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Pancreatic Neoplasms: HELP
Articles by Mustafa Suker
Based on 13 articles published since 2010
(Why 13 articles?)
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Between 2010 and 2020, M. Suker wrote the following 13 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. 2016

Suker, Mustafa / Beumer, Berend R / Sadot, Eran / Marthey, Lysiane / Faris, Jason E / Mellon, Eric A / El-Rayes, Bassel F / Wang-Gillam, Andrea / Lacy, Jill / Hosein, Peter J / Moorcraft, Sing Yu / Conroy, Thierry / Hohla, Florian / Allen, Peter / Taieb, Julien / Hong, Theodore S / Shridhar, Ravi / Chau, Ian / van Eijck, Casper H / Koerkamp, Bas Groot. ·Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. · Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Department of Hepatogastroenterology, Antoine Beclère Hospital, Assistance publique-Hôpitaux de Paris, Paris Sud University, Clamart, France. · Department of Hematology-Oncology, Massachusetts General Hospital, Boston, MA, USA. · Department of Radiation Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA. · Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA. · Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA. · Department of Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA. · Department of Medicine, Division of Medical Oncology, University of Kentucky-Markey Cancer Center, Lexington, KY, USA. · Department of Medicine, The Royal Marsden National Health Service Foundation Trust, London and Surrey, UK. · Department of Medical Oncology, Institut de Cancérologie de Lorraine and Lorraine University, Vandoeuvre-lès-Nancy, France. · Department of Hematology, Medical Oncology, Hemostasis, Rheumatology and Infectious Diseases, Paracelsus Medical University of Salzburg, Salzburg, Austria. · Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, Sorbonne Paris Cité, Paris Descartes University, Cancer Research Personalized Medicine (CARPEM), Paris, France. · Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA. · Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. Electronic address: b.grootkoerkamp@erasmusmc.nl. ·Lancet Oncol · Pubmed #27160474.

ABSTRACT: BACKGROUND: 35% of patients with pancreatic cancer have unresectable locally advanced disease at diagnosis. Several studies have examined systemic chemotherapy with FOLFIRINOX (leucovorin and fluorouracil plus irinotecan and oxaliplatin) in patients with locally advanced pancreatic cancer. We aimed to assess the effectiveness of FOLFIRINOX as first-line treatment in this patient population. METHODS: We systematically searched Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed Publisher, Cochrane, and Google Scholar from July 1, 1994, to July 2, 2015, for studies of treatment-naive patients of any age who received FOLFIRINOX as first-line treatment of locally advanced pancreatic cancer. Our primary outcome was overall survival. Secondary outcomes were progression-free survival; rates of grade 3 or 4 adverse events; and the proportion of patients who underwent radiotherapy or chemoradiotherapy, surgical resection after FOLFIRINOX, and R0 resection. We evaluated survival outcomes with the Kaplan-Meier method with patient-level data. Grade 3 or 4 adverse events, and the proportion of patients who underwent subsequent radiotherapy or chemoradiotherapy or resection, were pooled in a random-effects model. FINDINGS: We included 13 studies comprising 689 patients, of whom 355 (52%) patients had locally advanced pancreatic cancer. 11 studies, comprising 315 patients with locally advanced disease, reported survival outcomes and were eligible for patient-level meta-analysis. Median overall survival from the start of FOLFIRINOX ranged from 10·0 months (95% CI 4·0-16·0) to 32·7 months (23·1-42·3) across studies with a pooled patient-level median overall survival of 24·2 months (95% CI 21·7-26·8). Median progression-free survival ranged from 3·0 months (95% CI not calculable) to 20·4 months (6·5-34·3) across studies with a patient-level median progression-free survival of 15·0 months (95% 13·8-16·2). In ten studies comprising 490 patients, 296 grade 3 or 4 adverse events were reported (60·4 events per 100 patients). No deaths were attributed to FOLFIRINOX toxicity. The proportion of patients who underwent radiotherapy or chemoradiotherapy ranged from 31% to 100% across studies. In eight studies, 154 (57%) of 271 patients received radiotherapy or chemoradiotherapy after FOLFIRINOX. The pooled proportion of patients who received any radiotherapy treatment was 63·5% (95% CI 43·3-81·6, I(2) 90%). The proportion of patients who underwent surgical resection for locally advanced pancreatic cancer ranged from 0% to 43%. The proportion of patients who had R0 resection of those who underwent resection ranged from 50% to 100% across studies. In 12 studies, 91 (28%) of 325 patients underwent resection after FOLFIRINOX. The pooled proportion of patients who had resection was 25·9% (95% CI 20·2-31·9, I(2) 24%). R0 resection was reported in 60 (74%) of 81 patients. The pooled proportion of patients who had R0 resection was 78·4% (95% CI 60·2-92·2, I(2) 64%). INTERPRETATION: Patients with locally advanced pancreatic cancer treated with FOLFIRINOX had a median overall survival of 24·2 months-longer than that reported with gemcitabine (6-13 months). Future research should assess these promising results in a randomised controlled trial, and should establish which patients might benefit from radiotherapy or chemoradiotherapy or resection after FOLFIRINOX. FUNDING: None.

