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Pancreatic Neoplasms: HELP
Articles by Mushegh A. Sahakyan
Based on 14 articles published since 2010
(Why 14 articles?)
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Between 2010 and 2020, M. Sahakyan wrote the following 14 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Laparoscopic Completion Pancreatectomy for Local Recurrence in the Pancreatic Remnant after Pancreaticoduodenectomy: Case Reports and Review of the Literature. 2016

Sahakyan, Mushegh A / Yaqub, Sheraz / Kazaryan, Airazat M / Villanger, Olaug / Berstad, Audun Elnæs / Labori, Knut Jørgen / Edwin, Bjørn / Røsok, Bård Ingvald. ·The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway. sahakyan.mushegh@gmail.com. · Institute for Clinical Research, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com. · Department of Hepato-Pancreato-Billiary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Department of Surgery, Finnmark Hospital, Kirkenes, Norway. · Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Institute for Clinical Research, Medical Faculty, University of Oslo, Oslo, Norway. ·J Gastrointest Cancer · Pubmed #26732389.

ABSTRACT: -- No abstract --

2 Article Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study. 2019

van Hilst, Jony / de Rooij, Thijs / Klompmaker, Sjors / Rawashdeh, Majd / Aleotti, Francesca / Al-Sarireh, Bilal / Alseidi, Adnan / Ateeb, Zeeshan / Balzano, Gianpaolo / Berrevoet, Frederik / Björnsson, Bergthor / Boggi, Ugo / Busch, Olivier R / Butturini, Giovanni / Casadei, Riccardo / Del Chiaro, Marco / Chikhladze, Sophia / Cipriani, Federica / van Dam, Ronald / Damoli, Isacco / van Dieren, Susan / Dokmak, Safi / Edwin, Bjørn / van Eijck, Casper / Fabre, Jean-Marie / Falconi, Massimo / Farges, Olivier / Fernández-Cruz, Laureano / Forgione, Antonello / Frigerio, Isabella / Fuks, David / Gavazzi, Francesca / Gayet, Brice / Giardino, Alessandro / Groot Koerkamp, Bas / Hackert, Thilo / Hassenpflug, Matthias / Kabir, Irfan / Keck, Tobias / Khatkov, Igor / Kusar, Masa / Lombardo, Carlo / Marchegiani, Giovanni / Marshall, Ryne / Menon, Krish V / Montorsi, Marco / Orville, Marion / de Pastena, Matteo / Pietrabissa, Andrea / Poves, Ignaci / Primrose, John / Pugliese, Raffaele / Ricci, Claudio / Roberts, Keith / Røsok, Bård / Sahakyan, Mushegh A / Sánchez-Cabús, Santiago / Sandström, Per / Scovel, Lauren / Solaini, Leonardo / Soonawalla, Zahir / Souche, F Régis / Sutcliffe, Robert P / Tiberio, Guido A / Tomazic, Aleš / Troisi, Roberto / Wellner, Ulrich / White, Steven / Wittel, Uwe A / Zerbi, Alessandro / Bassi, Claudio / Besselink, Marc G / Abu Hilal, Mohammed / Anonymous5620925. ·Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands. · Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom. · Department of Surgery, San Raffaele Hospital, Milan, Italy. · Department of Surgery, Morriston Hospital, Swansea, United Kingdom. · Department of Surgery, Virginia Mason Medical Center, Seattle, United States. · Department of Surgery, Karolinska Institute, Stockholm, Sweden. · Department of General and HPB surgery and liver transplantation, Ghent University Hospital, Ghent, Belgium. · Department of Surgery, Linköping University, Linköping, Sweden. · Department of Surgery, Universitá di Pisa, Pisa, Italy. · Department of Surgery, Pederzoli Hospital, Peschiera, Italy. · Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy. · Department of Surgery, Universitätsklinikum Freiburg, Freiburg, Germany. · Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. · Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy. · Department of Surgery, Hospital of Beaujon, Clichy, France. · Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway. · Department of Surgery, Erasmus MC, Rotterdam, the Netherlands. · Department of Surgery, Hopital Saint Eloi, Montpellier, France. · Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain. · Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy. · Department of Surgery, Institut Mutualiste Montsouris, Paris, France. · Department of Surgery, Humanitas University Hospital, Milan, Italy. · Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany. · Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom. · Clinic for Surgery, UKSH Campus Lübeck, Lübeck, Germany. · Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation. · Department of Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia. · Department of Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom. · Department of Surgery, University hospital Pavia, Pavia, Italy. · Department of Surgery, Hospital del Mar, Barcelona, Spain. · Department of Surgery, University Hospital Birmingham, Birmingham, United Kingdom. · Surgical Clinic, Department of clinical and experimental sciences, University of Brescia, Brescia, Italy. · Department of Surgery, The Freeman Hospital Newcastle Upon Tyne, Newcastle, United Kingdom. ·Ann Surg · Pubmed #29099399.

