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Pancreatic Neoplasms: HELP
Articles by Gaya Spolverato
Based on 8 articles published since 2010
(Why 8 articles?)
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Between 2010 and 2020, G. Spolverato wrote the following 8 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Perioperative Blood Transfusion and the Prognosis of Pancreatic Cancer Surgery: Systematic Review and Meta-analysis. 2015

Mavros, Michael N / Xu, Li / Maqsood, Hadia / Gani, Faiz / Ejaz, Aslam / Spolverato, Gaya / Al-Refaie, Waddah B / Frank, Steven M / Pawlik, Timothy M. ·Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA. · Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Alfa Institute of Biomedical Sciences, Marousi, Athens, Greece. · Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. · State Key Laboratory of Oncology in Southern China, Guangzhou, China. · Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA. · Department of Surgery, MedStar Georgetown University Hospital Center, Washington, DC, USA. · Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tpawlik1@jhmi.edu. ·Ann Surg Oncol · Pubmed #26293837.

ABSTRACT: BACKGROUND: Perioperative blood transfusion (PBT) is common in pancreatic surgery. Recent studies have suggested that PBT may be associated with worse long-term outcomes. METHODS: A systematic review and meta-analysis of studies comparing long-term clinical outcomes of cancer patients undergoing curative-intent pancreatic surgery with regard to occurrence of PBT was performed. RESULTS: A total of 23 studies (4339 patients) were included in the systematic review, and 19 studies (3646 patients) were included in the meta-analysis. Nearly half (45.8 %) of all patients were female (range 25-60 %), and median age ranged from 59 to 72 years. About half (46.5 %, range 19-72 %) of the patients were transfused. Most had pancreatic ductal adenocarcinoma (69.5 %), while others had ampullary carcinoma (15.0 %), cholangiocarcinoma (7.4 %), or exocrine tumors of pancreas (8.1 %). Most (91.1 %) underwent pancreaticoduodenectomy, while the remaining patients underwent a total or distal pancreatectomy. The 5-year overall survival for all patients ranged from 0 to 65 %. Thirteen and nine of 19 studies reported a detrimental effect of PBT on survival on univariable and multivariable analysis, respectively. Overall, PBT was associated with shorter overall survival (pooled odds ratio 2.43, 95 % confidence interval 1.90-3.10); this finding was reproduced in sensitivity analysis. CONCLUSIONS: Patients receiving PBT had significantly lower 5-year survival after curative-intent pancreatic surgery. Further research should focus on implementing guidelines for and discerning factors associated with the poor outcomes after PBT.

2 Article Specific Medicare Severity-Diagnosis Related Group Codes Increase the Predictability of 30-Day Unplanned Hospital Readmission After Pancreaticoduodenectomy. 2018

Xourafas, Dimitrios / Merath, Katiuscha / Spolverato, Gaya / Ashley, Stanley W / Cloyd, Jordan M / Pawlik, Timothy M. ·Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Department of Surgery, Wexner Medical Center At The Ohio State University, Columbus, OH, USA. · Department of Surgery, Wexner Medical Center At The Ohio State University, Columbus, OH, USA. Tim.Pawlik@osumc.edu. · Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Professor of Surgery, Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, USA. Tim.Pawlik@osumc.edu. ·J Gastrointest Surg · Pubmed #30039447.