2 Clinical Trial Preoperative radiochemotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC trial): study protocol for a multicentre randomized controlled trial. 2016

Versteijne, Eva / van Eijck, Casper H J / Punt, Cornelis J A / Suker, Mustafa / Zwinderman, Aeilko H / Dohmen, Miriam A C / Groothuis, Karin B C / Busch, Oliver R C / Besselink, Marc G H / de Hingh, Ignace H J T / Ten Tije, Albert J / Patijn, Gijs A / Bonsing, Bert A / de Vos-Geelen, Judith / Klaase, Joost M / Festen, Sebastiaan / Boerma, Djamila / Erdmann, Joris I / Molenaar, I Quintus / van der Harst, Erwin / van der Kolk, Marion B / Rasch, Coen R N / van Tienhoven, Geertjan / Anonymous6810860. ·Department of Radiation Oncology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. e.versteijne@amc.uva.nl. · Department of Surgery, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands. c.vaneijck@erasmusmc.nl. · Department of Medical Oncology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. c.punt@amc.uva.nl. · Department of Surgery, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands. m.suker@erasmusmc.nl. · Department of Clinical Epidemiologic Biostatics, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. a.h.zwinderman@amc.uva.nl. · Clinical Research Department, Comprehensive Cancer Organisation the Netherlands (IKNL), Postbus 1281, 6501 BG, Nijmegen, The Netherlands. miriam.dohmen@radboudumc.nl. · Clinical Research Department, Comprehensive Cancer Organisation the Netherlands (IKNL), Postbus 1281, 6501 BG, Nijmegen, The Netherlands. k.groothuis@iknl.nl. · Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. o.r.busch@amc.uva.nl. · Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.g.besselink@amc.uva.nl. · Department of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands. Ignace.d.Hingh@catharinaziekenhuis.nl. · Department of Medical Oncology, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands. AtenTije@amphia.nl. · Department of Surgery, Isala Clinics, Postbus 10400, 8000 GK, Zwolle, The Netherlands. g.a.patijn@isala.nl. · Department of Surgery, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands. b.a.bonsing@lumc.nl. · Department of Medical Oncology, Maastricht University Medical Center, Postbus 3035, 6202 NA, Maastricht, The Netherlands. Judith.de.vos@mumc.nl. · Department of Surgery, Medical Spectrum Twente, Postbus 50 000, 7500 KA, Enschede, The Netherlands. j.klaase@mst.nl. · Department of Surgery, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090 HM, Amsterdam, The Netherlands. S.Festen@olvg.nl. · Department of Surgery, Sint Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands. d.boerma@antoniusziekenhuis.nl. · Department of Surgery, University Medical Center Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands. j.i.erdmann@umcg.nl. · Department of Surgery, University Medical Center Utrecht, Postbus 85500, 3508 GA, Utrecht, The Netherlands. i.q.molenaar@umcutrecht.nl. · Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands. HarstE@maasstadziekenhuis.nl. · Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands. marion.vanderkolk@radboudumc.nl. · Department of Radiation Oncology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. c.r.rasch@amc.uva.nl. · Department of Radiation Oncology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. g.vantienhoven@amc.uva.nl. ·Trials · Pubmed #26955809.