ABSTRACT: OBJECTIVE: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC. METHODS: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival. RESULTS: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60-400) vs 300 mL (150-500), P = 0.001] and hospital stay [8 (6-12) vs 9 (7-14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade ≥3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8-22) vs 22 (14-31), P < 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22-34] versus 31 (95% CI, 26-36) months (P = 0.929). CONCLUSIONS: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.

3 Article Extended laparoscopic distal pancreatectomy for adenocarcinoma in the body and tail of the pancreas: a single-center experience. 2018

Sahakyan, Mushegh A / Kleive, Dyre / Kazaryan, Airazat M / Aghayan, Davit L / Ignjatovic, Dejan / Labori, Knut Jørgen / Røsok, Bård Ingvald / Edwin, Bjørn. ·Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com. · The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. · The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway. · Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway. · Department of Faculty Surgery N2, I.M, Sechenov First Moscow State Medical University, Moscow, Russia. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. ·Langenbecks Arch Surg · Pubmed #30417281.

ABSTRACT: PURPOSE: Extended resection is required for pancreatic adenocarcinoma infiltrating adjacent organs and structures. The role of laparoscopy in this setting is unclear. In this study, the outcomes of extended laparoscopic distal pancreatectomy (ELDP) for pancreatic body/tail adenocarcinoma were examined. METHODS: Perioperative and oncologic data were analyzed in patients undergoing laparoscopic distal pancreatectomy (LDP) for adenocarcinoma at Oslo University Hospital. ELDP was defined as suggested by the International Study Group for Pancreatic Surgery. The outcomes of ELDP were compared to those following standard LDP (SLDP). RESULTS: From August 2001 to June 2016, 460 consecutive patients underwent LDP for pancreatic neoplasms including 116 (25%) adenocarcinoma. SLDP and ELDP were applied in 78 and 31 patients, respectively. The adrenal gland (33%) and colon (21%) were the most frequently resected organs during ELDP. The latter was associated with larger tumor size (5.5 vs 4 cm, p = 0.03), longer operative time (236 vs 158 min, p = 0.001) and higher conversion rate (16 vs 3%, p = 0.019) compared with SLDP. Morbidity and 90-day mortality were similar. Median follow-up was 18 months. In patients with ductal adenocarcinoma, ELDP (n = 22) was associated with significantly shorter recurrence-free and overall survival than SLDP (n = 59) (6.2 vs 9.6 months, p = 0.047 and 12.9 vs 27 months, p < 0.01, respectively). CONCLUSION: Although technically challenging, ELDP is feasible in patients with adenocarcinoma providing acceptable surgical outcomes. ELDP for ductal adenocarcinoma is associated with worse prognosis than SLDP, while its potential benefits over palliative care deserve further scrutiny.

4 Article Risk for hemorrhage after pancreatoduodenectomy with venous resection. 2018

Kleive, Dyre / Sahakyan, Mushegh / Søreide, Kjetil / Brudvik, Kristoffer W / Line, Pål-Dag / Gladhaug, Ivar P / Labori, Knut Jørgen. ·Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Nydalen, 0424, Oslo, Norway. dyrkle@ous-hf.no. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. dyrkle@ous-hf.no. · Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. · The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway. · Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK. · Department of Clinical Medicine, University of Bergen, Bergen, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Nydalen, 0424, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Institute of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. ·Langenbecks Arch Surg · Pubmed #30397778.

