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Pancreatic Neoplasms: HELP
Articles by Paolo Pederzoli
Based on 45 articles published since 2010
(Why 45 articles?)
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Between 2010 and 2020, P. Pederzoli wrote the following 45 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Prognostication and response assessment in liver and pancreatic tumors: The new imaging. 2015

De Robertis, Riccardo / Tinazzi Martini, Paolo / Demozzi, Emanuele / Puntel, Gino / Ortolani, Silvia / Cingarlini, Sara / Ruzzenente, Andrea / Guglielmi, Alfredo / Tortora, Giampaolo / Bassi, Claudio / Pederzoli, Paolo / D'Onofrio, Mirko. ·Riccardo De Robertis, Emanuele Demozzi, Gino Puntel, Mirko D'Onofrio, Department of Radiology, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. ·World J Gastroenterol · Pubmed #26078555.

ABSTRACT: Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.

2 Editorial Radiofrequency ablation of locally advanced pancreatic adenocarcinoma: an overview. 2010

D'Onofrio, Mirko / Barbi, Emilio / Girelli, Roberto / Martone, Enrico / Gallotti, Anna / Salvia, Roberto / Martini, Paolo-Tinazzi / Bassi, Claudio / Pederzoli, Paolo / Pozzi Mucelli, Roberto. ·Department of Radiology, University Hospital G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, Verona 37134, Italy. mirko.donofrio@univr.it ·World J Gastroenterol · Pubmed #20653055.

ABSTRACT: Radiofrequency ablation (RFA) of pancreatic neoplasms is restricted to locally advanced, non-resectable but non-metastatic tumors. RFA of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparotomy in open surgery. Intraoperative ultrasound covers the mandatory role of staging, evaluation of feasibility, guidance and monitoring of the procedure. Different types of needle can be used. The first aim in the evaluation of RFA as a treatment for locally advanced pancreatic ductal adenocarcinoma, in order of evaluation but not of importance, is to determine the feasibility of the procedure. The second aim is to establish the effect of RFA on tumoral mass in terms of necrosis and cytoreduction. The most important aim, third in order of evaluation, is the potential improvement of quality of life and survival rate. Nowadays, only a few studies assess the feasibility of the procedure. The present paper is an overview of RFA for pancreatic adenocarcinoma.

3 Review Diffusion-weighted imaging of pancreatic cancer. 2015

De Robertis, Riccardo / Tinazzi Martini, Paolo / Demozzi, Emanuele / Dal Corso, Flavia / Bassi, Claudio / Pederzoli, Paolo / D'Onofrio, Mirko. ·Riccardo De Robertis, Paolo Tinazzi Martini, Department of Radiology, Casa di Cura Pederzoli, 37019 Peschiera del Garda, Italy. ·World J Radiol · Pubmed #26516428.

ABSTRACT: Magnetic resonance imaging (MRI) is a reliable and accurate imaging method for the evaluation of patients with pancreatic ductal adenocarcinoma (PDAC). Diffusion-weighted imaging (DWI) is a relatively recent technological improvement that expanded MRI capabilities, having brought functional aspects into conventional morphologic MRI evaluation. DWI can depict the random diffusion of water molecules within tissues (the so-called Brownian motions). Modifications of water diffusion induced by different factors acting on the extracellular and intracellular spaces, as increased cell density, edema, fibrosis, or altered functionality of cell membranes, can be detected using this MR sequence. The intravoxel incoherent motion (IVIM) model is an advanced DWI technique that consent a separate quantitative evaluation of all the microscopic random motions that contribute to DWI, which are essentially represented by molecular diffusion and blood microcirculation (perfusion). Technological improvements have made possible the routine use of DWI during abdominal MRI study. Several authors have reported that the addition of DWI sequence can be of value for the evaluation of patients with PDAC, especially improving the staging; nevertheless, it is still unclear whether and how DWI could be helpful for identification, characterization, prognostic stratification and follow-up during treatment. The aim of this paper is to review up-to-date literature data regarding the applications of DWI and IVIM to PDACs.

4 Review Uncommon presentations of common pancreatic neoplasms: a pictorial essay. 2015

D'Onofrio, Mirko / De Robertis, Riccardo / Capelli, Paola / Tinazzi Martini, Paolo / Crosara, Stefano / Gobbo, Stefano / Butturini, Giovanni / Salvia, Roberto / Barbi, Emilio / Girelli, Roberto / Bassi, Claudio / Pederzoli, Paolo. ·Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy, mirko.donofrio@univr.it. ·Abdom Imaging · Pubmed #25772002.

ABSTRACT: Pancreatic neoplasms are a wide group of solid and cystic lesions with different and often characteristic imaging features, clinical presentations, and management. Among solid tumors, ductal adenocarcinoma is the most common: it arises from exocrine pancreas, comprises about 90% of all pancreatic neoplasms, and generally has a bad prognosis; its therapeutic management must be multidisciplinary, involving surgeons, oncologists, gastroenterologists, radiologists, and radiotherapists. The second most common solid pancreatic neoplasms are neuroendocrine tumors: they can be divided into functioning or non-functioning and present different degrees of malignancy. Cystic pancreatic neoplasms comprise serous neoplasms, which are almost always benign, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, which can vary from benign to frankly malignant lesions, and solid pseudopapillary tumors. Other pancreatic neoplasms, such as lymphoma, metastases, or pancreatoblastoma, are rarely seen in clinical practice and have different and sometimes controversial managements. Rare clinical presentations and imaging appearance of the most common pancreatic neoplasms, both solid and cystic, are more frequently seen and clinically relevant than rare pancreatic tumors; their pathologic and radiologic appearances must be known to improve their management. The purpose of this paper is to present some rare or uncommon clinical and radiological presentations of common pancreatic neoplasms providing examples of multi-modality imaging approach with pathologic correlations, thus describing the histopathological bases that can explain the peculiar imaging features, in order to avoid relevant misdiagnosis and to improve lesion management.

