period 2008-2013 (n = 17; 63 vs. 37%; p = 0.040). The rate of multifocal tumors was higher in the surgery group (n = 24; 89%) than in the 'no surgery' group (n = 22; 67%; p = 0.043). After a median follow-up of 126 months, 1 patient deceased due to postoperative complications within 30 days after surgery. The 5-, 10-, and 15-year progression-free survival (PFS) rates were 63, 39, and 10%, respectively. The median PFS was similar in the two groups. Overall, 13 patients (32.5%) were operated on after initial surgical or conservative treatment. The majority of the surgically treated patients had stage 1 (77.5%), T1 (77.5%), and G1 (85%) tumors. CONCLUSIONS: NF-PNEN ≤2 cm in MEN1 patients are indolent neoplasms posing a low oncological risk. Surgical treatment of these tumors at initial diagnosis is rarely justified in favor of conservative treatment.

54 Article Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms. 2016

Crippa, Stefano / Pergolini, Ilaria / Rubini, Corrado / Castelli, Paola / Partelli, Stefano / Zardini, Claudio / Marchesini, Giorgia / Zamboni, Giuseppe / Falconi, Massimo. ·Department of Surgery, Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. · Department of Biomedical Sciences and Public Health, Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. · Division of Pathology, Sacro Cuore-Don Calabria Hospital, Negrar, Italy. · General Surgery, Sacro Cuore-Don Calabria Hospital, Negrar, Italy. · Division of Pathology, Sacro Cuore-Don Calabria Hospital, Negrar, Italy; Department of Pathology, Università di Verona, Verona, Italy. · Department of Surgery, Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. Electronic address: falconi.massimo@hsr.it. ·Surgery · Pubmed #26704784.

ABSTRACT: BACKGROUND: Segmental/diffuse dilatation of the main pancreatic duct (MPD) is the typical feature of combined/main-duct intraductal papillary mucinous neoplasms (CMD-IPMNs). MPD dilation in IPMNs may be also expression of mucus hypersecretion/obstructive chronic pancreatitis (OCP). The aim of this study was to evaluate the presence and extension of MPD involvement by tumor/OCP and assess the risk of overtreatment. METHODS: Retrospective analysis of suspected CMD-IPMNs resected between January 2009 and October 2014 were included. Pathologic correlations among MPD dilatation, IPMN, and OCP was searched. RESULTS: Overall, 93 patients were resected for suspected CMD-IPMNs. At pathology, CMD-IPMNs were found in 69 patients (74%). Branch-duct IPMNs (BD-IPMNs) were found in 8 cases (9%), pancreatic ductal adenocarcinoma (PDAC) in absence of IPMN in 9 (10%), cystic neuroendocrine tumor (NET G2) in 1 (1%), serous cystadenoma in 2 (2%), and OCP alone/mucinous metaplasia in 4 patients (4%). Overall, 18 patients (19%) underwent an overtreatment because unnecessary (2 BD-IPMNs, 2 serous cystadenomas, and 4 OCPs only) or too extensive resections (9 CMD-IPMNs and 1 PDAC with associated OCP). In these, total pancreatectomy was the most common procedure (67%). Median size of MPD in IPMN-involved area was 12 mm compared with 7 mm when only OCP was found (P < .05). CONCLUSION: There is a considerable risk of overtreatment in patients with a preoperative morphologic diagnosis of CMD-IPMNs. Partial pancreatectomy with margin examination should be performed instead of upfront total pancreatectomy. Radiologic observation can be considered in asymptomatic patients with "worrisome" MPD dilatation (5-9 mm) and lacking other high-risk stigmata.

55 Article Long-term outcomes and prognostic factors in neuroendocrine carcinomas of the pancreas: Morphology matters. 2016

Crippa, Stefano / Partelli, Stefano / Bassi, Claudio / Berardi, Rossana / Capelli, Paola / Scarpa, Aldo / Zamboni, Giuseppe / Falconi, Massimo. ·Division of Pancreatic Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. · Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. · Department of Medical Oncology, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. · Department of Pathology, ARC-Net Research Centre, University and Hospital Trust of Verona, Verona, Italy. · Department of Pathology, Ospedale Sacro Cuore-Don Calabria, Negrar, Italy. · Division of Pancreatic Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. Electronic address: falconi.massimo@hsr.it. ·Surgery · Pubmed #26602841.

ABSTRACT: BACKGROUND: Limited data are available for pancreatic neuroendocrine carcinomas (NEC) defined by 2010 World Health Organization (WHO) criteria (mitotic count >20 mitoses/10 high-power fields and/or a Ki67 index of >20%), because most studies encompass heterogeneous cohorts of extrapulmonary/gastrointestinal NEC. Our aim was to evaluate the clinicopathologic characteristics, treatment, and prognosis of patients with pancreatic NEC defined by the 2010 WHO criteria. METHODS: We conducted a retrospective analysis of 59 patients with a histologic diagnosis of NEC between 1990 and 2012. All cases were re-reviewed and classified according to the WHO 2010 classification and the WHO 2000 criteria. RESULTS: All patients had stage III pancreatic NEC (n = 34; 58%) or IV pancreatic NEC (n = 25; 43%). Overall, 49 (83%) had poorly differentiated (PD) and 10 (17%) had a well-differentiated (WD) morphology. Fifteen patients (26%) were operated with curative intent (R0/R1), and 8 (14%) were R2 resections. Median disease-specific survival (DSS) for the entire cohort was 14 months. Median DSS did not differ between patient not undergoing resection and those undergoing R2 resection (10 vs 12 months; P > .46), but DSS was greater for patients who underwent R0/R1 resection compared with those with no resection/R2 resection (35 vs 11 months; P < .005). WD morphologic NEC had a greater survival than PD ones (43 vs 12 months; P = .004). Performance status, R2 resection/no resection, PD morphologic NEC, and no medical treatment were independent predictors of poor survival. CONCLUSION: Pancreatic NEC constitute a heterogeneous group of tumors. Although NEC is an aggressive disease, curative resection in localized disease is associated with improved survival. Morphologic WD pancreatic NEC represents a subgroup with what seems to be a markedly improved survival. Within the NEC category, tumor treatment should be individualized considering tumor morphology as well as the other 2010 WHO criteria.