ABSTRACT: PURPOSE: No consensus exists on the optimal anticoagulation therapy after pancreatoduodenectomy with venous resection (PDVR). The aim of the study was to analyze perioperative outcomes of patients receiving low- vs high-dose anticoagulation therapy and to identify risk factors for postpancreatectomy hemorrhage in patients undergoing PDVR. METHODS: Retrospective study of patients undergoing PDVR at a tertiary referral center between January 2006 and April 2017. Patients were investigated according to the dose of postoperative anticoagulation given (low- or high-dose low-molecular-weight heparin). Uni- and multivariate analysis were performed to assess risk factors for postpancreatectomy hemorrhage. RESULTS: A total of 141 patients underwent PDVR. Low-dose anticoagulation was given to 45 (31.9%) patients. Operative time (428 min vs 398 min, p = 0.025) and the use of interposition grafts (27% vs 11%, P = 0.033) were significantly higher in the high-dose group. There was no difference in the rate of early portal vein thrombosis (4.4% vs 4.2%, p = 0.939) or postpancreatectomy hemorrhage (13.3% vs 16.7%, p = 0.611) between the low- and high-dose groups. On multivariate analysis, serum bilirubin ≥ 200 μmol/L and clinically relevant postoperative fistula were the only factors associated with postpancreatectomy hemorrhage (OR 10.28, 95% CI 3.51-30.07, P < 0.001, and OR 6.39, 95% CI 1.59-25.74, P = 0.009). CONCLUSION: Preoperative hyperbilirubinemia and clinically relevant postoperative fistula are risk factors for postpancreatectomy hemorrhage after PDVR. Rates of postpancreatectomy hemorrhage did not differ between patients receiving high- vs low-dose low-molecular-weight heparin.

5 Article Incidence and management of arterial injuries during pancreatectomy. 2018

Kleive, Dyre / Sahakyan, Mushegh A / Khan, Ammar / Fosby, Bjarte / Line, Pål-Dag / Labori, Knut Jørgen. ·Institute of Clinical Medicine, University of Oslo, Oslo, Norway. dyrkle@ous-hf.no. · Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. dyrkle@ous-hf.no. · Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. · The Intervention Centre, Oslo University Hospital, Oslo, Norway. · Department of Transplantation Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. ·Langenbecks Arch Surg · Pubmed #29564544.

ABSTRACT: PURPOSE: The incidence of intraoperative arterial injury during pancreatectomy is not well described. This study aims to evaluate the incidence, management, and outcome of arterial injuries during pancreatectomy. METHODS: This is a retrospective study of 1535 consecutive patients undergoing pancreatectomy between 2006 and 2016 at Oslo University Hospital. The type of arterial injury and potential contributing factors were analyzed. Short-term outcomes were compared between patients with arterial injury and patients undergoing a planned arterial resection due to tumor involvement. RESULTS: Arterial injury was diagnosed in 14 patients (incidence 0.91%), while planned arterial resection was performed in 22 patients. The injuries were located in the superior mesenteric artery (n = 5), right hepatic artery (n = 5), common hepatic artery (n = 2), left hepatic artery (n = 1), and celiac trunk (n = 2). The artery was reconstructed in all except one patient. In 11 patients with injury, peripancreatic inflammation, aberrant arterial anatomy, close relationship between tumor and injured artery, or a combination of the three were found. Median estimated blood loss was 1100 ml in both groups. Rate of severe complications (≥ Clavien grade IIIa), comprehensive complication index, and 90-day mortality for patients with intraoperative arterial injury vs planned arterial resection were 43 vs 45% (p = 0.879), median 35.9 vs 21.8 (p = 0.287), and 14.3 vs 4.5% (p = 0.551), respectively. CONCLUSION: Arterial injury during pancreatectomy is an infrequent and manageable complication. Early recognition and primary repair in order to restore arterial liver perfusion may improve outcome. However, the morbidity is high and comparable to patients undergoing a planned arterial resection.