ABSTRACT: BACKGROUND: Pancreatic cancer is the fourth largest cause of cancer death in the United States and Europe with over 100,000 deaths per year in Europe alone. The overall 5-year survival ranges from 2-7 % and has hardly improved over the last two decades. Approximately 15 % of all patients have resectable disease at diagnosis, and of those, only a subgroup has a resectable tumour at surgical exploration. Data from cohort studies have suggested that outcome can be improved by preoperative radiochemotherapy, but data from well-designed randomized studies are lacking. Our PREOPANC phase III trial aims to test the hypothesis that median overall survival of patients with resectable or borderline resectable pancreatic cancer can be improved with preoperative radiochemotherapy. METHODS/DESIGN: The PREOPANC trial is a randomized, controlled, multicentric superiority trial, initiated by the Dutch Pancreatic Cancer Group. Patients with (borderline) resectable pancreatic cancer are randomized to A: direct explorative laparotomy or B: after negative diagnostic laparoscopy, preoperative radiochemotherapy, followed by explorative laparotomy. A hypofractionated radiation scheme of 15 fractions of 2.4 gray (Gy) is combined with a course of gemcitabine, 1,000 mg/m(2)/dose on days 1, 8 and 15, preceded and followed by a modified course of gemcitabine. The target volumes of radiation are delineated on a 4D CT scan, where at least 95 % of the prescribed dose of 36 Gy in 15 fractions should cover 98 % of the planning target volume. Standard adjuvant chemotherapy is administered in both treatment arms after resection (six cycles in arm A and four in arm B). In total, 244 patients will be randomized in 17 hospitals in the Netherlands. The primary endpoint is overall survival by intention to treat. Secondary endpoints are (R0) resection rate, disease-free survival, time to locoregional recurrence or distant metastases and perioperative complications. Secondary endpoints for the experimental arm are toxicity and radiologic and pathologic response. DISCUSSION: The PREOPANC trial is designed to investigate whether preoperative radiochemotherapy improves overall survival by means of increased (R0) resection rates in patients with resectable or borderline resectable pancreatic cancer. TRIAL REGISTRATION: Trial open for accrual: 3 April 2013 The Netherlands National Trial Register - NTR3709 (8 November 2012) EU Clinical Trials Register - 2012-003181-40 (11 December 2012).

3 Article Two cases of Hemosuccus pancreaticus after stereotactic radiotherapy to the pancreas: A case study. 2020

Pezzulla, D / Loi, M / Suker, M / van Eijck, C / Nuyttens, J. ·Department of Radiation Oncology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy. Electronic address: Pezzulla.donato@libero.it. · Radiotherapy Departement Hopital Tenon, Paris, France. · Department of Surgery, Erasmus MC University Medical Centre, Groene Hilledijk 301, Rotterdam, Netherlands. · Department of Radiotherapy, Erasmus MC cancer Centre, Groene Hilledijk 301, Rotterdam, Netherlands. ·Cancer Radiother · Pubmed #31980360.

ABSTRACT: Hemosuccus Pancreaticus (HP) is a very rare upper gastro-intestinal haemorrhagic event whose causes can be aneurismal lesions, acute and chronic pancreatic inflammatory conditions, and pancreatic masses. We present 2 cases of patients who underwent stereotactic radiotherapy for pancreatic lesions who manifested signs of HP after treatment. Two male patients were diagnosed with an inoperable locally advanced pancreatic cancer and underwent 8 cycles of chemotherapy followed by stereotactic radiotherapy to the pancreatic lesion delivering 40Gy in 8 fractions. The first patient complained of melena and had a necrotic tumoural mass with a new aneurysmal bulge 3 months after the SBRT. A stent was placed in the aneurysmal lesion, however, a few days later, the bleeding occurred again and the patient died. The other patient had local tumour progression 12 months after SBRT with a pancreatic mass eroding the near vessels. He developed a fast and massive bleeding. HP may occur after SBRT. Inflammation of the tumour mass can lead to erosion of the vessels with subsequent bleeding. The radiotherapy treatment may have contributed to the HP genesis. The treatment is complex and consists of the placement of a stent or surgery.

