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Pancreatic Neoplasms: HELP
Articles by Antonio Daniele Pinna
Based on 11 articles published since 2010
(Why 11 articles?)
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Between 2010 and 2020, Antonio Pinna wrote the following 11 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Editorial Why is pancreatic adenocarcinoma not screened for earlier? 2016

Maroni, Lorenzo / Ravaioli, Matteo / Pinna, Antonio Daniele. ·a Department of Medical and Surgical Sciences , Alma Mater Studiorum - Università di Bologna , Bologna , Italy. ·Expert Rev Anticancer Ther · Pubmed #27552648.

ABSTRACT: -- No abstract --

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

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

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

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

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

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

4 Article Pancreatic head excavation for tissue diagnosis may reduce unnecessary pancreaticoduodenectomies in the setting of chronic pancreatitis. 2017

Fancellu, Alessandro / Ginesu, Giorgio C / Feo, Claudio F / Cossu, Maria L / Puledda, Marco / Pinna, Antonio / Porcu, Alberto. ·Department of Clinical and Experimental Medicine, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, V.le San Pietro 43, 07100 Sassari, Italy. afancel@uniss.it. ·Hepatobiliary Pancreat Dis Int · Pubmed #28603101.

ABSTRACT: BACKGROUND: The necessity to obtain a tissue diagnosis of cancer prior to pancreatic surgery still remains an open debate. In fact, a non-negligible percentage of patients undergoing pancreaticoduodenectomy (PD) for suspected cancer has a benign lesion at final histology. We describe an approach for patients with diagnostic uncertainty between cancer and chronic pancreatitis, with the aim of minimizing the incidence of PD for suspicious malignancy finally diagnosed as benign disease. METHODS: Eighty-eight patients (85.4%) with a clinicoradiological picture highly suggestive for malignancy received formal PD (group 1). Fifteen patients (14.6%) in whom preoperative diagnosis was uncertain between pancreatic cancer and chronic pancreatitis underwent pancreatic head excavation (PHEX) for intraoperative tissue diagnosis (group 2): those diagnosed as having cancer received PD, whereas those with chronic pancreatitis received pancreaticojejunostomy (PJ). RESULTS: No patient received PD for benign disease. All patients in group 1 had adenocarcinoma on final histology. Eight patients of group 2 (53.3%) received PD after intraoperative diagnosis of cancer, whereas 7 (46.7%) received PJ because no malignancy was found at introperative frozen sections. No signs of cancer were encountered in patients receiving PHEX and PJ after a median follow-up of 42 months. Overall survival did not differ between patients receiving PD for cancer in the group 1 and those receiving PD for cancer after PHEX in the group 2 (P=0.509). CONCLUSION: Although the described technique has been used in a very selected group of patients, our results suggest that PHEX for tissue diagnosis may reduce rates of unnecessary PD, when the preoperative diagnosis is uncertain between cancer and chronic pancreatitis.

5 Article The Health Gain Obtainable from Pancreatic Resection for Adenocarcinoma in the Elderly. 2017

Cucchetti, Alessandro / Ercolani, Giorgio / Pezzilli, Raffaele / Cescon, Matteo / Frascaroli, Giacomo / Pinna, Antonio Daniele. ·Department of Medical and Surgical Sciences - DIMEC, S.Orsola - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. aleqko@libero.it. · S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy. aleqko@libero.it. · Department of Medical and Surgical Sciences - DIMEC, S.Orsola - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. · Surgical Oncology Unit, General Hospital Morgagni - Pierantoni, Forlì, Italy. · S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy. ·World J Surg · Pubmed #27826771.

ABSTRACT: BACKGROUND: In treating pancreatic ductal adenocarcinoma (PDAC), age does not represent a contraindication to surgery, even if aging is known to increase postoperative mortality and morbidity. Furthermore, long-term outcome remains poor and there is much debate on whether to operate or not in elderly patients. The aim of this study was to provide a general framework to evaluate the health gain obtainable from surgery for PDAC in relationship with age and tumor stage. METHODS: A Monte Carlo simulation model was built taking into consideration pertinent literature from population-based studies regarding surgical and non-surgical outcomes for stages I-II PDAC. The health gain obtainable from surgery, in comparison to the choice of not resecting patients, was measured through number needed-to-treat (NNT) calculation. RESULTS: Considering the typical stage I-II PDAC characteristics, the model showed that the mean lifespan after surgery was 28.1 ± 3.9 months and 9.3 ± 1.5 months after non-surgical therapies. The NNT with surgery in order to prevent one death at 5 years was 6 (95% CI 4-10), indicating an overall high gain obtainable from surgery. Sensitivity analyses on patient age and tumor stage suggested that starting from 76 years onward, the NNT progressively increases, resulting in a low cure rate of surgery in the elderly and becoming potentially harmful for patients aged above 80 years. These figures were more pronounced for tumor stages IIA and IIB. CONCLUSIONS: The present general framework suggests that the lifespan benefit obtainable from pancreatectomy in elderly patients is uncertain especially with the advancing of the tumor stage.

6 Article A comprehensive analysis on expected years of life lost due to pancreatic cancer. 2016

Cucchetti, Alessandro / Ercolani, Giorgio / Taffurelli, Giovanni / Serenari, Matteo / Maroni, Lorenzo / Pezzilli, Raffaele / Del Gaudio, Massimo / Ravaioli, Matteo / Cescon, Matteo / Pinna, Antonio D. ·Department of Medical and Surgical Sciences - DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. Electronic address: aleqko@libero.it. · Department of Medical and Surgical Sciences - DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. ·Pancreatology · Pubmed #26951889.

ABSTRACT: BACKGROUND: Pancreatic cancer represents a fatal malignancy leading to premature death and loss of life expectancy. The aim of the present study was to assess how many years of life are lost due to this cancer, in relationship with surgery and ageing. METHODS: Data from 716 consecutive patients discharged from a tertiary referral hospital (2002-2012) with a diagnosis of pancreatic cancer and with complete clinical and follow-up data were used to estimate the number of years of life-lost (YLL) through a semi-parametric extrapolation having an age-, sex- and year-of-onset- matched population derived from national life tables as reference. RESULTS: The mean entire lifespan estimated for the 716 patients was 1.4 years (95% C.I.:0.8-1.9) resulting in a number of YLL after diagnosis of 12 years (95% C.I.:11.5-12.6) per person. Surgical patients (147 cases; 20.5%) were younger and experienced higher post-diagnostic lifespan (3.5 years) than non-surgical older individuals (0.8 years; p < 0.001). These figures were reflected on the number of expected YLL (EYLL) that remained substantially unaffected by surgery (p = 0.821). Patients aged ≤68 years experienced the highest number of EYLL (20.8 years); whereas elderly patients had a loss of life that corresponded to only 6% of the entire life they had already lived. CONCLUSIONS: In a typical pancreatic cancer cohort, surgery was not able to modify population-based statistics because of a different age at tumor onset which nullifies any benefit from a "lifespan from birth" perspective. Pancreatic cancer in younger individuals must be ranked within the very first causes of EYLL due to malignancy.

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

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

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

8 Article Estimation of the Survival Benefit Obtainable From Screening for the Early Detection of Pancreatic Cancer. 2016

Cucchetti, Alessandro / Ercolani, Giorgio / Cescon, Matteo / Brandi, Giovanni / Taffurelli, Giovanni / Maroni, Lorenzo / Ravaioli, Matteo / Pezzilli, Raffaele / Pinna, Antonio Daniele. ·From the Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. ·Pancreas · Pubmed #26646274.

ABSTRACT: OBJECTIVE: The chance to improve survival from pancreatic adenocarcinoma relies on early diagnosis through screening, but any screening program is subject to lead-time bias and no data are available in this regard. Aim of the present study was to evaluate the benefit obtainable from a screening program for early detection of pancreatic adenocarcinoma, considering screen-related biases. METHODS: Monte Carlo simulation was performed using data from 1000 pancreatic cancer patients admitted in a tertiary referral hospital and from pertinent literature. Lead-time bias was assessed and subtracted from expected survival. RESULTS: Mean expected life expectancy was 13.0 months. Assuming a 20%, 30%, or 50% stage III/IV reduction with screening, pancreatic resections would increase from 217 to 290 in front of a 20% stage III/IV reduction to 324 in front of a 30% reduction and to 385 in front of a 50% reduction. After lead-time adjustment, life expectancies were 14.0, 14.6, and 15.9 months, respectively. The number-needed-to-screen calculation suggests that screening can be harmful in a proportion of patients inversely dependent on the length of follow-up and a significant improvement of survival after diagnosis. CONCLUSIONS: Pancreatic adenocarcinoma screening program would probably be successful in the presence of a considerable improvement of postdiagnostic survival; otherwise, it only increases surgical procedure amount.