6 Article Portal vein reconstruction using primary anastomosis or venous interposition allograft in pancreatic surgery. 2018

Kleive, Dyre / Berstad, Audun Elnaes / Sahakyan, Mushegh A / Verbeke, Caroline S / Naper, Christian / Haugvik, Sven Petter / Gladhaug, Ivar P / Line, Pål-Dag / Labori, Knut Jørgen. ·Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: dyrkle@ous-hf.no. · Department of Radiology, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pathology, Oslo University Hospital, Oslo, Norway. · Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. ·J Vasc Surg Venous Lymphat Disord · Pubmed #29128301.

ABSTRACT: OBJECTIVE: Superior mesenteric vein/portal vein (SMV/PV) resection and reconstruction during pancreatic surgery are increasingly common. Several reconstruction techniques exist. The aim of this study was to evaluate characteristics of patients and clinical outcomes for SMV/PV reconstruction using interposed cold-stored cadaveric venous allograft (AG+) or primary end-to-end anastomosis (AG-) after segmental vein resections during pancreatic surgery. METHODS: All patients undergoing pancreatic surgery with SMV/PV resection and reconstruction from 2006 to 2015 were identified. Clinical and histopathologic outcomes as well as preoperative and postoperative radiologic findings were assessed. RESULTS: A total of 171 patients were identified. The study included 42 and 71 patients reconstructed with AG+ and AG-, respectively. Patients in the AG+ group had longer mean operative time (506 minutes [standard deviation, 83 minutes] for AG+ vs 420 minutes [standard deviation, 91 minutes] for AG-; P < .01) and more intraoperative bleeding (median, 1000 mL [interquartile range (IQR), 650-2200 mL] for AG+ vs 600 mL [IQR, 300-1000 mL] for AG-; P < .01). Neoadjuvant therapy was administered more frequently for patients in the AG+ group (23.8% vs 8.5%; P = .02). Patients with AG+ had a longer length of tumor-vein involvement (median, 2.4 cm [IQR, 1.6-3.0 cm] for AG+ vs 1.8 cm [IQR, 1.2-2.4 cm] for AG-; P = .01), and a higher number of patients had a tumor-vein interface >180 degrees (35.7% for AG+ vs 21.1% for AG-; P = .02). There was no difference in number of patients with major complications (42.9% for AG+ vs 36.6% for AG-; P = .51) or early failure at the reconstruction site (9.5% for AG+ vs 8.5% for AG-; P = 1). A subgroup analysis of 10 patients in the AG+ group revealed the presence of donor-specific antibodies in all patients. CONCLUSIONS: The short-term outcome of SMV/PV reconstruction with interposed cold-stored cadaveric venous allografts is comparable to that of reconstruction with primary end-to-end anastomosis. Graft rejection could be a contributing factor to severe stenosis in patients reconstructed with allograft.

7 Article Can standardized pathology examination increase the lymph node yield following laparoscopic distal pancreatectomy for ductal adenocarcinoma? 2018

Sahakyan, Mushegh A / Haugvik, Sven P / Røsok, Bård I / Kazaryan, Airazat M / Ignjatovic, Dejan / Buanes, Trond / Labori, Knut J / Verbeke, Caroline S / Edwin, Bjørn. ·The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: sahakyan.mushegh@gmail.com. · Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway; Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway. · Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway. · The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Institute of Clinical Medicine, University of Oslo, Norway; Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Institute of Clinical Medicine, University of Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Norway; Department of Pathology, Rikshospitalet, Oslo University Hospital, Oslo, Norway. · The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway. ·HPB (Oxford) · Pubmed #28943397.

ABSTRACT: BACKGROUND: Lymph node yield (LNY) is an indicator of oncological adequacy of surgery in patients with pancreatic ductal adenocarcinoma (PDAC). Our hypothesis is that standardized pathology examination (SPE) aimed at accurate staging can increase the LNY without changing surgical technique. METHODS: After the introduction of SPE for distal pancreatosplenectomy specimens at Oslo University Hospital, prospective data were collected on patients with PDAC undergoing laparoscopic distal pancreatosplenectomy (LDP). Their data were compared with retrospective data from specimens examined in a non-standardized way (NSPE). RESULTS: SPE and NSPE were applied to 20 and 33 specimens, respectively. SPE was associated with a higher LNY and a higher median number of positive lymph nodes (PLN) in the specimen (18 vs 7, P = 0.001 and 4 vs 1, P = 0.005, respectively). In the stepwise regression model, SPE and younger age resulted in an increased LNY. In the logistic regression model, increased LNY and larger tumor size positively correlated with the presence of PLN. CONCLUSION: SPE of distal pancreatosplenectomy specimens is associated with higher LNY in patients with PDAC, which increases the likelihood of detecting PLN and reduces the risk of understaging. These findings also indicate that the LDP technique provides an adequate LNY in patients with PDAC.