4 Article Efficacy and feasibility of stereotactic radiotherapy after folfirinox in patients with locally advanced pancreatic cancer (LAPC-1 trial). 2019

Suker, Mustafa / Nuyttens, Joost J / Eskens, Ferry A L M / Haberkorn, Brigitte C M / Coene, Peter-Paul L O / van der Harst, Erwin / Bonsing, Bert A / Vahrmeijer, Alexander L / Mieog, J Sven D / Jan Swijnenburg, Rutger / Roos, Daphne / Koerkamp, B Groot / van Eijck, Casper H J. ·Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Radiotherapy, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Oncology, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Oncology, Maasstad Hospital, Rotterdam, Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, Netherlands. · Department of Surgery, Reinier de Graaf Group, Delft, Netherlands. ·EClinicalMedicine · Pubmed #31891135.

ABSTRACT: Background: We conducted a multicentre phase II trial to investigate feasibility and antitumor activity of sequential FOLFIRINOX and Stereotactic Body Radiotherapy (SBRT) in patients with locally advanced pancreatic cancer (LAPC), (LAPC-1 trial). Methods: Patients with biopsy-proven LAPC treated in four hospitals in the Netherlands between December 2014 and June 2017. Patients received 8 cycles of FOLFIRINOX followed by SBRT (5 fractions/8 Gy) if no tumour progression after the FOLFIRINOX treatment was observed. Primary outcome was 1-year overall survival (OS). Secondary outcomes were median OS, 1-year progression-free survival (PFS), treatment-related toxicity, and resection rate. The study is registered with ClinicalTrials.gov, NCT02292745, and is completed. Findings: Fifty patients were included. Nineteen (38%) patients did not receive all 8 cycles of FOLFIRINOX, due to toxicity ( Interpretation: FOLFIRINOX followed by SBRT in patients with LAPC is feasible and shows relevant antitumor activity. In 6 (12%) patients a potentially curative resection could be pursued following this combined treatment, with a complete histological response being observed in two patients.

5 Article Yield of staging laparoscopy before treatment of locally advanced pancreatic cancer to detect occult metastases. 2019

Suker, M / Koerkamp, B Groot / Coene, P P / van der Harst, E / Bonsing, B A / Vahrmeijer, A L / Mieog, J S D / Swijnenburg, R J / Dwarkasing, R S / Roos, D / van Eijck, C H J. ·Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. Electronic address: m.suker@erasmusmc.nl. · Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Radiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. · Department of Surgery, Reinier de Graaf Group, Delft, the Netherlands. ·Eur J Surg Oncol · Pubmed #31186205.

ABSTRACT: INTRODUCTION: Locally advanced pancreatic cancer (LAPC) is found in 35% of patients with pancreatic cancer. However, these patients often have occult metastatic disease. Patients with occult metastases are unlikely to benefit from locoregional treatments. This study evaluated the yield of occult metastases during staging laparoscopy in patients with LAPC. METHODS: Between January 2013 and January 2017 all patients with LAPC underwent a staging laparoscopy after a recent tri-phasic CT-scan of the chest and abdomen. Data were retrospectively reviewed from a prospectively maintained database. Univariate and multivariable logistic regression analysis was conducted to predict metastasis found at laparoscopy. RESULTS: A total of 91 (41% male, median age 64 years) LAPC patients were included. The median time between CT-scan and staging laparoscopy was 21 days. During staging laparoscopy metastases were found in 17 patients (19%, 95% CI: 12%-28%). Seven (8%) patients had liver-only, 9 (10%) patients peritoneal-only, and 1 (1%) patient both liver and peritoneal metastases. Univariate logistic regression analysis showed that CEA (OR 1.056, 95% CI 1.007-1.107, p = 0.02) was the only preoperative predictor for occult metastases. In a multivariable logistic regression analysis of the preoperative risk factors again only CEA was an independent predictor for occult metastatic disease (p = 0.03). Patients with a CEA above 5 μg/L had a risk of occult metastasis of 91%. FOLFIRINOX was given to 69 (76%) of the patients with a median number of cycles of 8. Subsequent radiotherapy was given to 44 (48%) patients after the FOLFIRINOX treatment. Six (14%) patients underwent a resection after FOLFIRINOX and radiotherapy. The overall 1-year survival was 53% in patients without occult metastasis versus 29% with occult metastasis (p = 0.11). The 1-year OS for patients that completed FOLFIRINOX and radiotherapy was 84%. CONCLUSION: The yield of staging laparoscopy for occult intrahepatic or peritoneal metastases in patients with locally advanced pancreatic cancer was 19%. Staging laparoscopy is recomended for patients with LAPC for accurate staging to determine optimal treatment.