ABSTRACT: BACKGROUND: The Medicare Severity-Diagnosis Related Group coding system (MS-DRG) is routinely used by hospitals for reimbursement purposes following pancreatic surgery. We aimed to determine whether specific pancreatectomy MS-DRG codes, when combined with distinct clinicopathologic and perioperative characteristics, increased the accuracy of predicting 30-day readmission after pancreaticoduodenectomy (PD). METHODS: Demographic, clinicopathologic, and perioperative factors were compared between readmitted and non-readmitted patients at Brigham and Women's Hospital following PD. Different pancreatectomy DRG codes, currently used for reimbursement purposes [407: without complication/co-morbidity (CC), 406: with CC, and 405: with major CC] were combined with clinical factors to assess their predictability of readmission. Univariate and multivariable analyses were performed to evaluate outcomes. RESULTS: Among 354 patients who underwent PD between 2010 and 2017, 69 (19%) were readmitted. The incidence of readmission was 13, 32, and 55% for patients with assigned DRG codes 407, 406, and 405, respectively (P = 0.0395). Readmitted patients were more likely to have had T4 disease (P = 0.0007), a vascular resection (P = 0.0078), and longer operative times (P = 0.012). On multivariable analysis, combining DRG 407 with relevant clinicopathologic factors was unable to predict readmission. In contrast, DRG 406 code among patients with N positive disease (P = 0.0263) and LOS > 10 days (P = 0.0505) was associated with readmission. DRG 405, preoperative obstructive jaundice (OR: 7.5, CI: 1.5-36, P = 0.0130), vascular resection (OR: 7.7, CI: 1.1-51, P = 0.0336), N positive stage of disease (OR: 0.2, CI: 0-0.9, P = 0.0447), and operative time > 410 min (OR: 5.9, CI: 1-32, P = 0.0399) were each strongly associated with 30-day readmission after PD [likelihood ratio (LR) < 0.0001]. CONCLUSIONS: Distinct pancreatectomy MS-DRG classification codes (405), combined with relevant clinicopathologic and perioperative characteristics, strongly predicted 30-day readmission after PD. DRG classification algorithms can be implemented to more accurately identify patients at a higher risk of readmission.

3 Article Neuroendocrine Liver Metastasis: Prognostic Implications of Primary Tumor Site on Patients Undergoing Curative Intent Liver Surgery. 2017

Spolverato, Gaya / Bagante, Fabio / Aldrighetti, Luca / Poultsides, George / Bauer, Todd W / Field, Ryan C / Marques, Hugo P / Weiss, Matthew / Maithel, Shishir K / Pawlik, Timothy M. ·Department of Surgery, University of Verona, Verona, Italy. · Scientific Institute San Raffaele, Milan, Italy. · Stanford University, Stanford, CA, USA. · University of Virginia, Charlottesville, VA, USA. · School of Medicine, Washington University, St Louis, MO, USA. · Curry Cabral Hospital, Lisbon, Portugal. · Johns Hopkins Hospital, Baltimore, MD, USA. · Emory University, Atlanta, GA, USA. · Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. tim.pawlik@osumc.edu. ·J Gastrointest Surg · Pubmed #28744737.

ABSTRACT: BACKGROUND: Neuroendocrine tumors typically arise from pancreatic (PNET) vs. gastrointestinal or thoracic origins (non-PNET). The impact of primary tumor site on long-term prognosis following resection of neuroendocrine liver metastasis (NELM) remains poorly defined. The objective of the current study was to define the association of primary tumor location on prognosis of patients undergoing curative intent liver resection for NELM. METHODS: Between 1990 and 2014, 421 patients who underwent resection of NELM were identified from a multi-institutional database. Clinicopathological characteristics, operative details, and outcomes were stratified and analyzed by location of the primary tumor (PNET vs. non-PNET). A propensity score-matched analysis was utilized to assess the impact of primary tumor location on long-term survival. RESULTS: Among the 421 patients, 197 (46.8%) patients had NELM from a PNET primary while 224 (53.2%) had a non-PNET primary (small bowel, n = 145; rectal, n = 10; bronchial, n = 22; other, n = 47). There were no differences in tumor burden and tumor site, while presence of extrahepatic disease was more common among patients with non-PNET NELM (extrahepatic disease, PNET NELM, n = 11 27.5% vs. non-PNET NELM, n = 29 72.5%; p = 0.010). Patients with PNET NELM were more likely to have non-functional disease compared with patients who had non-PNET NELM (non-functional, PNET NELM, n = 117 54.9% vs. non-PNET NELM, n = 96 45.1%; p = 0.011). On the final pathological specimen of the resected NELM, patients with PNET NELM were more likely to have a moderately differentiated tumor (59.3%), while patients with non-PNET NELM were more likely to have a poorly differentiated tumor (67.8%) (p = 0.005). Patients with PNET NELM had a worse 5-year DFS and 5-year OS compared with patients who had non-PNET NELM (DFS, PNET 36.2% vs. non-PNET 55.2%; p = 0.001 and OS, PNET 79.5% vs. non-PNET 83.4%; p = 0.008). After propensity score matching, both 5-year DFS and 5-year OS of the PNET and non-PNET groups were comparable (DFS, PNET 46.2% vs. non-PNET 55.9%; p = 0.22 and OS, PNET 81.5% vs. non-PNET 84.3%; p = 0.19). CONCLUSION: PNET patients more often present with non-functional NELM and moderately differentiated tumors. On propensity-matched analysis, factors such as extrahepatic disease and tumor grade, but not primary tumor location, were associated with prognosis of patients undergoing curative intent liver surgery for NELM.

4 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.

5 Article Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia. 2015

Amini, Neda / Spolverato, Gaya / Gupta, Rohan / Margonis, Georgios A / Kim, Yuhree / Wagner, Doris / Rezaee, Neda / Weiss, Matthew J / Wolfgang, Christopher L / Makary, Martin M / Kamel, Ihab R / Pawlik, Timothy M. ·Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. ·J Gastrointest Surg · Pubmed #25925237.

ABSTRACT: BACKGROUND: While sarcopenia is typically defined using total psoas area (TPA), characterizing sarcopenia using only a single axial cross-sectional image may be inadequate. We sought to evaluate total psoas volume (TPV) as a new tool to define sarcopenia and compare patient outcomes relative to TPA and TPV. METHOD: Sarcopenia was assessed in 763 patients who underwent pancreatectomy for pancreatic adenocarcinoma between 1996 and 2014. It was defined as the TPA and TPV in the lowest sex-specific quartile. The impact of sarcopenia defined by TPA and TPV on overall morbidity and mortality was assessed using multivariable analysis. RESULT: Median TPA and TPV were both lower in women versus men (both P < 0.001). TPA identified 192 (25.1%) patients as sarcopenic, while TPV identified 152 patients (19.9%). Three hundred sixty-nine (48.4%) patients experienced a postoperative complication. While TPA-sarcopenia was not associated with higher risk of postoperative complications (OR 1.06; P = 0.72), sarcopenia defined by TPV was associated with morbidity (OR 1.79; P = 0.002). On multivariable analysis, TPV-sarcopenia remained independently associated with an increased risk of postoperative complications (OR 1.69; P = 0.006), as well as long-term survival (HR 1.46; P = 0.006). CONCLUSION: The use of TPV to define sarcopenia was associated with both short- and long-term outcomes following resection of pancreatic cancer. Assessment of the entire volume of the psoas muscle (TPV) may be a better means to define sarcopenia rather than a single axial image.

6 Article Neutrophil-lymphocyte and platelet-lymphocyte ratio in patients after resection for hepato-pancreatico-biliary malignancies. 2015

Spolverato, G / Maqsood, H / Kim, Y / Margonis, Ga / Luo, T / Ejaz, A / Pawlik, T M. ·The Johns Hopkins University School of Medicine, Baltimore, Maryland. ·J Surg Oncol · Pubmed #25865111.

ABSTRACT: BACKGROUND AND OBJECTIVES: We sought to determine whether Neutrophil-lymphocyte ratio (NLR) or platelet-lymphocyte ratio (PLR) were associated with outcomes of patients undergoing surgery for a hepatopancreatico-biliary (HPB) malignancy. METHOD: Between 2000 and 2013, 452 patients who underwent an HPB procedure for a malignant indication were identified. Clinicopathological characteristics, NLR, and PLR, as well as short- and long-term outcomes were analyzed. High NLR and PLR were classified using a cut-off value of 5 and 190, respectively, based on ROC curve analysis. RESULTS: Patients with low versus high NLR and PLR had similar baseline characteristics with regard to performance status and tumor stage (all P > 0.05). Elevated PLR (HR = 1.40) tends to be association with shorter recurrence-free survival (RFS) (P = 0.05), whereas NLR was not a predictor of shorter RFS. Differently, both elevated NLR (HR = 1.94) and PLR (HR = 1.79) were associated with worse overall survival (OS) (both P < 0.05). Patients with NLR ≥5 and those with PLR ≥190 had a significantly shorter OS compared to patients with NLR <5 and PLR <190, respectively (log-rank test, both P < 0.05). Moreover, patients who had both NLR and PLR elevated had worse OS compared to patients with either one or none inflammatory markers elevated (log-rank P = 0.02). CONCLUSION: Elevated NLR and PLR were predictors of worse long-term outcome among patients with HPB malignancy undergoing resection.

7 Article Impact of blood transfusions and transfusion practices on long-term outcome following hepatopancreaticobiliary surgery. 2015

Ejaz, Aslam / Spolverato, Gaya / Kim, Yuhree / Margonis, Georgios A / Gupta, Rohan / Amini, Neda / Frank, Steven M / Pawlik, Timothy M. ·Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA. ·J Gastrointest Surg · Pubmed #25707813.

ABSTRACT: BACKGROUND: The long-term impact of transfusions with packed red blood cells (PRBC) among patients undergoing hepatopancreaticobiliary (HPB) surgery remains ill-defined. We sought to determine the impact of overall blood utilization, as well as a restrictive transfusion strategy, on long-term outcomes among patients undergoing an HPB resection for a malignancy. METHODS: Data on overall blood utilization and hemoglobin (Hb) levels that triggered a transfusion were obtained for patients with cancer undergoing pancreas or liver surgery between 2009 and 2013. Risk-adjusted recurrence-free (RFS) and overall survival (OS) were assessed based on receipt of PRBC and whether the patient received a transfusion using a restrictive transfusion strategy (intraoperative: Hb <10 g/dL; postoperative: Hb <8 g/dL). RESULTS: Four hundred forty-two patients underwent either a pancreas (58.1 %) or liver (41.9 %) resection. Most tumors were pancreatic in origin (41.8 %), while a subset were primary (23.1 %) or secondary (18.8 %) liver tumors. One hundred seventy-five (39.6 %) patients received ≥1 PRBC transfusion either intraoperatively (16.7 %), postoperatively (12.7 %), or both (10.2 %). There was a higher incidence of PRBC transfusion among patients undergoing a pancreas resection, those with higher comorbidities, and those with lower preoperative Hb levels. Perioperative morbidity was higher among patients receiving either 1-2 units (OR 3.14) or 3 or more units of PRBC (OR 8.54). Median OS was 31.9 months. Receipt of a blood transfusion was associated with a worse OS (1-2 units: HR 1.76; 3+units: HR 2.50; both P<0.05), and RFS (3+units: HR 2.91; P=0.02). Utilization of a restrictive transfusion strategy did not impact perioperative morbidity or long-term RFS or OS. CONCLUSIONS: Adoption of a more restrictive transfusion strategy in patients undergoing resection for cancer may preserve a limited resource, reduce costs, as well as avoid exposing oncology patients to the unnecessary risks associated with a transfusion.

8 Article Time-related changes in the prognostic significance of the total number of examined lymph nodes in node-negative pancreatic head cancer. 2014

Gleisner, Ana L / Spolverato, Gaya / Ejaz, Aslam / Pawlik, Timothy M. ·Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. ·J Surg Oncol · Pubmed #24975984.

ABSTRACT: BACKGROUND AND OBJECTIVES: The aim of study was to assess time trends in the association between the total number of lymph nodes examined (TNLE) and survival in patients operated for adenocarcinoma of the head of pancreas. METHODS: Patients operated for node-negative adenocarcinoma of the head of pancreas between 1988 and 2007 were identified from the Surveillance, Epidemiology and End Results (SEER) database. Patients diagnosed between 1988 and 2002 were compared to those diagnosed between 2003 and 2007. RESULTS: A total of 3,406 patients were included. Although TNLE was associated with survival, the effect was not uniform. Compared to patients with >12 TNLE, survival decreased with lower TNLE (4-12 TNLE: hazard ratio [HR] 1.27, 95% CI 1.10-1.46; <4 TNLE: HR 1.39, 95% CI 1.20-1.60) among patients diagnosed between 1988 and 2002. In contrast, for those diagnosed between 2003 and 2007, while there was decreased survival for those with <4 nodes (HR 1.44, 95% CI 1.22-1.71), no effect was seen for patients with TNLE 4-12 (HR 0.98, 95% CI 0.85-1.14). CONCLUSION: The prognostic significance of the TNLE in patients operated for adenocarcinoma of the head of the pancreas is not constant over time.