5 Review Pancreatic intraductal papillary mucinous neoplasm invading the duodenum: a case report and a review of the literature. 2014

DʼOnofrio, Mirko / Tinazzi Martini, Paolo / De Robertis, Riccardo / Pregarz, Massimo / Girelli, Roberto / Pederzoli, Paolo / Pozzi Mucelli, Roberto. ·Department of Radiology G.B. Rossi Hospital University of Verona Verona, Italy mirko.donofrio@univr.it Department of Radiology Casa di Cura Pederzoli Peschiera del Garda Verona, Italy Department of Radiology G.B. Rossi Hospital University of Verona Verona, Italy Department of Radiology Casa di Cura Pederzoli Peschiera del Garda Verona, Italy Department of Surgery Casa di Cura Pederzoli Peschiera del GardaVerona, Italy Department of Radiology G.B. Rossi Hospital University of Verona Verona, Italy. ·Pancreas · Pubmed #24622089.

ABSTRACT: -- No abstract --

6 Review Drain management after pancreatic resection: state of the art. 2011

Giovinazzo, Francesco / Butturini, Giovanni / Salvia, Roberto / Mascetta, Giuseppe / Monsellato, Daniela / Marchegiani, Giovanni / Pederzoli, Paolo / Bassi, Claudio. ·Surgical Department, Pancreas Centre, Hospital of 'G.B.Rossi', University of Verona, Piazzale 'L.A. Scuro', 37134, Verona, Italy. · Surgical Department, Pancreas Centre, Hospital of 'G.B.Rossi', University of Verona, Piazzale 'L.A. Scuro', 37134, Verona, Italy. claudio.bassi@univr.it. · Department of Surgery, General Surgery B, P.Le L.A. Scuro 10, 37134, Verona, Italy. claudio.bassi@univr.it. ·J Hepatobiliary Pancreat Sci · Pubmed #21861143.

ABSTRACT: BACKGROUND: Placement of intraperitoneal drain (ID) after abdominal surgery is a common practice. Postoperative pancreatic fistula (POPF), incidence of which ranges from 2% to more than 30%, represents the most common major complication after pancreatic resection. The goal of this paper is to review the state of the art in ID management after pancreatic resection. METHODS: Data from randomized controlled trials (RCT) are reported together with data from our institution in the period before and after the start of the two reported RCTs. RESULTS: One thousand five hundred eighty patients underwent surgical resection for pancreatic lesions at our institution from 1990 to 2010. The overall rate of POPF was 23% before and 19.5% after (p = 0.24) the performance of the RCTs. Both postoperative morbidity and average in-hospital stay were higher in the period before the RCTs (13.6 ± 11.4 versus 13.4 ± 10.3 days, respectively). CONCLUSIONS: POPF is a complex and multifactorial complication after pancreatic surgery. On the basis of the present results and review of the RCTs, the value of ID and its management after pancreatic surgery remain unclear.

7 Review Pancreaticoduodenectomy for pancreatic cancer: the Verona experience. 2011

Malleo, Giuseppe / Marchegiani, Giovanni / Salvia, Roberto / Butturini, Giovanni / Pederzoli, Paolo / Bassi, Claudio. ·Department of Surgery, General Surgery B, G.B. Rossi Hospital, P.Le L.A. Scuro 10, 37134, Verona, Italy. ·Surg Today · Pubmed #21431477.

ABSTRACT: Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality in the Western world. The current treatment is multimodal, and in resectable patients radical surgery represents the key-step toward long-term survival. Pancreaticoduodenectomy (PD) is the most widely performed operation, because the majority of ductal carcinomas arise in the head of the pancreas. Once considered extremely hazardous, PD has evolved into a safe procedure, with mortality below 5% and morbidity rates in the range from 20% to 60% at high-volume centers. Verona is regarded as one of the most prominent institutions for pancreatic surgery in Europe. More than 5500 patients with pancreatic diseases have been managed, and the surgical case load has increased substantially, with more than 1350 PDs performed. This review discusses this center's experience in surgical treatment of pancreatic head cancer. Furthermore, the preliminary results of radiofrequency thermal ablation of locally advanced ductal cancer are presented.

8 Clinical Trial Randomized phase III trial of gemcitabine plus cisplatin compared with single-agent gemcitabine as first-line treatment of patients with advanced pancreatic cancer: the GIP-1 study. 2010

Colucci, Giuseppe / Labianca, Roberto / Di Costanzo, Francesco / Gebbia, Vittorio / Cartenì, Giacomo / Massidda, Bruno / Dapretto, Elisa / Manzione, Luigi / Piazza, Elena / Sannicolò, Mirella / Ciaparrone, Marco / Cavanna, Luigi / Giuliani, Francesco / Maiello, Evaristo / Testa, Antonio / Pederzoli, Paolo / Falconi, Massimo / Gallo, Ciro / Di Maio, Massimo / Perrone, Francesco / Anonymous610652 / Anonymous620652 / Anonymous630652. ·Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy. ·J Clin Oncol · Pubmed #20194854.

ABSTRACT: PURPOSE: Single-agent gemcitabine became standard first-line treatment for advanced pancreatic cancer after demonstration of superiority compared with fluorouracil. The Gruppo Italiano Pancreas 1 randomized phase III trial aimed to compare gemcitabine plus cisplatin versus gemcitabine alone (ClinicalTrials.gov ID NCT00813696). PATIENTS AND METHODS: Patients with locally advanced or metastatic pancreatic cancer, age 18 to 75 years, and Karnofsky performance status (KPS) > or = 50, were randomly assigned to receive gemcitabine (arm A) or gemcitabine plus cisplatin (arm B). Arm A: gemcitabine 1,000 mg/m(2) weekly for 7 weeks, and, after a 1-week rest, on days 1, 8, and 15 every 4 weeks. Arm B: cisplatin 25 mg/m(2) added weekly to gemcitabine, except cycle 1 day 22. Primary end point was overall survival. To have 8% power of detecting a 0.74 hazard ratio (HR) of death, with bilateral alpha .05, 355 events were needed and 400 patients planned. RESULTS: Four hundred patients were enrolled (arm A: 199; arm B: 201). Median age was 63, 59% were male, 84% had stage IV, and 83% had KPS > or = 80. Median overall survival was 8.3 months versus 7.2 months in arm A and B, respectively (HR, 1.10; 95% CI, 0.89 to 1.35; P = .38). Median progression-free survival was 3.9 months versus 3.8 months in arm A and B, respectively (HR, 0.97; 95% CI, 0.80 to 1.19; P = .80). The objective response rate was 10.1% in A and 12.9% in B (P = .37). Clinical benefit was experienced by 23.0% in A and 15.1% in B (P = .057). Combination therapy produced more hematologic toxicity, without relevant differences in nonhematologic toxicity. CONCLUSION: The addition of weekly cisplatin to gemcitabine failed to demonstrate any improvement as first-line treatment of advanced pancreatic cancer.

9 Article Technique, safety, and feasibility of EUS-guided radiofrequency ablation in unresectable pancreatic cancer. 2018

Scopelliti, Filippo / Pea, Antonio / Conigliaro, Rita / Butturini, Giovanni / Frigerio, Isabella / Regi, Paolo / Giardino, Alessandro / Bertani, Helga / Paini, Marina / Pederzoli, Paolo / Girelli, Roberto. ·Department of Hepato-Pancreato-Biliary Surgery, Pederzoli Hospital, via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy. fscopelliti@ospedalepederzoli.it. · Department of Pancreatic Surgery, University of Verona, Verona, Italy. · Gastroenterology and Digestive Endoscopy Unit, Baggiovara Hospital, Modena, Italy. · Department of Hepato-Pancreato-Biliary Surgery, Pederzoli Hospital, via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy. · Department of General Surgery, Pederzoli Hospital, Peschiera del Garda, Italy. ·Surg Endosc · Pubmed #29766302.

ABSTRACT: BACKGROUND AND AIMS: Radiofrequency ablation (RFA) is a well-recognized local ablative technique applied in the treatment of different solid tumors. Intraoperative RFA has been used for non-metastatic unresectable pancreatic ductal adenocarcinoma (PDAC), showing increased overall survival in retrospective studies. A novel RFA probe has recently been developed, allowing RFA under endoscopic ultrasound (EUS) guidance. Aim of the present study was to assess the feasibility and safety of EUS-guided RFA for unresectable PDACs. METHODS: Patients with unresectable non-metastatic PDAC were included in the study following neoadjuvant chemotherapy. EUS-guided RFA was performed using a novel monopolar 18-gauge electrode with a sharp conical 1 cm tip for energy delivery. Pre- and post-procedural clinical and radiological data were prospectively collected. RESULTS: Ten consecutive patients with unresectable PDAC were enrolled. The procedure was successful in all cases and no major adverse events were observed. A delineated hypodense ablated area within the tumor was observed at the 30-day CT scan in all cases. CONCLUSIONS: EUS-guided RFA is a feasible and safe minimally invasive procedure for patients with unresectable PDAC. Further studies are warranted to demonstrate the impact of EUS-guided RFA on disease progression and overall survival.

10 Article Whole-genome landscape of pancreatic neuroendocrine tumours. 2017

Scarpa, Aldo / Chang, David K / Nones, Katia / Corbo, Vincenzo / Patch, Ann-Marie / Bailey, Peter / Lawlor, Rita T / Johns, Amber L / Miller, David K / Mafficini, Andrea / Rusev, Borislav / Scardoni, Maria / Antonello, Davide / Barbi, Stefano / Sikora, Katarzyna O / Cingarlini, Sara / Vicentini, Caterina / McKay, Skye / Quinn, Michael C J / Bruxner, Timothy J C / Christ, Angelika N / Harliwong, Ivon / Idrisoglu, Senel / McLean, Suzanne / Nourse, Craig / Nourbakhsh, Ehsan / Wilson, Peter J / Anderson, Matthew J / Fink, J Lynn / Newell, Felicity / Waddell, Nick / Holmes, Oliver / Kazakoff, Stephen H / Leonard, Conrad / Wood, Scott / Xu, Qinying / Nagaraj, Shivashankar Hiriyur / Amato, Eliana / Dalai, Irene / Bersani, Samantha / Cataldo, Ivana / Dei Tos, Angelo P / Capelli, Paola / Davì, Maria Vittoria / Landoni, Luca / Malpaga, Anna / Miotto, Marco / Whitehall, Vicki L J / Leggett, Barbara A / Harris, Janelle L / Harris, Jonathan / Jones, Marc D / Humphris, Jeremy / Chantrill, Lorraine A / Chin, Venessa / Nagrial, Adnan M / Pajic, Marina / Scarlett, Christopher J / Pinho, Andreia / Rooman, Ilse / Toon, Christopher / Wu, Jianmin / Pinese, Mark / Cowley, Mark / Barbour, Andrew / Mawson, Amanda / Humphrey, Emily S / Colvin, Emily K / Chou, Angela / Lovell, Jessica A / Jamieson, Nigel B / Duthie, Fraser / Gingras, Marie-Claude / Fisher, William E / Dagg, Rebecca A / Lau, Loretta M S / Lee, Michael / Pickett, Hilda A / Reddel, Roger R / Samra, Jaswinder S / Kench, James G / Merrett, Neil D / Epari, Krishna / Nguyen, Nam Q / Zeps, Nikolajs / Falconi, Massimo / Simbolo, Michele / Butturini, Giovanni / Van Buren, George / Partelli, Stefano / Fassan, Matteo / Anonymous6880896 / Khanna, Kum Kum / Gill, Anthony J / Wheeler, David A / Gibbs, Richard A / Musgrove, Elizabeth A / Bassi, Claudio / Tortora, Giampaolo / Pederzoli, Paolo / Pearson, John V / Waddell, Nicola / Biankin, Andrew V / Grimmond, Sean M. ·ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona 37134, Italy. · Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona 37134, Italy. · Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, UK. · West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G31 2ER, UK. · The Kinghorn Cancer Centre, Cancer Division, Garvan Institute of Medical Research, University of New South Wales, 384 Victoria St, Darlinghurst, Sydney, New South Wales 2010, Australia. · Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney, New South Wales 2200, Australia. · South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, New South Wales 2170, Australia. · QIMR Berghofer Medical Research Institute, Herston Road, Brisbane 4006, Australia. · Queensland Centre for Medical Genomics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia. · Department of Surgery, Pancreas Institute, University and Hospital Trust of Verona, Verona 37134, Italy. · Medical Oncology, University and Hospital Trust of Verona, Verona, Italy. · Department of Pathology, General Hospital of Treviso, Department of Medicine, University of Padua, Italy. · Department of Medicine, Section of Endocrinology, University and Hospital Trust of Verona, Verona, Italy. · The University of Queensland, School of Medicine, Brisbane 4006, Australia. · Pathology Queensland, Brisbane 4006, Australia. · Royal Brisbane and Women's Hospital, Department of Gastroenterology and Hepatology, Brisbane 4006, Australia. · Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. · School of Environmental &Life Sciences, University of Newcastle, Ourimbah, New South Wales 2258, Australia. · Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Centre for Cancer Bioinformatics, Peking University Cancer Hospital &Institute, Beijing 100142, China. · Department of Surgery, Princess Alexandra Hospital, Ipswich Rd, Woollongabba, Queensland 4102, Australia. · Department of Anatomical Pathology. St Vincent's Hospital, Sydney, New South Wales 2010, Australia. · Academic Unit of Surgery, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G4 OSF, UK. · Department of Pathology, Queen Elizabeth University Hospital, Greater Glasgow &Clyde NHS, Glasgow G51 4TF, UK. · Department of Molecular and Human Genetics, Human Genome Sequencing Center, Baylor College of Medicine, One Baylor Plaza, MS226, Houston, Texas 77030-3411, USA. · Michael E. DeBakey Department of Surgery and The Elkins Pancreas Center, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030-3411, USA. · Children's Hospital at Westmead, Westmead, New South Wales 2145, Australia. · Children's Medical Research Institute, The University of Sydney, Westmead, New South Wales 2145, Australia. · Department of Surgery, Royal North Shore Hospital, St Leonards, Sydney, New South Wales 2065, Australia. · University of Sydney. Sydney, New South Wales 2006, Australia. · Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia. · School of Medicine, Western Sydney University, Penrith, New South Wales 2175, Australia. · Department of Surgery, Fremantle Hospital, Alma Street, Fremantle, Western Australia 6160, Australia. · Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia. · School of Surgery M507, University of Western Australia, 35 Stirling Highway, Nedlands, Western Australia 6009, Australia. · St John of God Pathology, 12 Salvado Rd, Subiaco, Western Australia 6008, Australia. · Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco, Western Australia 6008, Australia. · University of Melbourne Centre for Cancer Research, University of Melbourne, Melbourne, 3010, Victoria, Australia. ·Nature · Pubmed #28199314.

ABSTRACT: The diagnosis of pancreatic neuroendocrine tumours (PanNETs) is increasing owing to more sensitive detection methods, and this increase is creating challenges for clinical management. We performed whole-genome sequencing of 102 primary PanNETs and defined the genomic events that characterize their pathogenesis. Here we describe the mutational signatures they harbour, including a deficiency in G:C > T:A base excision repair due to inactivation of MUTYH, which encodes a DNA glycosylase. Clinically sporadic PanNETs contain a larger-than-expected proportion of germline mutations, including previously unreported mutations in the DNA repair genes MUTYH, CHEK2 and BRCA2. Together with mutations in MEN1 and VHL, these mutations occur in 17% of patients. Somatic mutations, including point mutations and gene fusions, were commonly found in genes involved in four main pathways: chromatin remodelling, DNA damage repair, activation of mTOR signalling (including previously undescribed EWSR1 gene fusions), and telomere maintenance. In addition, our gene expression analyses identified a subgroup of tumours associated with hypoxia and HIF signalling.

11 Article Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage. 2017

De Robertis, Riccardo / Cingarlini, Sara / Tinazzi Martini, Paolo / Ortolani, Silvia / Butturini, Giovanni / Landoni, Luca / Regi, Paolo / Girelli, Roberto / Capelli, Paola / Gobbo, Stefano / Tortora, Giampaolo / Scarpa, Aldo / Pederzoli, Paolo / D'Onofrio, Mirko. ·Riccardo De Robertis, Department of Radiology, Casa di Cura Pederzoli, 37019 Peschiera del Garda, Italy. ·World J Gastroenterol · Pubmed #28127201.

ABSTRACT: AIM: To describe magnetic resonance (MR) imaging features of pancreatic neuroendocrine neoplasms (PanNENs) according to their grade and tumor-nodes-metastases stage by comparing them to histopathology and to determine the accuracy of MR imaging features in predicting their biological behavior. METHODS: This study was approved by our institutional review board; requirement for informed patient consent was waived due to the retrospective nature of the study. Preoperative MR examinations of 55 PanNEN patients (29 men, 26 women; mean age of 57.6 years, range 21-83 years) performed between June 2013 and December 2015 were reviewed. Qualitative and quantitative features were compared between tumor grades and stages determined by histopathological analysis. RESULTS: Ill defined margins were more common in G2-3 and stage III-IV PanNENs than in G1 and low-stage tumors ( CONCLUSION: MR features of PanNENs vary according to their grade of differentiation and their stage at diagnosis and could predict the biological behavior of these tumors.

12 Article Digital Subtraction of Magnetic Resonance Images Improves Detection and Characterization of Pancreatic Neuroendocrine Neoplasms. 2017

De Robertis, Riccardo / Tinazzi Martini, Paolo / Cingarlini, Sara / Ortolani, Silvia / Butturini, Giovanni / Regi, Paolo / Landoni, Luca / Tortora, Giampaolo / Pederzoli, Paolo / D'Onofrio, Mirko. ·From the *Department of Radiology, Casa di Cura Pederzoli, Peschiera del Garda; †PhD School in Inflammation, Immunity and Cancer, and ‡Department of Medical Oncology, G. B. Rossi Hospital, University of Verona, Verona; Departments of §Oncology and ∥Pancreatic Surgery, Casa di Cura Pederzoli, Peschiera del Garda; and ¶Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy. ·J Comput Assist Tomogr · Pubmed #27861198.

ABSTRACT: OBJECTIVE: The aim of this study was to evaluate the usefulness of digital image subtraction of contrast-enhanced magnetic resonance (MR) images for detection and characterization of pancreatic neuroendocrine neoplasms (PanNENs). METHODS: Magnetic resonance examinations of 50 histologically verified PanNENs were retrospectively evaluated by 2 radiologists; 50 ductal adenocarcinomas were included as a control group. Late arterial phase images and correspondent subtracted images were analyzed. Tumor detectability on a subjective 3-point scale and contrast-to-noise ratios were compared across sequences using paired Student t tests. Tumor signal intensity was compared between sequences using χ or Fisher exact tests. RESULTS: Subjective conspicuity and contrast-to-noise ratios of PanNENs were significantly higher on subtracted images compared with correspondent late arterial phase images (P < 0.001 and P = 0.002). The rate of clearly hyperenhancing PanNENs was higher on subtracted images compared with arterial phase images (76% vs 36%). CONCLUSIONS: Digital image subtraction improves tumor conspicuity and allows better characterization of PanNENs compared with late arterial phase images.

13 Article Oncocytic Intraductal Papillary Mucinous Neoplasms of the Pancreas: Imaging and Histopathological Findings. 2016

D'Onofrio, Mirko / De Robertis, Riccardo / Tinazzi Martini, Paolo / Capelli, Paola / Gobbo, Stefano / Morana, Giovanni / Demozzi, Emanuele / Marchegiani, Giovanni / Girelli, Roberto / Salvia, Roberto / Bassi, Claudio / Pederzoli, Paolo. ·From the *Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona; †Department of Radiology, Casa di cura Pederzoli, Peschiera del Garda; ‡Department of Pathology, G.B. Rossi Hospital, University of Verona, Verona; §Department of Pathology, Casa di cura Pederzoli, Peschiera del Garda; ∥Department of Radiology, Ca' Foncello Hospital, Treviso; ¶Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona; and #Department of Surgery, Casa di cura Pederzoli, Peschiera del Garda, Italy. ·Pancreas · Pubmed #27518461.

ABSTRACT: OBJECTIVES: To evaluate and correlate computed tomography/magnetic resonance findings and histopathologic features of oncocytic intraductal papillary mucinous neoplasms (O-IPMNs). METHODS: Computed tomography/magnetic resonance examinations and resection specimens of 16 O-IPMNs were retrospectively reviewed. Qualitative and quantitative imaging features were analyzed according to "worrisome features" and "high risk stigmata." Correlations between radiological and histopathological findings were evaluated using Fisher test. RESULTS: Most O-IPMNs (75%) presented as large mixed- or main duct-type lesions (mean size, 56.9 mm; range, 20-180); all branch-duct type lesions were larger than 3 cm. Ten lesions presented main pancreatic duct dilation of 10 mm or greater. Solid enhancing nodules were found in 10 cases. Two lesions presented foci of invasion at histopathologic analysis, the remaining presented high-grade dysplasia. Neither invasive carcinoma nor nodal metastases were found. No significant correlations were found between radiological predictors of malignancy and histopathological features. CONCLUSIONS: Oncocytic tumors are rare subtypes of pancreatic IPMN, whose imaging features are similar to other IPMN subtypes. Imaging predictors of malignancy as large size and huge solid internal nodules are frequently encountered in O-IPMNs; despite this, these features are not correlated with histopathological findings, being probably inapplicable to O-IPMNs.

14 Article C-Reactive Protein and Procalcitonin as Predictors of Postoperative Inflammatory Complications After Pancreatic Surgery. 2016

Giardino, A / Spolverato, G / Regi, P / Frigerio, I / Scopelliti, F / Girelli, R / Pawlik, Z / Pederzoli, P / Bassi, C / Butturini, G. ·Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy. giardinochir@gmail.com. · Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy. · The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery - Pancreas Institute, University of Verona, Verona, Italy. ·J Gastrointest Surg · Pubmed #27206502.

ABSTRACT: BACKGROUND: The association between postoperative inflammatory markers and risk of complications after pancreaticoduodenectomy (PD) is controversial. We sought to assess the diagnostic value of perioperative C-reactive protein (CRP) and procalcitonin (PCT) levels in the early identification of patients at risk for complications after PD. METHODS: In 2014, 84 patients undergoing elective PD were enrolled in a prospective database. Clinicopathological characteristics, CRP and PCT, as well as short-term outcomes, such as complications and pancreatic fistula, were analyzed. Complications and pancreatic fistula were defined based on the Clavien-Dindo classification and the International Study Group on Pancreatic Fistula (ISGPF) classification, respectively. High CRP and PCT were classified using cut-off values based on ROC curve analysis. RESULTS: The majority (73.8 %) of patients had pancreatic adenocarcinoma. CRP and PCT levels over the first 5 postoperative days (POD) were higher among patients who experienced a complication versus those who did not (p < 0.001). Postoperative CRP and PCT levels were also higher among patients who developed a grade B or C pancreatic fistula (p < 0.05). A CRP concentration >84 mg/l on POD 1 (AUC 0.77) and >127 mg/l on POD 3 (AUC 0.79) was associated with the highest risk of overall complications (OR 6.86 and 9.0, respectively; both p < 0.001). Similarly patients with PCT >0.7 mg/dl on POD 1 (AUC 0.67) were at higher risk of developing a postoperative complication (OR 3.33; p = 0.024). On POD 1, a CRP >92 mg/l (AUC 0.72) and a PCT >0.4 mg/dl (AUC 0.70) were associated with the highest risk of pancreatic fistula (OR 5.63 and 5.62, respectively; both p < 0.05). CONCLUSIONS: CRP and PCT concentration were associated with an increased risk of developing complications and clinical relevant pancreatic fistula after PD. Use of these biomarkers may help identify those patients at highest risk for perioperative morbidity and help guide postoperative management of patients undergoing PD.

15 Article Variation of tumoral marker after radiofrequency ablation of pancreatic adenocarcinoma. 2016

D'Onofrio, Mirko / Barbi, Emilio / Girelli, Roberto / Tinazzi Martini, Paolo / De Robertis, Riccardo / Ciaravino, Valentina / Salvia, Roberto / Butturini, Giovanni / Frigerio, Isabella / Milazzo, Teresa / Crosara, Stefano / Paiella, Salvatore / Pederzoli, Paolo / Bassi, Claudio. ·1 Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy ; 2 Department of Radiology, 3 Department of Surgery, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy ; 4 Department of Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy. ·J Gastrointest Oncol · Pubmed #27034788.

ABSTRACT: BACKGROUND: To evaluate the correlation between variations of CA 19.9 blood levels and the entity of necrosis at CT after radiofrequency ablation (RFA) of unresectable pancreatic adenocarcinoma. METHODS: In this study, from June 2010 to February 2014, patients with diagnosis of unresectable and not metastatic pancreatic ductal adenocarcinoma, expressing tumor marker CA 19.9, treated with RFA procedure were included. All these patients underwent RFA. CT study was performed 1 week after RFA. The dosage of CA 19.9 levels was performed 1 month after RFA. Features of necrosis at CT, as mean entity, density and necrosis percentages compared to the original lesion, were evaluated and compared by using t-test with CA 19.9 blood levels variations after RFA procedure. RESULTS: In this study were included 51 patients with diagnosis of unresectable and not metastatic pancreatic ductal adenocarcinoma, expressing tumor marker CA 19.9, treated with RFA procedure and with CT study and CA 19.9 available for analysis. After the procedure, CA 19.9 blood levels reduced in 24/51 (47%), remained stable in 10/51 (20%) and increased in 17/51 (33%). In patients with CA 19.9 levels reduced, the tumor marker were reduced less than 20% in 4/24 (17%) and more than 20% in 20/24 (83%); instead the tumor marker were reduced less than 30% in 8/24 (33%) and more than 30% in 16/24 (67%). At CT scan necrotic area density difference was not statistically significant. Also there was no statistically significant difference among the mean area, the mean volume and the mean ablation volume in percentage related to the treated tumor among the three different groups of patients divided depending on the CA 19.9 blood levels. But a tendency to a statistically significant difference was found in comparing the mean percentage of ablation volume between two subgroups of patients with a decrease of CA 19.9 levels with less or more than 20% reduction of tumor markers and between two subgroups with less or more than 30% reduction of CA 19.9 levels. CONCLUSIONS: RFA of unresectable pancreatic adenocarcinoma induces reduction of CA 19.9 blood levels in about half of the cases.

16 Article Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging. 2016

De Robertis, Riccardo / D'Onofrio, Mirko / Zamboni, Giulia / Tinazzi Martini, Paolo / Gobbo, Stefano / Capelli, Paola / Butturini, Giovanni / Girelli, Roberto / Ortolani, Silvia / Cingarlini, Sara / Pederzoli, Paolo / Scarpa, Aldo. ·Department of Radiology, Casa di cura Pederzoli, Peschiera del Garda, Italy. ·Neuroendocrinology · Pubmed #26646652.

ABSTRACT: BACKGROUND/AIMS: Diffusion-weighted imaging (DWI) can depict random motions of water molecules in biological tissues during magnetic resonance (MR) examinations. Few papers have tested its application to pancreatic neuroendocrine neoplasms (PanNENs). The aim of this paper is to assess the clinical value of DWI regarding the identification and characterization of PanNENs and diagnosis of liver metastases. METHODS: Preoperative MR examinations of 30 PanNEN patients were retrospectively reviewed; 30 patients with pathologically proven pancreatic ductal adenocarcinoma (PDAC) were included to compare the imaging features. Qualitative and quantitative MR features were compared between histotypes. A blinded-reader comparison of diagnostic confidence for PanNENs and liver metastases was conducted on randomized image sets. All results were compared with pathological data. RESULTS: PanNEN conspicuity was higher on DW images compared to conventional MR sequences. DWI had higher detection rates for PanNENs than had conventional sequences (93.3 vs. 71.1%). Sharp margins and absence of main pancreatic duct/common bile duct dilation and chronic pancreatitis were more common among PanNENs as compared to PDACs. Arterial iso- or hyperenhancement and portal hyperenhancement were more frequent within PanNENs as compared to PDACs. No differences between histotypes were found for quantitative features. Arterial-phase images had the highest interobserver agreement for the diagnosis of PanNEN (Cohen's κ = 0.667). DWI provided the highest detection rate for liver metastases as well as excellent interobserver agreement for the diagnosis of liver metastases (κ = 0.932), with good accuracy (AUC = 0.879-0.869). CONCLUSION: DWI has clinical value regarding the identification of PanNENs and the diagnosis of liver metastases, while conventional MR sequences are fundamental for their characterization.

17 Article Observational study of the incidence of pancreatic and extrapancreatic malignancies during surveillance of patients with branch-duct intraductal papillary mucinous neoplasm. 2015

Malleo, Giuseppe / Marchegiani, Giovanni / Borin, Alex / Capelli, Paola / Accordini, Federico / Butturini, Giovanni / Pederzoli, Paolo / Bassi, Claudio / Salvia, Roberto. ·*Unit of Surgery B; and †Unit of Pathology, The Pancreas Institute, Departments of Surgery and Pathology, University of Verona Hospital Trust, Verona, Italy. ·Ann Surg · Pubmed #25493361.

ABSTRACT: OBJECTIVE: This observational analysis assessed the incidence of pancreatic and extrapancreatic malignancies in BD-IPMN patients. BACKGROUND: Previous studies showed that progression to malignancy of pancreatic branch-duct (BD) intraductal papillary mucinous neoplasm (IPMN) is infrequent and that extrapancreatic malignancies (EPMs) occur with unusual frequency in IPMN patients. METHODS: Patients observed from 2000 to 2012 and enrolled in a surveillance protocol according to the current guidelines were considered eligible for the study. Only patients with follow-up of more than 12 months were evaluated. The incidence of EPM was calculated only in patients who were free of them at the time of IPMN diagnosis. Data were compared with Italian cancer statistics. The standardized incidence ratios (SIRs) and the 5- and 10-year incidence rates were estimated. RESULTS: The study population consisted of 569 patients. At a median follow-up of 56 months, 9 patients developed a pancreatic malignancy. Of these, 5 were unresectable. The SIR was 9.21 [95% confidence interval (CI), 1.85-26.91] in males, and 11.94 (95% CI, 4.36-26.0) in females, with a 5-year cumulative incidence of 1.4%. The EPM incidence analysis was performed in 456 patients. Thirty EPMs developed during the follow-up. The SIR was 1.40 (95% CI, 0.72-2.45) in males and 1.37 (95% CI, 0.81-2.16) in females. The 5-year rate of developing any EPM was 5.7%. CONCLUSIONS: BD-IPMN patients are at risk of pancreatic carcinogenesis. Although the 5-year incidence rate was as low as 1.4%, the surveillance protocol based on the current guidelines failed to identify a small subset of patients who progressed to advanced disease. Patients with BD-IPMN are not at risk of extrapancreatic carcinogenesis.

18 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.

19 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.

20 Article Triple approach strategy for patients with locally advanced pancreatic carcinoma. 2013

Giardino, Alessandro / Girelli, Roberto / Frigerio, Isabella / Regi, Paolo / Cantore, Maurizio / Alessandra, Auriemma / Lusenti, Annita / Salvia, Roberto / Bassi, Claudio / Pederzoli, Paolo. ·Pancreatic Unit, Casa di Cura Pederzoli, Peschiera del Garda (VR), Italy. giardinoalessandro@gmail.com ·HPB (Oxford) · Pubmed #23458679.

ABSTRACT: BACKGROUND: Radiofrequency ablation (RFA) is a relatively new technique, applied to metastatic solid tumours which, in recent studies, has been shown to be feasible and safe on locally advanced pancreatic carcinoma (LAPC). RFA can be combined with radio-chemotherapy (RCT) and intra-arterial plus systemic chemotherapy (IASC). The aim of this study was to investigate the impact on the prognosis of a multimodal approach to LAPC and define the best timing of RFA. METHODS: This is a retrospective observational study of patients who have consecutively undergone RFA associated with multiple adjuvant approaches. RESULTS: Between February 2007 and December 2011, 168 consecutive patients were treated by RFA, of which 107 were eligible for at least 18 months of follow-up. Forty-seven patients (group 1) underwent RFA as an up-front treatment and 60 patients as second treatment (group 2) depending on clinician choice. The median overall survival (OS) of the whole series was 25.6 months: 14.7 months in the group 1 and 25.6 months in the group 2 (P = 0.004). Those patients who received the multimodal treatment (RFA, RCT and IASC-triple approach strategy) had an OS of 34.0 months. CONCLUSIONS: The multimodal approach seems to be feasible and associated with an improved longer survival rate.

21 Article Pancreatic tumors and immature immunosuppressive myeloid cells in blood and spleen: role of inhibitory co-stimulatory molecules PDL1 and CTLA4. An in vivo and in vitro study. 2013

Basso, Daniela / Fogar, Paola / Falconi, Massimo / Fadi, Elisa / Sperti, Cosimo / Frasson, Chiara / Greco, Eliana / Tamburrino, Domenico / Teolato, Sara / Moz, Stefania / Bozzato, Dania / Pelloso, Michela / Padoan, Andrea / De Franchis, Giuseppe / Gnatta, Elisa / Facco, Monica / Zambon, Carlo-Federico / Navaglia, Filippo / Pasquali, Claudio / Basso, Giuseppe / Semenzato, Gianpietro / Pedrazzoli, Sergio / Pederzoli, Paolo / Plebani, Mario. ·Department of Medicine, University of Padova, Padova, Italy. daniela.basso@sanita.padova.it ·PLoS One · Pubmed #23359812.

ABSTRACT: BACKGROUND: Blood and spleen expansion of immature myeloid cells (IMCs) might compromise the immune response to cancer. We studied in vivo circulating and splenic T lymphocyte and IMC subsets in patients with benign and malignant pancreatic diseases. We ascertained in vitro whether pancreatic adenocarcinoma (PDAC)-associated IMC subsets are induced by tumor-derived soluble factors and whether they are immunosuppressive focusing on the inhibitory co-stimulatory molecules PDL1 and CTLA4. METHODOLOGY AND PRINCIPAL FINDINGS: 103 pancreatic and/or splenic surgical patients were enrolled including 52 PDAC, 10 borderline and 10 neuroendocrine tumors (NETs). Lymphocytes and IMCs were analysed by flow cytometry in blood, in spleen and in three PDAC cell conditioned (CM) or non conditioned PBMC. PDL1 and CTLA4 were studied in 30 splenic samples, in control and conditioned PBMC. IMCs were FACS sorted and co-coltured with allogenic T lymphocytes. In PDAC a reduction was found in circulating CD8(+) lymphocytes (p = 0.004) and dendritic cells (p = 0.01), which were reduced in vitro by one PDAC CM (Capan1; p = 0.03). Blood myeloid derived suppressive cells (MDSCs) CD33(+)CD14(-)HLA-DR(-) were increased in PDAC (p = 0.022) and were induced in vitro by BxPC3 CM. Splenic dendritic cells had a higher PDL1 expression (p = 0.007), while CD33(+)CD14(+)HLA-DR(-) IMCs had a lower CTLA4 expression (p = 0.029) in PDAC patients. In vitro S100A8/A9 complex, one of the possible inflammatory mediators of immune suppression in PDAC, induced PDL1 (p = 0.018) and reduced CTLA4 expression (p = 0.028) among IMCs. IMCs not expressing CTLA4 were demonstrated to be immune suppressive. CONCLUSION: In PDAC circulating dendritic and cytotoxic T cells are reduced, while MDSCs are increased and this might favour tumoral growth and progression. The reduced CTLA4 expression found among splenic IMCs of PDAC patients was demonstrated to characterize an immune suppressive phenotype and to be consequent to the direct exposure of myeloid cells to pancreatic cancer derived products, S100A8/A9 complex in particular.

22 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.

23 Article Pancreatic resections for cystic neoplasms: from the surgeon's presumption to the pathologist's reality. 2012

Salvia, Roberto / Malleo, Giuseppe / Marchegiani, Giovanni / Pennacchio, Silvia / Paiella, Salvatore / Paini, Marina / Pea, Antonio / Butturini, Giovanni / Pederzoli, Paolo / Bassi, Claudio. ·Unit of General Surgery B, Pancreas Institute, G.B. Rossi Hospital, Department of Surgery, University of Verona Hospital Trust, Verona. Italy. salvia@ospedaleuniverona.it ·Surgery · Pubmed #22766364.

ABSTRACT: BACKGROUND: Current guidelines for the management of pancreatic cystic neoplasms are based on the assumption that these lesions can be classified correctly on the basis of features of cross-sectional imaging. However, a certain degree of overlap between different lesions exists, and little is known about the rate of inaccurate preoperative diagnoses. To address this issue, preoperative and final pathologic diagnoses of patients resected for a presumed pancreatic cystic neoplasm were compared. METHODS: Retrospective analysis was undertaken of patients managed operatively between 2000 and 2010. Preoperative workup was reviewed to identify diagnostic pitfalls and potential risk factors for incorrect preoperative characterization of cystic lesions presumed to be neoplastic. RESULTS: We analyzed 476 patients. Final pathologic diagnosis matched the preoperative diagnosis in 78% of cases. The highest accuracy was reached for solid pseudopapillary neoplasms (95%) and for main duct/mixed duct intraductal papillary mucinous neoplasms (81%). Surprisingly, 23 cysts (5%) were found to be ductal adenocarcinoma, whereas 45 patients (9%) underwent a pancreatic resection for a non-neoplastic condition. The use of a routine radiologic workup, including contrast-enhanced ultrasonography and magnetic resonance imaging, was associated with a favorably correct characterization of the cystic lesion. Endoscopic ultrasonography did not seem to improve diagnostic accuracy. Increased levels of serum carbohydrate antigen (CA)19-9 resulted as risk factors for an incorrect diagnosis as well as for a final diagnosis of a ductal adenocarcinoma. CONCLUSION: The overall rate of inaccurate preoperative diagnoses in a tertiary care center with a broad experience in pancreatology approached 22%. Serum CA19-9 is an important complementary tool within the context of preoperative investigation of cystic neoplasms of the pancreas.

24 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.

25 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.

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