8 Article Trends in indications, complications and outcomes for venous resection during pancreatoduodenectomy. 2017

Kleive, D / Sahakyan, M A / Berstad, A E / Verbeke, C S / Gladhaug, I P / Edwin, B / Fosby, B / Line, P-D / Labori, K J. ·Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. · Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Intervention Centre, Oslo University Hospital, Oslo, Norway. · Department of Radiology, Oslo University Hospital, Oslo, Norway. · Department of Pathology, Oslo University Hospital, Oslo, Norway. · Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway. ·Br J Surg · Pubmed #28815556.

ABSTRACT: BACKGROUND: Pancreatoduodenectomy with superior mesenteric-portal vein resection has become a common procedure in pancreatic surgery. The aim of this study was to compare standard pancreatoduodenectomy with pancreatoduodenectomy plus venous resection at a high-volume centre, and to examine trends in management and outcome over a decade for the latter procedure. METHODS: This retrospective observational study included all patients undergoing pancreatoduodenectomy with or without venous resection at Oslo University Hospital between January 2006 and December 2015. Trends were evaluated by assessing preoperative clinical and radiological characteristics, as well as perioperative outcomes in three time intervals (early, intermediate and late). RESULTS: A total of 784 patients had a pancreatoduodenectomy, of whom 127 (16·2 per cent) underwent venous resection. Venous resection resulted in a longer operating time (median 422 versus 312 min; P = 0·001) and greater estimated blood loss (EBL) (median 700 versus 500 ml; P = 0·004) than standard pancreatoduodenectomy. The rate of severe complications was significantly higher for pancreatoduodenectomy with venous resection (37·0 versus 26·3 per cent; P = 0·014). The overall burden of complications, evaluated using the Comprehensive Complication Index (CCI), did not differ (median score 8·7 versus 8·7; P = 0·175). Trends in venous resection over time showed a significant reduction in EBL (median 1050 versus 375 ml; P = 0·001) and duration of hospital stay (median 14 versus 9 days; P = 0·011) between the early and late periods. However, despite an improvement in the intermediate period, severe complication rates returned to baseline in the late period (18 of 43 versus 9 of 42 versus 20 of 42 patients in early, intermediate and late periods respectively; P = 0·032), as did CCI scores (median 20·9 versus 0 versus 20·9; P = 0·041). CONCLUSION: Despite an initial improvement in severe complications for venous resection during pancreatoduodenectomy, this was not maintained over time. Every fourth patient with venous resection needed relaparotomy, most frequently for bleeding.

9 Article Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: Long-term oncologic outcomes after standard resection. 2017

Sahakyan, Mushegh A / Kim, Song Cheol / Kleive, Dyre / Kazaryan, Airazat M / Song, Ki Byung / Ignjatovic, Dejan / Buanes, Trond / Røsok, Bård I / Labori, Knut Jørgen / Edwin, Bjørn. ·The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. Electronic address: sahakyan.mushegh@gmail.com. · Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of HPB Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Department of HPB Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of HPB Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. ·Surgery · Pubmed #28756944.