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

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

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

10 Article Efficacy and cost-effectiveness of immediate surgery versus a wait-and-see strategy for sporadic nonfunctioning T1 pancreatic endocrine neoplasms. 2015

Cucchetti, Alessandro / Ricci, Claudio / Ercolani, Giorgio / Campana, Davide / Cescon, Matteo / D'Ambra, Marielda / Pinna, Antonio Daniele / Minni, Francesco / Casadei, Riccardo. ·Department of Medical and Surgical Sciences - DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. ·Neuroendocrinology · Pubmed #25228538.

ABSTRACT: BACKGROUND: Whether patients with small (<2 cm), sporadic nonfunctioning pancreatic endocrine tumors (NF-PETs) should directly undergo pancreatic surgery or should be followed longitudinally to detect growth and malignancy still has to be defined. STUDY DESIGN: Based on the pertinent literature of the past decade, a Markov model was developed to investigate this issue. In the wait-and-see strategy arm, surgery was performed if the tumor attained a size ≥2 cm or surpassed 20% of the initial size. In a Monte Carlo probabilistic analysis, 100 hypothetical patients undergoing a wait-and-see strategy were compared to 100 patients directly undergoing surgery, with the aim of investigating the efficacy and cost-effectiveness of the two strategies. RESULTS: During the postdiagnostic lifetime, 63 NF-PETs in the wait-and-see group showed significant growth and underwent surgery: 38 were stage I, 10 were stage II, 15 were stage III and none were stage IV. In the base-case scenario, the mean life expectancy and quality-adjusted life expectancy were found to be superior after immediate surgery [26.1 years and 11.8 quality-adjusted life years (QALYs)] than with the wait-and-see strategy (22.1 years and 8.3 QALYs) as the consequence of ageing during the wait-and-see follow-up which increased mortality due to surgery, when surgery was needed. The model was sensitive to starting age and length of follow-up; in particular, for patients >65 years of age, the two strategies provided similar results but the wait-and-see strategy was more cost-effective. CONCLUSIONS: The wait-and-see strategy for NF-PETs <2 cm represents a reasonable approach in patients over 65 years of age; otherwise, immediate surgery is preferable.

11 Article The safety of a pancreaticoduodenectomy in patients older than 80 years: risk vs. benefits. 2012

Melis, Marcovalerio / Marcon, Francesca / Masi, Antonio / Pinna, Antonio / Sarpel, Umut / Miller, George / Moore, Harvey / Cohen, Steven / Berman, Russell / Pachter, H Leon / Newman, Elliot. ·Department of Surgery, New York University School of Medicine, New York, NY 10010, USA. marcovalerio.melis@nyumc.org ·HPB (Oxford) · Pubmed #22882194.

ABSTRACT: BACKGROUND: A pancreaticoduodenectomy (PD) offers the only chance of a cure for pancreatic cancer and can be performed with low mortality and morbidity. However, little is known about outcomes of a PD in octogenarians. METHODS: Differences in two groups of patients (Group Y, <80 and Group O, ≥80 year-old) who underwent a PD for pancreatic adenocarcinoma were analysed. Study end-points were length of post-operative stay, overall morbidity, 30-day mortality and overall survival. RESULTS: There were 175 patients in Group Y (mean age 64 years) and 25 patients in Group O (mean age 83 years). Octogenarians had worse Eastern Cooperative Oncology Group (ECOG) Performance Status (PS ≥1: 90% vs. 51%) and American Society of Anesthesiology (ASA) score (>2: 71% vs. 47%). The two groups were similar in underlying co-morbidities, operative time, rates of portal vein resection, intra-operative complications, blood loss, pathological stage and status of resection margins. Octogenarians had a longer post-operative stay (20 vs. 14 days) and higher overall morbidity (68% vs. 44%). There was a single death in each group. At a median follow-up of 13 months median survival appeared similar in the two groups (17 vs. 13 months). CONCLUSIONS: As 30-day mortality and survival are similar to those observed in younger patients, a PD can be offered to carefully selected octogenarians.