6 Article Pancreatic cancer treated with SBRT: Effect of anatomical interfraction variations on dose to organs at risk. 2019

Loi, Mauro / Magallon-Baro, Alba / Suker, Mustafa / van Eijck, Casper / Sharma, Aman / Hoogeman, Mischa / Nuyttens, Joost. ·Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. Electronic address: m.loi@erasmusmc.nl. · Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. · Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. ·Radiother Oncol · Pubmed #31005226.

ABSTRACT: BACKGROUND AND PURPOSE: Interfraction shape and position variations of organs at risk (OARs) may increase uncertainty in dose delivery during stereotactic body radiotherapy (SBRT), potentially leading to overirradiation or concessions in planned tumor dose and/or coverage to prevent clinical constraints violation. The aim of our study was to quantitatively analyze the impact of anatomical interfraction variations on dose to OARs in pancreatic cancer (PC) treated by SBRT using a CyberKnife with integrated CT-on-rails. MATERIALS AND METHODS: Thirty-five PC patients treated with SBRT (40 Gy/5 fractions) underwent a CT-scan in treatment position before each of the first three fractions using the CT-on-rails system. OARs (stomach, duodenum, bowel) were manually delineated and concatenated to one structure (Gastro-Intestinal Organ, GIO). To overlay the planned dose distribution, fiducial-based alignment of the fraction CT with the planning CT was performed. Planned DVH parameters of the OAR were compared to the parameters calculated in the fractions CTs. RESULTS: Compared to the treatment plan, the median V35, D2, D5, D10 and Dmax of the fraction CTs in the GIO was increased by 1.0 (IQR: 0.2-2.6), 4.4% (0.4-10.8), 2.3% (0.2-7.5), 3.3% (-0.4 to 7.1), and 12.0% (5.0-18.9) respectively. Median increase was statistically significant for all parameters in GIO and for V35 in all critical structures at Wilcoxon test. CONCLUSIONS: Anatomical interfraction variations increase OAR dose during SBRT for pancreatic cancer daily imaging using integrated CT/CyberKnife may allow to implement strategies to reduce the risk of OAR overirradiation during pancreatic SBRT.

7 Article Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial. 2019

de Rooij, Thijs / van Hilst, Jony / van Santvoort, Hjalmar / Boerma, Djamila / van den Boezem, Peter / Daams, Freek / van Dam, Ronald / Dejong, Cees / van Duyn, Eino / Dijkgraaf, Marcel / van Eijck, Casper / Festen, Sebastiaan / Gerhards, Michael / Groot Koerkamp, Bas / de Hingh, Ignace / Kazemier, Geert / Klaase, Joost / de Kleine, Ruben / van Laarhoven, Cornelis / Luyer, Misha / Patijn, Gijs / Steenvoorde, Pascal / Suker, Mustafa / Abu Hilal, Moh'd / Busch, Olivier / Besselink, Marc / Anonymous13631124. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Surgery, St Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht, the Netherlands. · Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. · Department of Surgery, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands. · Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands, and Universitätsklinikum Aachen, Aachen, Germany. · Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands. · Clinical Research Unit, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Surgery, OLVG, Amsterdam, the Netherlands. · Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. · Department of Surgery, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. · Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. · Department of Surgery, Isala Clinics, Zwolle, the Netherlands. · Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK. ·Ann Surg · Pubmed #30080726.