ABSTRACT: BACKGROUND: Surgical resection is the only curative option in patients with pancreatic ductal adenocarcinoma. Little is known about the oncologic outcomes of laparoscopic distal pancreatectomy. This bi-institutional study aimed to examine the long-term oncologic results of standard laparoscopic distal pancreatectomy in a large cohort of patients with pancreatic ductal adenocarcinoma. METHODS: From January 2002 to March 2016, 207 patients underwent standard laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma at Oslo University Hospital-Rikshospitalet (Oslo, Norway) and Asan Medical Centre (Seoul, Republic of Korea). After the exclusion criteria were applied (distant metastases at operation, conversion to an open operation, loss to follow-up), 186 patients were eligible for the analysis. Perioperative and oncologic variables were analyzed for association with recurrence and survival. RESULTS: Median overall and recurrence-free survivals were 32 and 16 months, while 5-year overall and recurrence-free survival rates were estimated to be 38.2% and 35.9%, respectively. Ninety-six (52%) patients developed recurrence: 56 (30%) extrapancreatic, 27 (15%) locoregional, and 13 (7%) combined locoregional and extrapancreatic. Thirty-seven (19.9%) patients had early recurrence (within 6 months of operation). In the multivariable analysis, tumor size >3 cm and no adjuvant chemotherapy were associated with early recurrence (P = .017 and P = .015, respectively). The Cox regression model showed that tumor size >3 cm and lymphovascular invasion were independent predictors of decreased recurrence-free and overall survival. CONCLUSION: Standard laparoscopic distal pancreatectomy is associated with satisfactory long-term oncologic outcomes in patients with pancreatic ductal adenocarcinoma. Several risk factors, such as tumor size >3 cm, no adjuvant chemotherapy, and lymphovascular invasion, are linked to poor prognosis after standard laparoscopic distal pancreatectomy.

10 Article Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. 2017

Edwin, Bjørn / Sahakyan, Mushegh A / Abu Hilal, Mohammad / Besselink, Marc G / Braga, Marco / Fabre, Jean-Michel / Fernández-Cruz, Laureano / Gayet, Brice / Kim, Song Cheol / Khatkov, Igor E / Anonymous7950896. ·The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, 0027, Norway. sahakyan.mushegh@gmail.com. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com. · University Hospital Southampton, NHS Foundation Trust, Southampton, UK. · Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. · Department of Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy. · Department of Digestive Surgery, Hospital Saint-Eloi, Montpellier, France. · Department of Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain. · Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. · Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France. · Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. · Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia. · Faculty of Surgery No. 2, Moscow State University of Medicine and Dentistry, Moscow, Russia. ·Surg Endosc · Pubmed #28205034.

ABSTRACT: BACKGROUND: Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery (EAES), aimed to develop consensus statements and clinical recommendations on the application of LAPS in these patients. METHODS: An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery. Each panelist performed a critical appraisal of the literature and prepared evidence-based statements assessed by other panelists during Delphi process. The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi. Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey. RESULTS: LAPS included laparoscopic distal pancreatectomy (LDP), pancreatoduodenectomy (LPD), enucleation, central pancreatectomy, and ultrasound. In general, LAPS was found to be safe, especially in experienced hands, and also advantageous over an open approach in terms of intraoperative blood loss, postoperative recovery, and quality of life. Eighty-five percent or higher proportion of responders agreed with the majority (69.5%) of statements. However, the evidence is predominantly based on retrospective case-control studies and systematic reviews of these studies, clearly affected by selection bias. Furthermore, no randomized controlled trials (RCTs) have been published to date, although four RCTs are currently underway in Europe. CONCLUSIONS: LAPS is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. LDP is feasible and safe, performed in many centers, while LPD is limited to few centers. RCTs and registry studies are essential to proceed with the assessment of LAPS.

11 Article Perioperative outcomes and survival in elderly patients undergoing laparoscopic distal pancreatectomy. 2017

Sahakyan, Mushegh A / Edwin, Bjørn / Kazaryan, Airazat M / Barkhatov, Leonid / Buanes, Trond / Ignjatovic, Dejan / Labori, Knut Jørgen / Røsok, Bård Ingvald. ·The Interventional Centre, Oslo University Hospital, 0027, Oslo, Norway. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Surgery, Yerevan State Medical University, Yerevan, Armenia. · Department of HPB Surgery, Oslo University Hospital, Oslo, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. ·J Hepatobiliary Pancreat Sci · Pubmed #27794204.

ABSTRACT: BACKGROUND: The outcomes following laparoscopic distal pancreatectomy (LDP) in elderly patients have not been widely reported to date. This study aimed to analyze perioperative and oncologic outcomes in patients aged ≥70 years (elderly group) and compare with those <70 years (non-elderly group). METHODS: From April 1997 to September 2015, 402 consecutive patients with lesions in the body and tail of the pancreas underwent LDP at Rikshospitalet, Oslo University Hospital. RESULTS: Of these, 118 (29.4%) were elderly, whereas 284 (70.6%) were non-elderly. Despite higher rate of comorbidities and American Society of Anesthesiologists score (P = 0.001 and 0.001, respectively), elderly patients had lower postoperative morbidity, pancreatic fistula (PF) and readmission rates, compared with non-elderly (P = 0.032, 0.001 and 0.025, respectively). Spleen-preserving LDP (SPLDP) resulted in similar postoperative outcomes in the two groups. Elderly patients with pancreatic ductal adenocarcinoma (PDAC) were comparable to non-elderly in terms of median and 3-year survival (20.2 vs. 19 months (P = 0.94, log-rank) and 26.7% vs. 34.3%, respectively). CONCLUSIONS: Both LDP and SPLDP are safe in patients aged ≥70 years, providing outcomes similar to those in younger group. Elderly patients with PDAC can benefit from LDP, since age itself is not associated with decreased survival after surgery.

12 Article Role of laparoscopic enucleation in the treatment of pancreatic lesions: case series and case-matched analysis. 2017

Sahakyan, Mushegh A / Røsok, Bård Ingvald / Kazaryan, Airazat M / Barkhatov, Leonid / Haugvik, Sven-Petter / Fretland, Åsmund Avdem / Ignjatovic, Dejan / Labori, Knut Jørgen / Edwin, Bjørn. ·The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com. · Department of Surgery No 1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com. · Department of HPB Sugery, Oslo University Hospital - Rikshospitalet, Oslo, Norway. · The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. ·Surg Endosc · Pubmed #27620912.

ABSTRACT: BACKGROUND: Previous studies report successful application of laparoscopic pancreatic enucleation (LPE). However, the evidence is limited to small series. This study aimed to evaluate the indications, technique and outcome of LPE at a tertiary care institution. METHODS: Between February 1998 and April 2016, 45 consecutive LPEs were performed at Oslo University Hospital-Rikshospitalet. Twenty-four (53.3 %) patients subjected to right-sided LPE (RLPE) were compared with 21 (46.7 %) patients who had undergone left-sided LPE (LLPE). A case-matched analysis (1:2) was performed to compare the outcomes following LLPE and laparoscopic distal pancreatectomy (LDP). RESULTS: Patient demographics, BMI, ASA score and pathological characteristics were similar between the RLPE and LLPE groups. Operative time was slightly longer for RLPE [123 (53-320) vs 102 (50-373) min, P = 0.09]. The rates of severe morbidity (≥Accordion grade III) and clinically relevant pancreatic fistula (grades B/C) were comparable, although with a trend for higher rate of complications following LLPE (16.7 vs 33.3 %; P = 0.19 and 20.8 vs 33.3 %, P = 0.34, respectively). The hospital stay was similar between RLPE and LLPE [5 (2-80) vs 7 (2-52), P = 0.49]. A case-matched analysis demonstrated shorter operating time [145 (90-350) vs 103 (50-233) min, P = 0.02], but higher readmission rate following LLPE (25 vs 3.1 %, P = 0.037). CONCLUSION: LLPE seems to be associated with a higher risk of postoperative morbidity and readmission rates than LDP. RLPE is a feasible, safe approach and a reasonable alternative to pancreatoduodenectomy in selected patients with pancreatic lesions.

13 Article Impact of obesity on surgical outcomes of laparoscopic distal pancreatectomy: A Norwegian single-center study. 2016

Sahakyan, Mushegh A / Røsok, Bård Ingvald / Kazaryan, Airazat M / Barkhatov, Leonid / Lai, Xiaoran / Kleive, Dyre / Ignjatovic, Dejan / Labori, Knut Jørgen / Edwin, Bjørn. ·Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of Surgery No1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia. Electronic address: sahakyan.mushegh@gmail.com. · Department of HPB Sugery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Biostatistics, Oslo Center for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of HPB Sugery, Oslo University Hospital, Rikshospitalet, Oslo, Norway. ·Surgery · Pubmed #27498300.