56 Article Long-Term Outcomes of Surgical Management of Pancreatic Neuroendocrine Tumors with Synchronous Liver Metastases. 2015

Partelli, Stefano / Inama, Marco / Rinke, Anja / Begum, Nehara / Valente, Roberto / Fendrich, Volker / Tamburrino, Domenico / Keck, Tobias / Caplin, Martyn E / Bartsch, Detlef / Thirlwell, Christina / Fusai, Giuseppe / Falconi, Massimo. ·Pancreatic Surgery Unit, University Hospital of Ancona, Ancona, Italy. ·Neuroendocrinology · Pubmed #26043944.

ABSTRACT: BACKGROUND: The value of surgical resection in the management of pancreatic neuroendocrine tumors (PNET) with liver metastases (LM) is still debated. The aim of this study was to evaluate the outcomes of surgery of PNET with LM. METHODS: Patients with PNET with synchronous LM between 2000 and 2011 from 4 high-volume institutions were included. The patients were divided into 3 groups: curative resection, palliative resection, and no resection. RESULTS: Overall, 166 patients were included. Eighteen patients (11%) underwent curative resection, 73 patients (43%) underwent palliative resection, and 75 patients (46%) underwent conservative treatment. The median overall survival (OS) from the time of diagnosis was 73 months. Patients who underwent curative resection had a significantly better median OS from the initial diagnosis compared with those who underwent palliative resection and those who were conservatively treated (97 vs. 89 vs. 36 months, p = 0.0001). The median OS from the time of diagnosis in those patients who underwent radical or palliative resection was 97 months, with a 5-year survival rate of 76%. On multivariate analysis, factors associated with OS from the time of diagnosis were the presence of bilobar metastases, tumor grading, and curative resection in a first model. On a second model, curative or palliative surgery was an independent predictor of OS. Among 91 patients who underwent surgery, the presence of pancreatic neuroendocrine carcinoma G3 was the only factor independently associated with a poorer survival after surgery (median OS: 35 vs. 97 months, p < 0.0001). CONCLUSIONS: Patients with LM from PNET benefit from surgical resection, although surgery should be reserved to well- or moderately differentiated forms.

57 Article Adjuvant Chemoradiation in Pancreatic Cancer: A Pooled Analysis in Elderly (≥75 years) Patients. 2015

Mattiucci, Gian-Carlo / Falconi, Massimo / VAN Stiphout, Ruud G P M / Alfieri, Sergio / Calvo, Felipe A / Herman, Joseph M / Maidment, Bert W / Miller, Robert C / Regine, William F / Reni, Michele / Sharma, Navesh / Partelli, Stefano / Genovesi, Domenico / Balducci, Mario / Deodato, Francesco / Valentini, Vincenzo / Morganti, Alessio G. ·Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy gcmattiucci@rm.unicatt.it. · Department of Surgery, University of Verona, Verona, Italy. · Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre, Maastricht, the Netherlands. · Department of Surgery, Sacro Cuore Catholic University, Rome, Italy. · Department of Oncology, Gregorio Marañón General Hospital, Complutense University, Madrid, Spain. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A. · Department of Radiation Oncology, University of Virginia, Charlottesville, VA, U.S.A. · Department of Radiation Oncology, Mayo Clinic, Rochester, MN, U.S.A. · Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, U.S.A. · Department of Oncology, S. Raffaele Scientific Institute, Milan, Italy. · Department of Radiotherapy, Sacro Cuore Catholic University, Rome, Italy. · Department of Radiotherapy, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy. · Unit of Radiotherapy, Unit of General Oncology, Giovanni Paolo II Foundation, Campobasso, Italy. ·Anticancer Res · Pubmed #26026108.

ABSTRACT: AIM: To determine the impact of postoperative chemoradiation (POCR) on overall survival (OS) after resection of pancreatic adenocarcinoma (PAC) in elderly (≥75 years) patients. MATERIALS AND METHODS: A multi-center retrospective review of 1248 patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive PAC was performed. Exclusion criteria included age <75 years, metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiotherapy (IORT) and postoperative death. RESULTS: A total of 98 patients were included in the analysis (males=39.8%, females=60.2%; R1 resections=33.7%; pN1=61.2%); 63 patients received POCR and 26 patients received adjuvant chemotherapy alone. The median follow-up was 25.6 months. The mean age for the entire cohort of patients was 78.1±2.9 (SD) years. No differences were observed between patients receiving or not receiving POCR in terms of age (p=0.081), tumor diameter (p=0.412), rate of R1 resection (p=0.331) and incidence of lymph node-positive disease (p=0.078). The only factor predicting an improved OS was POCR. The median OS was 69.0 months in patients treated by POCR and 23.0 months in patients treated without POCR (p=0.008). Even by Cox multivariate analysis, the only significant predictor of OS was POCR (hazard ratio=0.449; 95% confidence interval=0.212-0.950; p=0.036). CONCLUSION: The study represents the first comparative approach on POCR in elderly patients after resection of PAC. OS was higher in patients who received POCR. Further analyses are warranted to evaluate the toxicity rate/grade and the impact of POCR on patient quality of life.

58 Article Surgical resection does not improve survival in patients with renal metastases to the pancreas in the era of tyrosine kinase inhibitors. 2015

Santoni, Matteo / Conti, Alessandro / Partelli, Stefano / Porta, Camillo / Sternberg, Cora N / Procopio, Giuseppe / Bracarda, Sergio / Basso, Umberto / De Giorgi, Ugo / Derosa, Lisa / Rizzo, Mimma / Ortega, Cinzia / Massari, Francesco / Iacovelli, Roberto / Milella, Michele / Di Lorenzo, Giuseppe / Buti, Sebastiano / Cerbone, Linda / Burattini, Luciano / Montironi, Rodolfo / Santini, Daniele / Falconi, Massimo / Cascinu, Stefano. ·Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy, mattymo@alice.it. ·Ann Surg Oncol · Pubmed #25472645.