ABSTRACT: OBJECTIVE: This trial followed a structured nationwide training program in minimally invasive distal pancreatectomy (MIDP), according to the IDEAL framework for surgical innovation, and aimed to compare time to functional recovery after minimally invasive and open distal pancreatectomy (ODP). BACKGROUND: MIDP is increasingly used and may enhance postoperative recovery as compared with ODP, but randomized studies are lacking. METHODS: A multicenter patient-blinded randomized controlled superiority trial was performed in 14 centers between April 2015 and March 2017. Adult patients with left-sided pancreatic tumors confined to the pancreas without vascular involvement were randomly assigned (1:1) to undergo MIDP or ODP. Patients were blinded for type of surgery using a large abdominal dressing. The primary endpoint was time to functional recovery. Analysis was by intention to treat. This trial was registered with the Netherlands Trial Register (NTR5689). RESULTS: Time to functional recovery was 4 days [interquartile range (IQR) 3-6) in 51 patients after MIDP versus 6 days (IQR 5-8) in 57 patients after ODP (P < 0.001). The conversion rate of MIDP was 8%. Operative blood loss was less after MIDP (150 vs 400 mL; P < 0.001), whereas operative time was longer (217 vs 179 minutes; P = 0.005). The Clavien-Dindo grade ≥III complication rate was 25% versus 38% (P = 0.21). Delayed gastric emptying grade B/C was seen less often after MIDP (6% vs 20%; P = 0.04). Postoperative pancreatic fistulas grade B/C were seen in 39% after MIDP versus 23% after ODP (P = 0.07), without difference in percutaneous catheter drainage (22% vs 20%; P = 0.77). Quality of life (day 3-30) was better after MIDP as compared with ODP, and overall costs were non-significantly less after MIDP. No 90-day mortality was seen after MIDP versus 2% (n = 1) after ODP. CONCLUSIONS: In patients with left-sided pancreatic tumors confined to the pancreas, MIDP reduces time to functional recovery compared with ODP. Although the overall rate of complications was not reduced, MIDP was associated with less delayed gastric emptying and better quality of life without increasing costs.

8 Article The Systemic-immune-inflammation Index Independently Predicts Survival and Recurrence in Resectable Pancreatic Cancer and its Prognostic Value Depends on Bilirubin Levels: A Retrospective Multicenter Cohort Study. 2019

Aziz, Mohammad Hosein / Sideras, Kostandinos / Aziz, Nasir Ahmad / Mauff, Katya / Haen, Roel / Roos, Daphne / Saida, Lawlaw / Suker, Mustafa / van der Harst, Erwin / Mieog, Jan Sven / Bonsing, Bert A / Klaver, Yarne / Koerkamp, Bas Groot / van Eijck, Casper H. ·Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands. · Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands. · Department of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands. · Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Medical Oncology, Laboratory of Tumor Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands. ·Ann Surg · Pubmed #29334554.

ABSTRACT: OBJECTIVE: Our aim was to determine the prognostic significance of the systemic-immune-inflammation index (SIII) in patients with resectable pancreatic cancer, using cancer-specific survival as the primary outcome. BACKGROUND: Pancreatic cancer is associated with a dysfunctional immune system and poor prognosis. We examined the prognostic significance of the SIII in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and the effects of bilirubin on this index. METHODS: We retrospectively assessed all pancreatic resections performed between 2004 and 2015 at 4 tertiary referral centers to identify pathologically confirmed PDAC patients. Baseline clinicopathologic characteristics, preoperative laboratory values such as absolute neutrophil, lymphocyte, and platelet counts, C-reactive protein, albumin, bilirubin, and CA19-9 levels, and also follow-up information, were collected. The associations of the calculated inflammatory indices with outcome were both internally and externally validated. RESULTS: In all, 590 patients with resectable PDAC were included. The discovery and validation cohort included 170 and 420 patients, respectively. SIII >900 [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.55-3.48], lymph node ratio (HR 3.75, 95% CI 2.08-6.76), and CA19.9 >200 kU/L (HR 1.62, 95% CI 1.07-2.46) were identified as independent predictors of cancer-specific survival. Separate model analysis confirmed that preoperative SIII contributed significantly to prognostication. However, SIII appeared to lose its prognostic significance in patients with bilirubin levels above 200 μmol/L. CONCLUSIONS: SIII is an independent predictor of cancer-specific survival and recurrence in patients with resectable PDAC. SIII may lose its prognostic significance in patients with high bilirubin levels. Properly designed prospective studies are needed to further confirm this hypothesis.