ABSTRACT: BACKGROUND: Obesity is known as a risk factor for intra- and postoperative complications in pancreatic operation. However, the operative outcomes in obese patients undergoing laparoscopic distal pancreatectomy remain unclear. METHODS: A total number of 423 patients underwent laparoscopic distal pancreatectomy at Oslo University Hospital-Rikshospitalet from April 1997 to December 2015. Patients were categorized into 3 groups based on the body mass index: normal weight (18.5-24.9 kg/m RESULTS: Obese patients had significantly longer operative time and increased blood loss compared with overweight and normal weight patients (190 [61-480] minutes vs 158 [56-520] minutes vs 153 [29-374] minutes, P = .009 and 200 [0-2,800] mL vs 50 [0-6250] mL vs 90 [0-2,000] mL, P = .01, respectively). A multiple linear regression analysis identified obesity as predictive of prolonged operative time and increased blood loss during laparoscopic distal pancreatectomy. The rates of clinically relevant pancreatic fistula and severe complications (≥grade III by Accordion classification) were comparable in the 3 groups (P = .23 and P = .37, respectively). A multivariate logistic regression model did not demonstrate an association between obesity and postoperative morbidity (P = .09). The duration of hospital stay was comparable in the 3 groups (P = .13). CONCLUSION: In spite of longer operative time and greater blood loss, laparoscopic distal pancreatectomy in obese patients is associated with satisfactory postoperative outcomes, similar to those in normal weight and overweight patients. Hence, laparoscopic distal pancreatectomy should be equally considered both in obese and nonobese patients.

14 Article Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. 2016

Sahakyan, Mushegh A / Kazaryan, Airazat M / Rawashdeh, Majd / Fuks, David / Shmavonyan, Mark / Haugvik, Sven-Petter / Labori, Knut Jørgen / Buanes, Trond / Røsok, Bård Ingvald / Ignjatovic, Dejan / Abu Hilal, Mohammad / Gayet, Brice / Kim, Song Cheol / Edwin, Bjørn. ·The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com. · Department of Surgery No 1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com. · The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. · Department of Surgery, Finnmark Hospital, Kirkenes, Norway. · University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. · Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France. · Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. · Department of Hepato-Pancreato-Billiary Sugery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. · Department of Surgery, Vestre Viken Hospital Trust, Drammen, Norway. · Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway. · Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. ·Surg Endosc · Pubmed #26514135.

ABSTRACT: BACKGROUND: Laparoscopy is widely accepted as a feasible option for distal pancreatectomy. However, the experience in laparoscopic distal pancreatectomy (LDP) for pancreatic ductal adenocarcinoma (PDAC) is limited to a small number of studies, reported by expert centers. The present study aimed to evaluate perioperative and oncological outcomes after LDP for PDAC in a large, multicenter cohort of patients. METHODS: A retrospective analysis of the data on 196 patients with histologically verified PDAC, operated at Oslo University Hospital-Rikshospitalet (Oslo, Norway), Asan Medical Center (Seoul, Republic of Korea), Institut Mutualiste Montsouris (Paris, France) and University Hospital Southampton (Southampton, UK) between January 2002 and April 2015 was conducted. The patients with standard (SLDP) and extended (i.e., en bloc with adjacent organ, ELDP) resections were compared in terms of perioperative and oncological outcomes. RESULTS: Out of 196 LDP procedures, 191 (97.4 %) were completed through laparoscopy, while five (2.6 %) were converted to open surgery. ELDP was performed in 30 (15.7 %) cases. Sixty-one (31.9 %) patients experienced postoperative complications, including 48 (25.1 %) with pancreatic fistula. The rate of clinically relevant fistula (grade B/C) was 15.7 %. Median postoperative hospital stay was 8 (2-63) days. Median follow-up was 16 months. Median survival was 31.3 months (95 % CI 22.9-39.6). Three- and 5-year actuarial survival rates were 42.4 and 30 %, respectively. SLDP was associated with significantly higher survival compared with ELDP (p = 0.032). CONCLUSIONS: LDP seems to be a feasible and safe procedure, providing satisfactory oncological outcomes in patients with PDAC.