ABSTRACT: BACKGROUND: The aim of this study was to compare survival of resected and unresected patients in a large cohort of patients with metastases to the pancreas from renal cell carcinoma (PM-RCC). METHODS: Data from 16 Italian centers involved in the treatment of metastatic RCC were retrospectively collected. The Kaplan-Meier and log-rank test methods were used to evaluate overall survival (OS). Clinical variables considered were sex, age, concomitant metastasis to other sites, surgical resection of PM-RCC, and time to PM-RCC occurrence. RESULTS: Overall, 103 consecutive patients with radically resected primary tumors were enrolled in the analysis. PM-RCCs were synchronous in only three patients (3 %). In 56 patients (54 %), the pancreas was the only metastatic site, whereas in the other 47 patients, lung (57 %), lymph nodes (28 %), and liver (21 %) were the most common concomitant metastatic sites. Median time for PM-RCC occurrence was 9.6 years (range 0-24 years) after nephrectomy. Surgical resection of PM-RCC was performed in 44 patients (median OS 103 months), while 59 patients were treated with tyrosine kinase inhibitors (TKIs; median OS 86 months) (p = 0.201). At multivariate analysis, Memorial Sloan Kettering Cancer Center risk group was the only independent prognostic factor. None of the other clinical variables, such as age, sex, pancreatic surgery, or the presence of concomitant metastases, were significantly associated with outcome in PM-RCC patients. CONCLUSIONS: The presence of PM-RCC is associated with a long survival, and surgical resection does not improve survival in comparison with TKI therapy. However, surgical resection leads to a percentage of disease-free PM-RCC patients.

59 Article The role of combined Ga-DOTANOC and (18)FDG PET/CT in the management of patients with pancreatic neuroendocrine tumors. 2014

Partelli, Stefano / Rinzivillo, Maria / Maurizi, Angela / Panzuto, Francesco / Salgarello, Matteo / Polenta, Vanessa / Delle Fave, Gianfranco / Falconi, Massimo. ·Pancreatic Surgery Unit, Clinica Chirurgia del Pancreas, Università Politecnica delle Marche, Ancona, Italy. ·Neuroendocrinology · Pubmed #25301162.

ABSTRACT: PURPOSE: The aim of this study was to evaluate the effect of combined (68)Ga and (18)F-FDG PET/CT on treatment management for patients with pancreatic neuroendocrine tumor (PNET). METHODS: Between January 2012 and April 2014, 49 consecutive patients with a cytologically and/or histologically proven diagnosis of PNET underwent combined (68)Ga and (18)FDG PET/CT on the same day. RESULTS: The study group consisted of 21 males and 28 females with a median age of 59 years. Disease detection was achieved in 48 out of the 49 cases with (68)Ga imaging, and in 36 of the 49 cases with (18)FDG PET/CT. These results corresponded to sensitivities of 98% for (68)Ga versus 73% for (18)FDG PET/CT. Patients with NET-G1/NET-G2 had a positive (68)Ga and negative (18)FDG PET/CT in 13 cases, whereas both (68)Ga and (18)FDG PET/CT were positive in 27 cases. Patients with NEC-G3 were positive by both (68)Ga and (18)FDG PET/CT in 7 cases and positive only by (18)FDG in 1 case. Another NEC-G3 patient was only positive by (68)Ga PET/CT. The median Ki67 was 7% for (68)Ga PET/CT-positive tumors and 10% for tumors with both (68)Ga and (18)FDG PET/CT positivity (p = 0.130). Half of the patients with a prevalent uptake of (18)FDG (n = 7) had an NEC-G3 compared with 12% of patients with a prevalent uptake of (68)Ga (p = 0.012). There were no significant differences between patients with positive (68)Ga and those with positive (18)FDG with regards to treatment choice. CONCLUSIONS: The association of (18)FDG slightly increases sensitivity of (68)Ga PET/CT alone in the diagnosis of PNET. A combined dual tracer PET/CT does not influence the choice of treatment strategy.

60 Article Evaluation of a predictive model for pancreatic fistula based on amylase value in drains after pancreatic resection. 2014

Partelli, Stefano / Tamburrino, Domenico / Crippa, Stefano / Facci, Enrico / Zardini, Claudio / Falconi, Massimo. ·Department of Surgery, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy. · Department of Surgery, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy. Electronic address: m.falconi@univpm.it. ·Am J Surg · Pubmed #25001423.

ABSTRACT: BACKGROUND: Amylase value in drains (AVD) is a predictor of pancreatic fistula (PF). We evaluated the accuracy of an AVD-based model. METHODS: Two hundred thirty-one patients underwent pancreatoduodenectomy with pancreaticojejunostomy (PDPJ) or pancreatoduodenectomy with duct-to-mucosa (PDDTM) and distal pancreatectomy (DP). Patients with AVD greater than 5,000 U/L on postoperative day (POD) 1 underwent AVD measurement on POD5. RESULTS: Sensitivity and specificity of POD1 AVD greater than 5,000 in predicting PF were 71% and 90%, respectively. The sensitivity and specificity of POD5 AVD greater than 200 were 90% and 83%, respectively. AVD greater than 1,000 (for PDPJ) and 2,000 U/L (PDDTM and DP) represented the most accurate cutoffs on POD1. AVD greater than 200 (PDPJ), 300 (PDDTM), and 50 U/L (DP) represented the cutoffs with the highest sensitivity in predicting PF on POD5. CONCLUSION: AVD-based model for predicting PF after pancreatic resection is an accurate tool, although AVD cutoffs should be evaluated for each type of operation.

61 Article The role of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in resectable pancreatic cancer. 2014

Crippa, Stefano / Salgarello, Matteo / Laiti, Silvia / Partelli, Stefano / Castelli, Paola / Spinelli, Antonello E / Tamburrino, Domenico / Zamboni, Giuseppe / Falconi, Massimo. ·Division of Pancreatic Surgery, Department of Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. · Department of Nuclear Medicine, University of Verona, Negrar, Italy. · Residency Programme in Surgery, University of Verona, Italy. · Department of Pathology, Ospedale Sacro Cuore-Don Calabria, Negrar, Italy. · Department of Medical Physics and Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy. · Division of Pancreatic Surgery, Department of Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. Electronic address: m.falconi@univpm.it. ·Dig Liver Dis · Pubmed #24721105.

ABSTRACT: BACKGROUND: The role of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in pancreatic ductal adenocarcinoma is debated. We retrospectively assessed the value of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in addition to conventional imaging as a staging modality in pancreatic cancer. METHODS: (18)Fluoro-deoxyglucose positron emission tomography/computed tomography was performed in 72 patients with resectable pancreatic carcinoma after multi-detector computed tomography positron emission tomography was considered positive for a maximum standardized uptake value >3. RESULTS: Overall, 21% of patients had a maximum standardized uptake value ≤ 3, and 60% of those had undergone neoadjuvant treatment (P=0.0001). Furthermore, 11% of patients were spared unwarranted surgery since positron emission tomography/computed tomography detected metastatic disease. All liver metastases were subsequently identified with contrast-enhanced ultrasound. Sensitivity and specificity of positron emission tomography/computed tomography for distant metastases were 78% and 100%. The median CA19.9 concentration was 48.8 U/mL for the entire cohort and 292 U/mL for metastatic patients (P=0.112). CONCLUSIONS: The widespread application of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in patients with resectable pancreatic carcinoma seems not justified. It should be considered in selected patients at higher risk of metastatic disease (i.e. CA19.9>200 U/mL) after undergoing other imaging tests. Neoadjuvant treatment is significantly associated with low metabolic activity, limiting the value of positron emission tomography in this setting.

62 Article Incidental diagnosis as prognostic factor in different tumor stages of nonfunctioning pancreatic endocrine tumors. 2014

Crippa, Stefano / Partelli, Stefano / Zamboni, Giuseppe / Scarpa, Aldo / Tamburrino, Domenico / Bassi, Claudio / Pederzoli, Paolo / Falconi, Massimo. ·Department of Surgery, Policlinico GB Rossi, University of Verona, Verona, Italy; Department of Surgery, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy. · Department of Pathology, Policlinico GB Rossi, University of Verona, Verona, Italy; Department of Pathology, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy. · Department of Pathology, Policlinico GB Rossi, University of Verona, Verona, Italy. · Department of Surgery, Policlinico GB Rossi, University of Verona, Verona, Italy. · Department of Surgery, Policlinico GB Rossi, University of Verona, Verona, Italy. Electronic address: m.falconi@univpm.it. ·Surgery · Pubmed #24646958.

ABSTRACT: BACKGROUND: Incidentally discovered nonfunctioning pancreatic endocrine tumors (NF-pNETs) increasingly are being detected, and their management is debated. Moreover, the prognostic importance of incidental diagnosis for locally advanced or metastatic NF-pNETs is unknown. The aim of this study is to analyze the outcomes of incidentally discovered/symptomatic NF-pNETs stratified by tumor stage. A preliminary experience with nonoperative treatment of incidental NF-pNETs is reported. METHODS: Consecutive patients with symptomatic/incidental NF-PETs observed between 1990 and 2009 were analyzed, with different tumor stages considered. Nonoperative management of incidental NF-pNETs was evaluated. RESULTS: Among 355 patients with NF-pNETs, the diagnosis was incidental in 124 (35%). Incidental NF-pNETs were associated more commonly with lower tumor stages compared with symptomatic tumors (P < .0001), but 30% of incidental NF-pNETs were stage III-IV. Incidental NF-pNETs had greater rates of radical resections and of R0 margins (P < .0001). Five-year progression-free survival (PFS) was 83% and 32% for incidental and symptomatic NF-pNETs, respectively (P < .0001). Five-year PFS was better for incidental NF-pNETs compared with symptomatic tumors for each tumor stage, including stage III (69% vs 27%, P < .0001) and stage IV (60% vs 17%, P = .112). After a median follow-up of 36 months, there was no tumor progression in 12 patients who underwent nonoperative management of incidental NF-pNETs. CONCLUSION: A total of 30% of incidental NF-pNETs present with stage III-IV disease. PFS is much greater for incidental NF-pNETs compared with symptomatic patients, and this difference is evident also for stage III-IV tumors, suggesting that absence of symptoms may indicate a less-aggressive disease. Nonoperative management can be an alternative to surgery in selected incidental NF-pNETs.

63 Article Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors. 2014

Heeger, Kristin / Falconi, Massimo / Partelli, Stefano / Waldmann, Jens / Crippa, Stefano / Fendrich, Volker / Bartsch, Detlef K. ·Department of Surgery, Philipps-University, Baldingerstraße, D-35043, Marburg, Germany, dietzel@med.uni-marburg.de. ·Langenbecks Arch Surg · Pubmed #24522434.

ABSTRACT: PURPOSE: Only small, potentially benign pancreatic tumors located ≥3 mm distant from the main pancreatic duct (MPD) are considered good candidates for enucleation. This study evaluates the outcome of enucleations with regard to their distance to the MPD. METHODS: Clinical characteristics, complications, and outcomes of prospectively documented patients with small (≤30 mm), potentially benign pancreatic tumors, who underwent enucleation, were retrospectively analyzed. Patients were divided in two groups, either deep enucleation (DE, distance ≤3 mm) or standard enucleation (SE, distance >3 mm), as determined by intraoperative ultrasonography (IOUS). RESULTS: Sixty patients underwent DE (n = 30) or SE (n = 30) with IOUS. Both groups did not differ regarding age, tumor size, pathology, and operating time. Complications occurred in 24/30 (80 %) patients of the DE group compared to 15/30 (50 %) patients after SE (P = 0.029). Mortality was nil. The most frequent complication was pancreatic fistula (POPF) occurring in 22/30 (73.3 %) patients after DE and 9/30 (30 %) patients undergoing SE (P = 0.002). Especially, the rate of clinically significant POPF types B and C was higher after DE (21 of 30 patients) compared to SE (7 of 30 patients, P = 0.0006). Univariate and multivariate analyses revealed DE as the only significant factor that negatively influenced the occurrence of POPF. Postoperative hospital stay tended to be longer after DE (15 vs. 11.5 days, P = 0.050). All but two patients with metastatic gastrinoma and two patients, who died of unrelated causes, showed no evidence of disease after a median follow-up of 24 (3-235) months. CONCLUSIONS: Deep enucleation of small, potentially benign pancreatic tumors should be considered with caution given the high rate of clinically relevant POPF.

64 Article The natural history of a branch-duct intraductal papillary mucinous neoplasm of the pancreas. 2014

Crippa, Stefano / Partelli, Stefano / Tamburrino, Domenico / Falconi, Massimo. ·Division of Surgery, Ospedale "Sacro Cuore-Don Calabria," Negrar (VR), Italy; Department of Surgery, University of Verona, Verona, Italy; Division of Pancreatic and Digestive Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. Electronic address: ste.crippa@libero.it. · Division of Surgery, Ospedale "Sacro Cuore-Don Calabria," Negrar (VR), Italy; Department of Surgery, University of Verona, Verona, Italy; Division of Pancreatic and Digestive Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy. · Division of Surgery, Ospedale "Sacro Cuore-Don Calabria," Negrar (VR), Italy; Department of Surgery, University of Verona, Verona, Italy. ·Surgery · Pubmed #23261026.

ABSTRACT: -- No abstract --

65 Article Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors. 2013

Gaujoux, Sébastien / Partelli, Stefano / Maire, Frédérique / D'Onofrio, Mirko / Larroque, Béatrice / Tamburrino, Domenico / Sauvanet, Alain / Falconi, Massimo / Ruszniewski, Philippe. ·MD, Department of Hepatobiliary and Pancreatic Surgery, Hospital Beaujon, 100, Boulevard du Général Leclerc, 92110 Clichy, France. alain.sauvanet@bjn.aphp.fr. ·J Clin Endocrinol Metab · Pubmed #24057286.

ABSTRACT: CONTEXT: Asymptomatic sporadic nonfunctioning, well-differentiated pancreatic neuroendocrine tumors (NF-PNETs) are increasingly diagnosed, and their management is controversial because of their overall good but heterogeneous prognosis. OBJECTIVE: The objective of the study was to assess the natural history of asymptomatic sporadic NF-PNETs smaller than 2 cm in size and the risk-benefit balance of nonoperative management. EXPERIMENTAL DESIGN: From January 2000 to June 2011, 46 patients with proven asymptomatic sporadic NF-PNETs smaller than 2 cm in size were followed up for at least 18 months with serial imaging in tertiary referral centers. RESULTS: Patients were mainly female (65%), with a median age of 60 years. Tumors were mainly located in the pancreatic head (52%), with a median lesion size of 13 mm (range 9-15). After a median follow-up of 34 months (range 24-52) and an average of four (range 3-6) serial imaging sessions, distant or nodal metastases appeared on the imaging in none of the patients. In six patients (13%), a 20% or greater increase in size was observed. Overall median tumor growth was 0.12 mm per year, and neither patients nor tumor characteristics were found to be significant predictors of tumor growth. Overall, eight patients (17%) underwent surgery after a median time from initial evaluation of 41 months (range 27-58); all resected lesions were European Neuroendocrine Tumor Society T stage 1 (n = 7) or 2 (n = 1), grade 1, node negative, with neither vascular nor peripancreatic fat invasion. CONCLUSIONS: In selected patients, nonoperative management of asymptomatic sporadic NF-PNETs smaller than 2 cm in size is safe. Larger and prospective multicentric studies with long-term follow-up are now needed to validate this wait-and-see policy.

66 Article Pattern and clinical predictors of lymph node involvement in nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs). 2013

Partelli, Stefano / Gaujoux, Sebastien / Boninsegna, Letizia / Cherif, Rim / Crippa, Stefano / Couvelard, Anne / Scarpa, Aldo / Ruszniewski, Philippe / Sauvanet, Alain / Falconi, Massimo. ·Departments of Surgery and Pathology, University of Verona, Verona, Italy. ·JAMA Surg · Pubmed #23986355.

ABSTRACT: IMPORTANCE: Nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) are often indolent neoplasms without lymph node (LN) metastasis at diagnosis. Therefore, in patients with low risk of LN metastasis, the extent of surgery and lymphadenectomy could be limited and follow-up adjusted to the very low risk of relapse. OBJECTIVE: To construct a predicting model to assess the risk of pN+ prior to surgical resection for NF-PanNETs using preoperative retrievable variables. DESIGN: Retrospective review using multiple logistic regression analysis to construct predictive model of pN+ based on preoperatively available data. SETTING: The combined prospective databases of the Surgical Departments of the University of Verona, Verona, Italy, and Beaujon Hospital, Clichy, France, were queried for clinical and pathological data. PARTICIPANTS: All patients with resected (R0 or R1), pathologically confirmed NF-PanNETs between January 1, 1993 and December 31, 2009. MAIN OUTCOME AND MEASURE: Risk of lymph node metastases in patients with pancreatic neuroendocrine tumors. RESULTS: Among 181 patients, nodal metastases were reported in 55 patients (30%) and were associated with decreased 5-year disease-free survival (70% vs 97%, P < .001). Multivariable analysis showed that independent factors associated with nodal metastasis were radiological nodal status (rN) (odds ratio [OR], 5.58; P < .001) and tumor grade (NET-G2 vs NET-G1: OR, 4.87; P < .001) (first model). When the tumor grade was excluded, rN (OR, 4.73; P = .001) and radiological tumor size larger than 4 cm (OR, 2.67; P = .03) were independent predictors of nodal metastasis (second model). The area under the receiver operating characteristic curve for the first and second models were 80% and 74%, respectively. CONCLUSIONS AND RELEVANCE: Patients with NF-PanNET-G1 have a very low risk of pN+ in the absence of radiological signs of node involvement. When preoperative grading assessment is not achieved, the radiological size of the lesion is a powerful alternative predictor of pN+. The risk of pathological nodal involvement in patients with NF-PanNETs can be accurately estimated by a clinical predictive model.

67 Article Radiolabelled somatostatin analogue treatment in gastroenteropancreatic neuroendocrine tumours: factors associated with response and suggestions for therapeutic sequence. 2013

Campana, Davide / Capurso, Gabriele / Partelli, Stefano / Nori, Francesca / Panzuto, Francesco / Tamburrino, Domenico / Cacciari, Giulia / Delle Fave, Gianfranco / Falconi, Massimo / Tomassetti, Paola. ·Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. davide.campana@unibo.it ·Eur J Nucl Med Mol Imaging · Pubmed #23619938.

ABSTRACT: PURPOSE: Peptide receptor radionuclide therapy (PRRT) is a relatively new treatment modality for patients with unresectable or metastatic gastroenteropancreatic neuroendocrine tumours (GEP NETs). The aim of this study was to determine the time to progression of patients treated with PRRT and to identify the prognostic factors related to treatment response. METHODS: Patients with sporadic GEP NETs prospectively treated with PRRT were retrospectively analysed. The primary end point was progression-free survival (PFS). RESULTS: A total of 69 patients (37 men and 32 women; 45 with pancreatic and 24 with gastrointestinal lesion; 22 NET G1 and 41 NET G2) were treated with (90)Y or (177)Lu. The objective response rate was 27.5% (partial response, PR), while 50.7% had stable disease and 23.2% had progressive disease. Significant differences in PFS were observed in relationship to the stage of the disease (44 months for stage III, 23 months for stage IV), the evidence of a PR 6 months after the end of the PRRT (39 months in patients with a PR, 22 months in patients without a PR) and previous transarterial chemoembolization (TACE, yes 13 months vs no 31 months). Stage IV, NET G2 and previous TACE were found to be significant factors for tumour progression at multivariate analysis. CONCLUSION: Low tumour burden and a low proliferation index represent independent prognostic factors for long PFS, while previous chemoembolization techniques represent independent prognostic factors for early tumour progression and shorter PFS. Our data suggest that chemoembolization techniques to reduce the hepatic tumour burden should be avoided.

68 Article Time trends in the treatment and prognosis of resectable pancreatic cancer in a large tertiary referral centre. 2013

Barugola, Giuliano / Partelli, Stefano / Crippa, Stefano / Butturini, Giovanni / Salvia, Roberto / Sartori, Nora / Bassi, Claudio / Falconi, Massimo / Pederzoli, Paolo. ·Department of Surgery, University of Verona, Verona, Italy. ·HPB (Oxford) · Pubmed #23490217.

ABSTRACT: OBJECTIVES: Mortality in pancreatic cancer has remained unchanged over the last 20-30 years. The aim of the present study was to analyse survival trends in a selected population of patients submitted to resection for pancreatic cancer at a single institution. METHODS: Included were 544 patients who underwent pancreatectomy for pancreatic cancer between 1990 and 2009. Patients were categorized into two subgroups according to the decade in which resection was performed (1990-1999 and 2000-2009). Predictors of survival were analysed using univariate and multivariate analyses. RESULTS: Totals of 114 (21%) and 430 (79%) resections were carried out during the periods 1990-1999 and 2000-2009, respectively (P < 0.0001). Hospital length of stay (16 days versus 10 days; P < 0.001) and postoperative mortality (3% versus 1%; P = 0.160) decreased over time. Median disease-specific survival significantly increased from 16 months in the first period to 29 months in the second period (P < 0.001). Following multivariate analysis, poorly differentiated tumour [hazard ratio (HR) 3.1, P < 0.001], lymph node metastases (HR = 1.9, P < 0.001), macroscopically positive margin (R2) resection (HR = 3.2, P < 0.0001), no adjuvant therapy (HR = 1.6, P < 0.001) and resection performed in the period 1990-1999 (HR = 2.18, P < 0.001) were significant independent predictors of a poor outcome. CONCLUSIONS: Longterm survival after surgery for pancreatic cancer significantly improved over the period under study. Better patient selection and the routine use of adjuvant therapy may account for this improvement.

69 Article Partial pancreaticoduodenectomy can provide cure for duodenal gastrinoma associated with multiple endocrine neoplasia type 1. 2013

Lopez, Caroline L / Falconi, Massimo / Waldmann, Jens / Boninsegna, Letizia / Fendrich, Volker / Goretzki, Peter K / Langer, Peter / Kann, Peter H / Partelli, Stefano / Bartsch, Detlef K. ·Department of Surgery, Philipps-University, Marburg, Germany. ·Ann Surg · Pubmed #22580937.

ABSTRACT: OBJECTIVE: To evaluate the outcome of pancreaticoduodenectomy (PD) versus non-PD resections for the treatment of gastrinoma in multiple endocrine neoplasia type 1. BACKGROUND: Gastrinoma in MEN1 is considered a rarely curable disease and its management is highly controversial both for timing and extent of surgery. METHODS: Clinical characteristics, complications and outcomes of 27 prospectively collected MEN1 patients with biochemically proven gastrinoma, who underwent surgery, were analyzed with special regard to the gastrinoma type and the initial operative procedure. RESULTS: Twenty-two (81%) patients with gastrinoma in MEN1 had duodenal gastrinomas and 5 patients (19%) had pancreatic gastrinomas. At the time of diagnosis, 21 (77%) gastrinomas were malignant (18 duodenal, 3 pancreatic), but distant metastases were only present in 4 (15%) patients. Patients with pancreatic gastrinomas underwent either distal pancreatic resections or gastrinoma enucleation with lymphadenectomy, 2 patients also had synchronous resections of liver metastases. One of these patients was biochemically cured after a median of 136 (77-312) months. Thirteen patients with duodenal gastrinomas underwent PD resections (group 1, partial PD [n = 11], total PD [n = 2]), whereas 9 patients had no-PD resections (group 2) as initial operative procedure. Perioperative morbidity and mortality, including postoperative diabetes, differed not significantly between groups (P > 0.5). All patients of group 1 and 5 of 9 (55%) patients of group 2 had a negative secretin test at hospital discharge. However, after a median follow-up of 136 (3-276) months, 12 (92%) patients of group 1 were still normogastrinemic compared to only 3 of 9 (33%) patients of group 2 (P = 0.023). Three (33%) patients of group 2 had to undergo up to 3 reoperations for recurrent or metastatic disease compared to none of group 1. CONCLUSIONS: Duodenal gastrinoma in MEN1 should be considered a surgically curable disease. PD seems to be the adequate approach to this disease, providing a high cure rate and acceptable morbidity compared to non-PD resections.

70 Article Impact of lymphadenectomy on survival after surgery for sporadic gastrinoma. 2012

Bartsch, D K / Waldmann, J / Fendrich, V / Boninsegna, L / Lopez, C L / Partelli, S / Falconi, M. ·Department of Surgery, University Hospital Giessen and Marburg, Marburg, Germany. ·Br J Surg · Pubmed #22864882.

ABSTRACT: BACKGROUND: The study was undertaken to determine prognostic factors and the value of systematic lymphadenectomy on survival in sporadic gastrinoma. METHODS: Patients with sporadic gastrinoma who underwent initial surgery during a 21-year period in two tertiary referral centres were analysed retrospectively with respect to clinical characteristics, operative procedures and outcome. RESULTS: Forty-eight patients with a median age of 52 (range 22-73) years were analysed. Some 18 patients had pancreatic and 26 had duodenal gastrinomas, whereas the primary tumour remained unidentified in four patients. After a median postoperative follow-up of 83 (range 3-296) months, 20 patients had no evidence of disease, 13 patients were alive with disease, 11 patients had died from the disease and four had died from unrelated causes. In 41 patients who underwent potentially curative surgery, systematic lymphadenectomy with excision of more than ten lymph nodes resulted in a higher rate of biochemical cure after surgery than no or selective lymphadenectomy (13 of 13 versus 18 of 28 patients; P = 0·017), with a trend towards prolonged disease specific survival (P = 0·062) and disease-free survival (P = 0·120), and a reduced risk of death (0 of 13 versus 7 of 24 patients; P = 0·037). Negative prognostic factors for disease specific survival were pancreatic location (P = 0·029), tumour size equal to or larger than 25 mm (P = 0·003), Ki-67 index more than 5 per cent (P < 0·001), preoperative gastrin level 3000 pg/ml or more (P = 0·003) and liver metastases (P < 0·001). Sex, age, type of surgery and presence of lymph node metastases had no influence on disease free or disease specific survival. CONCLUSION: In sporadic gastrinoma, systematic lymphadenectomy during initial surgery may reduce the risk of persistent disease and improve survival.

71 Article Poorly differentiated resectable pancreatic cancer: is upfront resection worthwhile? 2012

Crippa, Stefano / Partelli, Stefano / Zamboni, Giuseppe / Barugola, Giuliano / Capelli, Paola / Inama, Marco / Bassi, Claudio / Pederzoli, Paolo / Falconi, Massimo. ·Department of Surgery, University of Verona, Verona, Italy. ste.crippa@libero.it ·Surgery · Pubmed #22766365.

ABSTRACT: BACKGROUND: Poorly differentiated, resectable pancreatic ductal adenocarcinoma is associated with early recurrence and may benefit from neoadjuvant treatment. The aim of this study was to evaluate clinicopathologic characteristics and survival of patients with resectable pancreatic ductal adenocarcinoma according to histologic grading. METHODS: A total of 502 patients who underwent resection for pancreatic ductal adenocarcinoma between 1990 and 2008 were analyzed via the use of different histologic grading. RESULTS: Well-differentiated (G1), moderately differentiated (G2), and poorly differentiated (G3) pancreatic ductal adenocarcinomas were found in 23 (4.5%), 310 (62%), and 169 (33.5%) patients. Adjuvant therapy, N status, grading, and R status were independent predictors of disease-specific survival for the entire cohort, with 1- and 5-year disease-specific survival rates of 81% and 21%, respectively. Only the presence of symptoms was a significant clinical predictor of G3 status (P = .035). G3 neoplasms were characterized by a greater rate of lymph node metastases, microvascular/perineural invasion, and R2 resections. Median disease-specific survival was 77, 26, and 20 months for G1, G2, and G3 neoplasms (P < .0001). Median disease-free survival was 63, 14, and 9 months for G1, G2, and G3 pancreatic ductal adenocarcinoma (P < .0001). Adjuvant therapy improved disease-specific survival in G2 (P < .04) and G3 (P < .0001) pancreatic ductal adenocarcinoma, with a greater survival benefit for G3 neoplasms (hazard ratio: 1.334 vs 2.116). CONCLUSION: G3 pancreatic ductal adenocarcinoma is associated with a lesser rate of disease-free survival after resection and with the presence of other poor prognostic factors. The benefit of adjuvant therapy is greater in G3 than in G1 and G2 neoplasms. On the basis of these findings, patients with resectable G3 PDAC can be considered as possible targets for neoadjuvant treatment.

72 Article Faecal elastase-1 is an independent predictor of survival in advanced pancreatic cancer. 2012

Partelli, Stefano / Frulloni, Luca / Minniti, Consolato / Bassi, Claudio / Barugola, Giuliano / D'Onofrio, Mirko / Crippa, Stefano / Falconi, Massimo. ·Department of Surgery, University of Verona, Policlinico GB Rossi, Verona, Italy. ·Dig Liver Dis · Pubmed #22749648.

ABSTRACT: BACKGROUND: The relationship between prognosis of advanced pancreatic cancer and exocrine secretion impairment is unknown. AIM: To investigate a possible correlation between faecal elastase-1 value and survival in advanced pancreatic cancer. METHODS: 194 patients with advanced pancreatic cancer were prospectively enrolled between 2007 and 2009 and underwent faecal elastase-1 measurement. Exocrine pancreatic secretion was defined as "moderately reduced" (faecal elastase-1: 100-200 μg/g), "severely reduced" (faecal elastase-1<100 and >20 μg/g) and "extremely reduced" (faecal elastase-1≤20 μg/g). RESULTS: Median faecal elastase-1 was 204 μg/g (interquartile range 19; 489). Overall, 48 patients (25%) had an extremely reduced exocrine pancreatic secretion, 28 (14%) a severely reduced exocrine pancreatic secretion and 21 (11%) a moderately reduced exocrine pancreatic secretion. Patients with extremely reduced exocrine pancreatic secretion had higher rates of pancreatic head localizations (P<0.01) and of jaundice (P<0.01). Median overall survival was 10.5 months. Patients with faecal elastase-1≤20 μg/g had a worse prognosis (median survival: 7 versus 11 months, P=0.031). Presence of metastases (Hazard ratio 1.81, P<0.0001), haemoglobin ≤12 g/L (Hazard ratio 2.12, P=0.001), albumin ≤40 g/L (Hazard ratio 1.64, P=0.010) and FE-1≤20 μg/g (Hazard ratio 1.59 P=0.023) resulted as independent predictors of survival in advanced pancreatic cancer patients. CONCLUSIONS: A low value of faecal elastase-1 is strongly correlated with a poor survival in advanced pancreatic cancer.

73 Article Surgical management of insulinomas: short- and long-term outcomes after enucleations and pancreatic resections. 2012

Crippa, Stefano / Zerbi, Alessandro / Boninsegna, Letizia / Capitanio, Vanessa / Partelli, Stefano / Balzano, Gianpaolo / Pederzoli, Paolo / Di Carlo, Valerio / Falconi, Massimo. ·Department of Surgery, Chirurgia Generale B, Policlinico GB Rossi, University of Verona, Piazzale La Scuro, 10-37134, Verona, Italy. ·Arch Surg · Pubmed #22430908.

ABSTRACT: OBJECTIVE: To analyze the characteristics and outcomes following enucleation and pancreatic resections of insulinomas. DESIGN: Retrospective cohort study; prospective database. SETTINGS: Academic, tertiary, and referral centers. PATIENTS: Consecutive patients with insulinomas (symptoms of hyperinsulinism and positive fasting glucose test) who underwent surgical treatment between January 1990 and December 2009. MAIN OUTCOME MEASURES: Operative morbidity, tumor recurrence, and survival after treatment. RESULTS: A total of 198 patients (58.5% women; median age, 48 years) were identified. There were 175 (88%) neuroendocrine tumors grade G1 and 23 (12%) neuroendocrine tumors grade G2. Malignant insulinomas defined by lymph node/liver metastases were found in 7 patients (3.5%). Multiple insulinomas were found in 8% of patients, and 5.5% of patients had multiple endocrine neoplasia type 1. Surgical procedures included 106 enucleations (54%) and 92 pancreatic resections (46%). Mortality was nil. Rate of clinically significant pancreatic fistula was 18%. Enucleations had a higher reoperation rate compared with pancreatic resections (8.5% vs 1%; P = .02). Multiple endocrine neoplasia type 1 was significantly associated with younger age at onset (P < .005) and higher rates of malignancies and multiple lesions. Median follow-up was 65 months. Six patients (3%; 5 patients had neuroendocrine tumors grade G2) developed tumor recurrence. Four patients (2%) died of disease. New exocrine (1.5%) and endocrine (4%) insufficiencies were associated only with pancreatic resections. CONCLUSIONS: Outcomes following surgical resection of insulinomas are satisfactory, with no mortality and good functional results. Recurrence is uncommon (3%), and it is more likely associated with neuroendocrine tumors grade G2. Insulinomas in multiple endocrine neoplasia type 1 are at higher risk for being malignant and multifocal, requiring pancreatic resections.

74 Article Malignant pancreatic neuroendocrine tumour: lymph node ratio and Ki67 are predictors of recurrence after curative resections. 2012

Boninsegna, Letizia / Panzuto, Francesco / Partelli, Stefano / Capelli, Paola / Delle Fave, Gianfranco / Bettini, Rossella / Pederzoli, Paolo / Scarpa, Aldo / Falconi, Massimo. ·Department of Surgery, University of Verona, Verona, Italy. ·Eur J Cancer · Pubmed #22129889.

ABSTRACT: INTRODUCTION: Malignant pancreatic neuroendocrine tumours (PNENs) are generally associated with a good prognosis after radical resection. In other pancreatic malignancies predictors of recurrence and the role of lymph node ratio (LNR) are well known, but both have been scarcely investigated for malignant PNETs. METHODS: The prospective database from the surgical Department of Verona University was queried. Clinical and pathological data of all patients with resected malignant PNET between 1990 and 2008 were reviewed. Univariate and multivariate analysis were performed. RESULTS: Fifty-seven patients (male/female ratio=1) with a median age of 58 years (33-78) entered in the study. Twenty-nine (51%) patients underwent pancreaticoduodenectomy and 28 (49%) distal pancreatectomy. Postoperative mortality was nil with a 37% morbidity rate. There were 36 (63%) patients with lymph node metastases (N1). Of these, 23 (64%) had a lymph node ratio (LNR) >0 and ≤0.20 and 13 (36%) had a LNR >0.20. The median overall survival and the median disease free survival (DFS) were 190 and 80 months, respectively. Recurrent disease was identified in 24 patients (42%) with a 2 and 5-year DFS rate of 82% and 49%, respectively. On multivariate analysis, LNR >0.20 (HR=2.75) and a value of Ki67 >5% (HR=3.39) were significant predictors of recurrence (P<0.02). CONCLUSIONS: After resection for malignant PNETs, LNR and a Ki67 >5% are the most powerful predictors of recurrence. The presence of these factors should be considered for addressing patients to adjuvant treatment in future clinical trials.

75 Article Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy. 2012

Barugola, Giuliano / Partelli, Stefano / Crippa, Stefano / Capelli, Paola / D'Onofrio, Mirko / Pederzoli, Paolo / Falconi, Massimo. ·Department of Surgery, Policlinico GB Rossi, University of Verona, Italy. ·Am J Surg · Pubmed #21824596.

ABSTRACT: BACKGROUND: Neoadjuvant treatment frequently is performed in unresectable/borderline resectable pancreatic cancer. The aim of this study was to retrospectively compare postoperative outcomes and survival of patients who underwent pancreatectomy after neoadjuvant treatment for locally advanced/borderline resectable pancreatic cancer (neoadjuvant treatment group) with those of patients with resectable disease who underwent upfront surgery. METHODS: Between 2000 and 2008, there were 403 patients who underwent pancreatic cancer resection, 41 (10.1%) patients after neoadjuvant treatment for initially unresectable tumors and 362 (89.9%) patients had upfront surgery. Univariate and multivariable analyses were performed. RESULTS: Mortality/morbidity rates were similar in the 2 groups. Nodal metastases were significantly lower in the neoadjuvant treatment group (31.7% vs 86.2%; P < .001). A complete pathologic response was observed in 13.6% after neoadjuvant treatment. Median disease-specific survival from resection was 35 and 27 months in the neoadjuvant treatment and upfront groups, respectively (P = .74). In the neoadjuvant treatment group survival rates were similar in N0/N1 patients. CONCLUSIONS: Postoperative mortality and morbidity do not significantly increase after neoadjuvant treatment. Neoadjuvant treatment in locally advanced pancreatic cancer can lead to an objective pathologic response, but this does not significantly improve survival after resection.

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