9 Article FOLFIRINOX and radiotherapy for locally advanced pancreatic cancer: A cohort study. 2018

Suker, Mustafa / Nuyttens, Joost J / Groot Koerkamp, Bas / Eskens, Ferry A L M / van Eijck, Casper H J. ·Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. · Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. · Department of Medical Oncology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. ·J Surg Oncol · Pubmed #30259526.

ABSTRACT: INTRODUCTION: One-third of the patients with pancreatic cancer present with locally advanced unresectable pancreatic cancer (LAPC). Our aim was to determine survival outcomes and toxicity after FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin) followed by radiotherapy (RT) in biopsy-proven patients with LAPC. METHODS: We analysed a cohort of biopsy-proven patients with LAPC, who were eligible for induction FOLFIRINOX (eight cycles) and subsequent RT (30 fractions, 60 Gy). Eligible patients underwent a staging laparoscopy to detect occult metastasis before the treatment. The primary outcome was overall survival (OS), and secondary outcomes were progression-free survival (PFS), treatment-related toxicity, and resection rate. RESULTS: Forty-four patients were diagnosed with biopsy-proven LAPC. Twenty-five patients were eligible and all underwent staging laparoscopy before the treatment. In three (12%) patients occult metastases were found. Twenty-two patients started induction FOLFIRINOX, 17 (77%) completed all cycles. Seventeen (77%) patients were treated with subsequent RT, with 16 (94%) receiving the full dosage. Three (14%) patients underwent a radical resection after the treatment. Median OS was 15.4 months (95% confidence interval [CI], 10.0-20.7), median PFS was 11 months (95% CI, 7.7-14.4). CONCLUSIONS: Median OS after FOLFIRINOX and RT was 15 months in patients with LAPC. Toxicity remains severe, however, most patients completed all eight scheduled cycles of FOLFIRINOX and RT.

10 Article The Dutch Pancreas Biobank Within the Parelsnoer Institute: A Nationwide Biobank of Pancreatic and Periampullary Diseases. 2018

Strijker, Marin / Gerritsen, Arja / van Hilst, Jony / Bijlsma, Maarten F / Bonsing, Bert A / Brosens, Lodewijk A / Bruno, Marco J / van Dam, Ronald M / Dijk, Frederike / van Eijck, Casper H / Farina Sarasqueta, Arantza / Fockens, Paul / Gerhards, Michael F / Groot Koerkamp, Bas / van der Harst, Erwin / de Hingh, Ignace H / van Hooft, Jeanin E / Huysentruyt, Clément J / Kazemier, Geert / Klaase, Joost M / van Laarhoven, Cornelis J / van Laarhoven, Hanneke W / Liem, Mike S / de Meijer, Vincent E / van Rijssen, L Bengt / van Santvoort, Hjalmar C / Suker, Mustafa / Verhagen, Judith H / Verheij, Joanne / Verspaget, Hein W / Wennink, Roos A / Wilmink, Johanna W / Molenaar, I Quintus / Boermeester, Marja A / Busch, Olivier R / Besselink, Marc G / Anonymous3030939. · ·Pancreas · Pubmed #29521943.

ABSTRACT: OBJECTIVES: Large biobanks with uniform collection of biomaterials and associated clinical data are essential for translational research. The Netherlands has traditionally been well organized in multicenter clinical research on pancreatic diseases, including the nationwide multidisciplinary Dutch Pancreatic Cancer Group and Dutch Pancreatitis Study Group. To enable high-quality translational research on pancreatic and periampullary diseases, these groups established the Dutch Pancreas Biobank. METHODS: The Dutch Pancreas Biobank is part of the Parelsnoer Institute and involves all 8 Dutch university medical centers and 5 nonacademic hospitals. Adult patients undergoing pancreatic surgery (all indications) are eligible for inclusion. Preoperative blood samples, tumor tissue from resected specimens, pancreatic cyst fluid, and follow-up blood samples are collected. Clinical parameters are collected in conjunction with the mandatory Dutch Pancreatic Cancer Audit. RESULTS: Between January 2015 and May 2017, 488 patients were included in the first 5 participating centers: 4 university medical centers and 1 nonacademic hospital. Over 2500 samples were collected: 1308 preoperative blood samples, 864 tissue samples, and 366 follow-up blood samples. CONCLUSIONS: Prospective collection of biomaterials and associated clinical data has started in the Dutch Pancreas Biobank. Subsequent translational research will aim to improve treatment decisions based on disease characteristics.

11 Article Quality assurance of the PREOPANC trial (2012-003181-40) for preoperative radiochemotherapy in pancreatic cancer : The dummy run. 2017

Versteijne, Eva / Lens, Eelco / van der Horst, Astrid / Bel, Arjan / Visser, Jorrit / Punt, Cornelis J A / Suker, Mustafa / van Eijck, Casper H J / van Tienhoven, Geertjan. ·Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. E.versteijne@amc.uva.nl. · Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Department of Surgery, Erasmus Medical Center, Erasmus University, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. ·Strahlenther Onkol · Pubmed #28608305.

ABSTRACT: BACKGROUND: The Dutch Pancreatic Cancer Group initiated the national, multicentre, controlled PREOPANC trial, randomising between preoperative radiochemotherapy and direct explorative laparotomy for patients with (borderline) resectable pancreatic cancer. The aim of this dummy run is to evaluate compliance with the radiotherapy protocol of this trial, and the quality of delineation and radiation plans. METHODS: Eleven radiation oncology departments open for accrual of patients in the PREOPANC trial were provided with all necessary information of a selected 'dummy' patient. Each institute was asked to delineate the target volumes, including gross tumour volume, internal gross tumour volume (iGTV), internal clinical target volume, and planning target volume. The institutions were also asked to provide a radiation treatment plan in accordance with the PREOPANC trial protocol. RESULTS: The range of the iGTV was 19.3-77.2 cm CONCLUSION: All institutions showed acceptable deviations from the PREOPANC trial protocol and achieved an acceptable quality of delineation and radiation technique. All institutions were allowed to continue participation in the PREOPANC trial.

12 Article Are a Double Duct Sign or Endoscopic Biopsies Reliable Predictors of Malignancy in Periampullary Lesions. 2015

Ten Berge, Josianne C E M / Suker, Mustafa / Bruno, Marco J / Poley, Jan-Werner / Dwarkasing, Roy / Biermann, Katharina / van Eijck, Casper H J. ·Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. ·Dig Surg · Pubmed #26138752.

ABSTRACT: AIM: To determine the predictive value of a double duct sign (DDS) and endoscopic biopsies to differentiate invasive carcinoma from premalignant lesions. METHODS: Two hundred and forty one patients (mean age 65.8; male 55.6%) diagnosed with a periampullary lesion from January 1987 through March 2013 were reviewed retrospectively with regard to background characteristics, histology of endoscopic biopsy, diameter of both common bile duct (CBD) and main pancreatic duct (PD), bilirubin levels and final diagnosis. RESULTS: DDS predicted malignancy with 73% specificity and 72% sensitivity. Endoscopic biopsies predicted malignancy with 96% specificity, 71% sensitivity and a negative predictive value (NPV) of 51%. Multivariable logistic regression analysis showed that DDS is a significant predictor for the presence of malignancy with an odds ratio of 6.37 adjusted to age, gender and endoscopic biopsy. CONCLUSION: Although DDS is indicative of malignancy in periampullary lesions, its clinical use is limited, given the low sensitivity and specificity. The diagnostic value of endoscopic biopsies is also poor due to a low sensitivity and NPV. If a double duct sign is present, physicians must be aware of an increased possibility of a malignant underlying cause, even if the histopathological examination of the biopsies did not show invasive malignancy.

13 Unspecified Pancreatic Duct Obstruction in a Middle-Aged Woman: A Case Report. 2017

Suker, Mustafa / Doukas, Michael / van Eijck, Casper / Biermann, Katharina. ·Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. · Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. ·J Pancreat Cancer · Pubmed #30631833.

ABSTRACT: