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Pancreatic Neoplasms: HELP
Articles by John Albert Windsor
Based on 21 articles published since 2010
(Why 21 articles?)
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Between 2010 and 2020, J. Windsor wrote the following 21 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review The Impact of the Depth of Venous Invasion on Survival Following Pancreatoduodenectomy for Pancreatic Cancer: a Meta-analysis of Available Evidence. 2019

Ratnayake, Chathura B B / Shah, Nehal / Loveday, Benjamin / Windsor, John A / Pandanaboyana, Sanjay. ·Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. · HPB unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. · Department of HPB Surgery, Northern General Hospital, Sheffield, UK. · Department of HPB Surgery, Royal Melbourne Hospital, Melbourne, Australia. · HPB and Transplant Unit, Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK. sanjay.pandanaboyana@nuth.nhs.uk. ·J Gastrointest Cancer · Pubmed #31062188.

ABSTRACT: PURPOSE: The prognostic significance of portal/superior mesenteric vein (PV/SMV) invasion at the time of pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) is contentious. The aim of this meta-analysis was to compare the survival outcomes in patients with histologically proven adventitial (superficial) versus media/intimal (deep) PV/SMV invasion at the time of PD for PDAC. METHODS: A systematic search of the PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. All articles reporting outcomes specific to the depth of PDAC invasion into the PV/SMV wall were included. The primary outcome measure was overall survival. RESULTS: Six studies including 310 patients who underwent pancreatic resection with PV/SMV resection for PDAC were included in this meta-analysis. There was no difference in overall survival comparing superficial vs deep invasion at 12 months (64% vs 58% respectively, risk difference, - 0.09; CI, - 0.21-0.04; P = 0.183), 36 months (22% vs 18% respectively, risk difference, - 0.05; CI, - 0.16-0.19; P = 0.857) and mean overall survival (42.8 months vs 25.7 months respectively, standard mean difference, - 0.27; CI, - 0.58, 0.03; P = 0.078). Although larger tumours were seen in those with confirmed deep vein wall invasion (P < 0.001), no difference was observed between the superficial and deep invasion groups with regard to age (P = 0.298), R1 resection (P = 0.896), nodal metastatic disease (P = 0.120) and perineural invasion (P = 0.609). CONCLUSIONS: This meta-analysis suggests that the depth of PV/SMV wall invasion by PDAC may not impact survival after PD. However, given the limited sample size, further research is warranted with homogenous cohorts and longer follow-up.

2 Review Pain in pancreatic ductal adenocarcinoma: A multidisciplinary, International guideline for optimized management. 2018

Drewes, Asbjørn M / Campbell, Claudia M / Ceyhan, Güralp O / Delhaye, Myriam / Garg, Pramod K / van Goor, Harry / Laquente, Berta / Morlion, Bart / Olesen, Søren S / Singh, Vikesh K / Sjøgren, Per / Szigethy, Eva / Windsor, John A / Salvetti, Marina G / Talukdar, Rupjyoti. ·Centre for Pancreatic Diseases, Department of Gastroenterology, Aalborg University Hospital, Denmark. Electronic address: amd@rn.dk. · Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA. · Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. · Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium. · Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. · Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Medical Oncology, Catalan Institute of Oncology, Barcelona, Spain. · Centre for Algology & Pain Management, University Hospitals Leuven, Pellenberg, Belgium. · Centre for Pancreatic Diseases, Department of Gastroenterology, Aalborg University Hospital, Denmark. · Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, 21205, USA. · Section of Palliative Medicine, Copenhagen University Hospital, Copenhagen, Denmark. · Division of Gastroenterology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA. · Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, New Zealand. · Medical Surgical Department, School of Nursing, University of Sao Paulo, Brazil. · Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India. ·Pancreatology · Pubmed #29706482.

ABSTRACT: Abdominal pain is an important symptom in most patients with pancreatic ductal adenocarcinoma (PDAC). Adequate control of pain is often unsatisfactory due to limited treatment options and significant variation in local practice, emphasizing the need for a multidisciplinary approach. This review contends that improvement in the management of PDAC pain will result from a synthesis of best practice and evidence around the world in a multidisciplinary way. To improve clinical utility and evaluation, the evidence was rated according to the GRADE guidelines by a group of international experts. An algorithm is presented, which brings together all currently available treatment options. Pain is best treated early on with analgesics with most patients requiring opioids, but neurolytic procedures are often required later in the disease course. Celiac plexus neurolysis offers medium term relief in a substantial number of patients, but other procedures such as splanchnicectomy are also available. Palliative chemotherapy also provides pain relief as a collateral benefit. It is stressed that the assessment of pain must take into account the broader context of other physical and psychological symptoms. Adjunctive treatments for pain, depression and anxiety as well as radiotherapy, endoscopic therapy and neuromodulation may be required in selected patients. There are few comparative studies to help define which combination and order of these treatment options should be applied. New pain therapies are emerging and could for example target neural transmitters. However, until better methods are available, management of pain should be individualized in a multidisciplinary setting to ensure optimal care.

3 Review Does revision of resection margins based on frozen section improve overall survival following pancreatoduodenectomy for pancreatic ductal adenocarcinoma? A meta-analysis. 2017

Barreto, Savio G / Pandanaboyana, Sanjay / Ironside, Natasha / Windsor, John A. ·Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia; School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia. Electronic address: georgebarreto@yahoo.com. · Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. · Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. ·HPB (Oxford) · Pubmed #28420560.

ABSTRACT: BACKGROUND: Margin status is the main surgical determinant of long-term outcome in pancreatic cancer. Intraoperative frozen section (IOFS) detects microscopic positive margins at a stage when margin revision is possible. The aim of this study was to determine if IOFS driven-revision of pancreatic resection margin(s) improves overall survival (OS) in pancreatic cancer. METHODS: A systematic review of major reference databases was undertaken. Patients were divided into 3 groups based on initial FS (FSR0 for negative margin and FSR1 for positive microscopic margin) and final Permanent Section report (PSR0 for negative margin and PSR1 for positive microscopic margin): Group 1 (FSR0 → PSR0), Group 2 (FSR1 → PSR0), and Group 3 (FSR1 → PSR1). Patients in Groups 2 and 3 had surgical revision of the FSR1 margin. Data was meta-analysed. RESULTS: 4 studies included in the final analysis. No difference in OS and incidence of lymph node metastases between Groups 2 and 3 (P = 0.590 and P = 0.410). CONCLUSIONS: IOFS-based revision of R1 pancreatic resection margin does not improve OS, even when it results in an R0 margin. This suggests that any benefit of margin revision based on FS is over-ridden by markers of more advanced or aggressive disease.

4 Review Meta-analysis and cost effective analysis of portal-superior mesenteric vein resection during pancreatoduodenectomy: Impact on margin status and survival. 2017

Bell, Richard / Ao, Braden Te / Ironside, Natasha / Bartlett, Adam / Windsor, John A / Pandanaboyana, Sanjay. ·Department of HPB and Transplant Surgery, St James Hospital, Leeds, UK. · Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand. · HPB/Upper GI Unit, Department of Hepatobiliary and Pancreatic Surgery, Auckland City Hospital, New Zealand. · HPB/Upper GI Unit, Department of Hepatobiliary and Pancreatic Surgery, Auckland City Hospital, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. · HPB/Upper GI Unit, Department of Hepatobiliary and Pancreatic Surgery, Auckland City Hospital, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Electronic address: spandanaboyana@adhb.govt.nz. ·Surg Oncol · Pubmed #28317585.

ABSTRACT: INTRODUCTION: The benefit of portal-superior mesenteric vein resection (PSMVR) with pancreatoduodenectomy (PD) remains controversial. This study assesses the impact of PSMVR on resection margin status and survival. METHOD: An electronic search was performed to identify relevant articles. Pooled odds ratios were calculated for outcomes using the fixed or random-effects models for meta-analysis. A decision analytical model was developed for estimating cost effectiveness. RESULTS: Sixteen studies with 4145 patients who underwent pancreatoduodenectomy were included: 1207 patients had PSMVR and 2938 patients had no PSMVR. The R1 resection rate and post-operative mortality was significantly higher in PSMVR group (OR1.59[1.35, 1.86] p=<0.0001, and OR1.72 [1.02,2.92] p = 0.04 respectively). The overall survival at 5-years was worse in the PSMVR group (HR0.20 [0.07,0.55] P = 0.020). Tumour size (p = 0.030) and perineural invasion (P = 0.009) were higher in the PSMVR group. Not performing PSMVR yielded cost savings of $1617 per additional month alive without reduction in overall outcome. CONCLUSION: On the basis of retrospective data this study shows that PD with PSMVR is associated with a higher R1 rate, lower 5-year survival and is not cost-effective. It appears that PD with PSMVR can only be justified if R0 resection can be achieved. The continuing challenge is accurate selection of these patients.

5 Review Justifying vein resection with pancreatoduodenectomy. 2016

Barreto, Savio G / Windsor, John A. ·Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta-the Medicity, Gurgaon, India. · Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. Electronic address: j.windsor@auckland.ac.nz. ·Lancet Oncol · Pubmed #26972858.

ABSTRACT: Interest in radical surgery to achieve complete resection and improve long-term survival in patients undergoing pancreatoduodenectomy for ductal adenocarcinoma has been renewed. This surgery includes extended lymphadenectomy, multivisceral resections, and synchronous arterial and venous resections. The evidence that these surgeries improve long-term survival is poor, except perhaps for synchronous venous resection, which can be justified if a margin negative (R0) resection is achieved without increased morbidity and mortality, and if there is no invasion of the vein wall. The recognition of patients with borderline resectable pancreatic cancer and the increasing use of neoadjuvant treatment makes it more difficult to know if the vein is invaded, increases reliance on trial dissection to establish resectability, and might increase the number of synchronous venous resections done. This Personal View seeks to review the justification for pancreatoduodenectomy with synchronous venous resection to promote debate and draw attention to the gaps in knowledge for further research.

6 Review Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency. 2016

Anonymous1200855 / Smith, Ross C / Smith, Sarah F / Wilson, Jeremy / Pearce, Callum / Wray, Nick / Vo, Ruth / Chen, John / Ooi, Chee Y / Oliver, Mark / Katz, Tamarah / Turner, Richard / Nikfarjam, Mehrdad / Rayner, Christopher / Horowitz, Michael / Holtmann, Gerald / Talley, Nick / Windsor, John / Pirola, Ron / Neale, Rachel. ·Department of Surgery, University of Sydney, NSW, Australia; Australasian Pancreatic Club, Australia. Electronic address: Ross.smith@sydney.edu.au. · Australasian Pancreatic Club, Australia. · Liverpool Hospital, University of NSW, Australia. · Institute for Immunology and Infectious Diseases, Murdoch University, WA, Australia; Fremantle Hospital, WA, Australia. · Nutrition & Dietetics, School of Health Sciences, Flinders University, Adelaide, SA, Australia. · South Australian Liver Transplant & HPB Unit, RAH & Flinders Medical Centre, SA, Australia. · School of Women's and Children's Health, Dept. of Medicine, University of NSW, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia. · Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, VIC, Australia. · Sydney Children's Hospital, Randwick, NSW, Australia. · Hobart Clinical School and Dept. Surgery, University of Tasmania, Australia. · Dept. Surgery, University of Melbourne, VIC, Australia; Australasian Pancreatic Club, Australia. · School of Medicine, University of Adelaide, SA, Australia; Centre for Digestive Diseases, Royal Adelaide Hospital, SA, Australia. · Endocrine and Metabolic Unit, University of Adelaide and Royal Adelaide Hospital, SA, Australia. · Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia; Translational Research Institute, Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Qld, Australia. · Faculty of Health and Medicine, University of Newcastle, NSW, Australia; Royal Australasian College of Physicians, Australia. · Dept. of Surgery, University of Auckland, New Zealand. · Faculty of Medicine, SW Sydney Clinical School, University of NSW, Australia. · Cancer Control Laboratory, Queensland Institute of Medical Research, Qld, Australia. ·Pancreatology · Pubmed #26775768.

ABSTRACT: AIM: Because of increasing awareness of variations in the use of pancreatic exocrine replacement therapy, the Australasian Pancreatic Club decided it was timely to re-review the literature and create new Australasian guidelines for the management of pancreatic exocrine insufficiency (PEI). METHODS: A working party of expert clinicians was convened and initially determined that by dividing the types of presentation into three categories for the likelihood of PEI (definite, possible and unlikely) they were able to consider the difficulties of diagnosing PEI and relate these to the value of treatment for each diagnostic category. RESULTS AND CONCLUSIONS: Recent studies confirm that patients with chronic pancreatitis receive similar benefit from pancreatic exocrine replacement therapy (PERT) to that established in children with cystic fibrosis. Severe acute pancreatitis is frequently followed by PEI and PERT should be considered for these patients because of their nutritional requirements. Evidence is also becoming stronger for the benefits of PERT in patients with unresectable pancreatic cancer. However there is as yet no clear guide to help identify those patients in the 'unlikely' PEI group who would benefit from PERT. For example, patients with coeliac disease, diabetes mellitus, irritable bowel syndrome and weight loss in the elderly may occasionally be given a trial of PERT, but determining its effectiveness will be difficult. The starting dose of PERT should be from 25,000-40,000 IU lipase taken with food. This may need to be titrated up and there may be a need for proton pump inhibitors in some patients to improve efficacy.

7 Review International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer. 2016

Takaori, Kyoichi / Bassi, Claudio / Biankin, Andrew / Brunner, Thomas B / Cataldo, Ivana / Campbell, Fiona / Cunningham, David / Falconi, Massimo / Frampton, Adam E / Furuse, Junji / Giovannini, Marc / Jackson, Richard / Nakamura, Akira / Nealon, William / Neoptolemos, John P / Real, Francisco X / Scarpa, Aldo / Sclafani, Francesco / Windsor, John A / Yamaguchi, Koji / Wolfgang, Christopher / Johnson, Colin D / Anonymous8441108. ·Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: takaori@kuhp.kyoto-u.ac.jp. · Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy. · Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom. · Department of Radiation Oncology, University Hospitals Freiburg, Germany. · Department of Pathology and Diagnostics, University of Verona, Verona, Italy. · Department of Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom. · Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. · Pancreatic Surgery Unit, Università Vita e Salute, Milano, Italy. · HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, United Kingdom. · Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan. · Endoscopic Unit, Paoli-Calmettes Institute, Marseille, France. · NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom. · Department of Radiation Oncology and Image-applied Therapy, Kyoto University Hospital, Kyoto, Japan. · Division of General Surgery, Yale University, New Haven, CT, United States of America. · Epithelial Carcinogenesis Group, CNIO-Spanish National Cancer Research Centre, Madrid, Spain. · Department of Surgery, University of Auckland, HBP/Upper GI Unit, Auckland City Hospital, Auckland, New Zealand. · Department of Advanced Treatment of Pancreatic Disease, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. · Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States of America. · University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom. ·Pancreatology · Pubmed #26699808.

ABSTRACT: BACKGROUND: Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies. METHODS: A panel of expert pancreatologists gathered at the 46th European Pancreatic Club Meeting combined with the 18th International Association of Pancreatology Meeting and collaborated on critical reviews of eight English language guidelines for the clinical management of pancreatic cancer. Clinical questions (CQs) of interest were proposed by specialists in each of nine areas. The recommendations for the CQs in existing guidelines, as well as the evidence on which these were based, were reviewed and compared. The evidence was graded as sufficient, mediocre or poor/absent. RESULTS: Only 4 of the 36 CQs, had sufficient evidence for agreement. There was also agreement in five additional CQs despite the lack of sufficient evidence. In 22 CQs, there was disagreement regardless of the presence or absence of evidence. There were five CQs that were not addressed adequately by existing guidelines. CONCLUSION: The existing guidelines provide both evidence- and consensus-based recommendations. There is also considerable disagreement about the recommendations in part due to the lack of high level evidence. Improving the clinical management of patients with pancreatic cancer, will require continuing efforts to undertake research that will provide sufficient evidence to allow agreement.

8 Review Artery first approach to pancreatoduodenectomy: current status. 2016

Pandanaboyana, Sanjay / Bell, Richard / Windsor, John. ·HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. · Department of Hepatobiliary and Pancreatic Surgery, St James Hospital, Leeds, UK. ·ANZ J Surg · Pubmed #26246127.

ABSTRACT: BACKGROUND: The need for an early determination of resectability and before an irreversible step is taken during pancreatoduodenectomy promoted the development of an 'artery first approach' (AFA). The aim of this study was to review the current evidence related to this approach, with particular reference to margins and survival. METHODS: An electronic search was performed in MEDLINE, EMBASE and PubMed databases from 1960 to 2015 using both subject headings (MeSH) and truncated word searches to identify all published related articles to this topic. RESULTS: Six different AFAs have been published. Four studies evaluated the impact of AFA on perioperative outcomes and survival. Three studies showed no difference in the perioperative outcomes, margin status, lymph node yield and survival while one study showed improved margin status and survival comparing AFA with standard resection. CONCLUSION: The current evidence regarding the benefits of AFA in relation to decreasing margin positivity or increasing survival is sparse. Further larger studies and randomized controlled trails are needed to ascertain the benefits of AFA.

9 Review Meta-analysis of antecolic versus retrocolic gastric reconstruction after a pylorus-preserving pancreatoduodenectomy. 2015

Bell, Richard / Pandanaboyana, Sanjay / Shah, Nehal / Bartlett, Adam / Windsor, John A / Smith, Andrew M. ·Department of HPB Surgery, St James University Hospital, Leeds, UK. ·HPB (Oxford) · Pubmed #25267428.

ABSTRACT: INTRODUCTION: Delayed gastric emptying (DGE) is a common complication after a pylorus-preserving pancreatoduodenectomy (PPPD) and is associated with significant morbidity. This study determines whether DGE is affected by antecolic (AC) or retrocolic (RC) reconstruction after a PPPD. METHOD: An electronic search was performed of the MEDLINE, EMBASE and PubMed databases to identify all articles related to this topic. Pooled risk ratios (RR) were calculated for categorical outcomes, and mean differences (MD) for secondary continuous outcomes using the fixed-effects and random-effects models for meta-analysis. RESULTS: Nine studies including 878 patients met the inclusion criteria. DGE was lower with an AC reconstruction RR 0.31 [0.12, 0.78] Z = 2.47 (P = 0.010). Length of stay (LOS) MD -4 days [-7.63, -1.14] Z = 2.65 (P = 0.008) and days to commence a solid diet MD -5 days [-6.63, -3.15] Z = 5.50 (P ≤ 0.000) were also significantly in favour of the AC group. There was no difference in the incidence of pancreatic fistula, intra-abdominal collection/bile leak or mortality between the two groups. CONCLUSION: AC reconstruction after PPPD is associated with a lower incidence of DGE. Time to oral intake was significantly shorter with AC reconstruction, with a reduced hospital stay.

10 Review Factors that affect risk for pancreatic disease in the general population: a systematic review and meta-analysis of prospective cohort studies. 2014

Alsamarrai, Ammar / Das, Stephanie L M / Windsor, John A / Petrov, Maxim S. ·Department of Surgery, University of Auckland, Auckland, New Zealand. · Department of Surgery, University of Auckland, Auckland, New Zealand. Electronic address: max.petrov@gmail.com. ·Clin Gastroenterol Hepatol · Pubmed #24509242.

ABSTRACT: BACKGROUND & AIMS: Pancreatic diseases place significant burdens on health care systems worldwide. However, there is lack of agreement about which factors increase or reduce risk for pancreatic disease. We reviewed high-quality studies of factors that affect risk for pancreatic diseases in the general population. METHODS: We searched 3 databases (Medline, Embase, and Scopus) for prospective cohort studies of modifiable risk and/or protective factors for acute pancreatitis, chronic pancreatitis, and pancreatic cancer in adult populations. Factors that were investigated in 2 or more studies were assessed by meta-analysis if the required data were available. Subgroup analyses were performed when appropriate. Outcome measures were relative risk (RR) and 95% confidence interval (CI). RESULTS: Our analysis included 51 population-based studies with more than 3 million individuals and nearly 11,000 patients with pancreatic diseases. A total of 31 different factors were investigated. Current tobacco use was the single most important risk factor for pancreatic diseases (RR, 1.87; 95% CI, 1.54-2.27), followed by obesity (RR, 1.48; 95% CI, 1.15-1.92) and heavy use of alcohol (RR, 1.37; 95% CI, 1.19-1.58). Tobacco and heavy use of alcohol had bigger effects on risk of acute pancreatitis and chronic pancreatitis than pancreatic cancer. Vegetable consumption (RR, 0.71; 95% CI, 0.57-0.88) and fruit consumption (RR, 0.73; 95% CI, 0.60-0.90) provided the greatest degree of protection against pancreatic diseases on the basis of meta-analyses. Vegetable consumption had stronger association with protection against acute pancreatitis and fruit consumption with protection against pancreatic cancer. CONCLUSIONS: On the basis of systematic review and meta-analysis, current tobacco use, obesity, and heavy use of alcohol are associated with significant increases in risk for pancreatic diseases. Vegetables and fruit consumption are associated with reduced risk for pancreatic diseases. Prevention strategies for acute pancreatitis, chronic pancreatitis, and pancreatic cancer should consider these factors.

11 Review 'Artery-first' approaches to pancreatoduodenectomy. 2012

Sanjay, P / Takaori, K / Govil, S / Shrikhande, S V / Windsor, J A. ·Hepatopancreatobiliary/Upper Gastrointestinal Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. ·Br J Surg · Pubmed #22569924.

ABSTRACT: BACKGROUND: The technique of pancreatoduodenectomy (PD) has evolved. Previously, non-resectability was determined by involvement of the portal vein-superior mesenteric vein. Because venous resection can be achieved safely and with greater awareness of the prognostic significance of the status of the posteromedial resection margin, non-resectability is now determined by involvement of the superior mesenteric artery (SMA). This change, with a need for early determination of resectability before an irreversible step, has promoted the development of an 'artery-first' approach. The aim of this study was to review, and illustrate, this approach. METHODS: An electronic search was performed on MEDLINE, Embase and PubMed databases from 1960 to 2011 using both medical subject headings and truncated word searches to identify all published articles that related to this topic. RESULTS: The search revealed six different surgical approaches that can be considered as 'artery first'. These involved approaching the SMA from the retroperitoneum (posterior approach), the uncinate process (medial uncinate approach), the infracolic region medial to the duodenojejunal flexure (inferior infracolic or mesenteric approach), the infracolic retroperitoneum lateral to the duodenojenunal flexure (left posterior approach), the supracolic region (inferior supracolic approach) and through the lesser sac (superior approach). CONCLUSION: The six approaches described provide a range of options for the early determination of arterial involvement, depending on the location and size of the tumour, and before the 'point of no return'. Whether these approaches will achieve an increase in the proportion of patients with negative margins, improve locoregional control and increase long-term survival has yet to be determined.

12 Article Biomarkers Urgently Needed to Advance Treatment Decisions for Pancreatic Ductal Adenocarcinoma. 2019

Windsor, John A. ·Department of Surgery, University of Auckland, Auckland, New Zealand. · Hepatopancreatobiliary and Upper Gastrointestinal Unit, Department of General Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand. ·JAMA Surg · Pubmed #30942878.

ABSTRACT: -- No abstract --

13 Article Patient characteristics and clinical outcomes following initial surgical intervention for MEN1 associated pancreatic neuroendocrine tumours: A systematic review and exploratory meta-analysis of the literature. 2019

Ratnayake, Chathura Bathiya Bandara / Loveday, Benjamin Pt / Windsor, John Albert / Lawrence, Benjamin / Pandanaboyana, Sanjay. ·Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. · Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. · Regional Cancer and Blood Service, Auckland City Hospital, Auckland, New Zealand; Discipline of Oncology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. · Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. Electronic address: spandanaboyana@adhb.govt.nz. ·Pancreatology · Pubmed #30894303.

ABSTRACT: BACKGROUND: This systematic review aimed to define the outcomes of different pancreatic resection procedures for multiple endocrine neoplasia type 1 (MEN1) associated pancreatic neuroendocrine neoplasms (pNENs). METHODS: A search of PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. RESULTS: Twenty-seven studies including 533 patients undergoing initial pancreatic resection for MEN1 associated pNENs were included in this systematic review. Three hundred and sixty-six (68.7%) distal pancreatectomies (DP), 120 (22.5%) sole enucleations (SE) and 47 (8.8%) pancreaticoduodenectomies (PD) were identified. SE was associated with a higher rate of recurrence than DP (25/67, 37% vs 40/190, 21% respectively, P = 0.008) but a lower rate of endocrine insufficiency than PD (1/20, 5% vs 8/21, 38% respectively, P = 0.010). A meta-analysis of major pancreatic resections (PD or DP) vs SE in 15 studies showed that SE is associated with an increased rate of recurrence (Major resection 42/184, 23% vs SE 20/53, 38% RR 0.65 CI 0.43-0.96 P = 0.032) but reduced rate of postoperative endocrine insufficiency (Resection 37/93, 40% vs SE 0/24, 0% RR 7.37 CI 1.57-34.64 P = 0.008). Similarly, insulinomas and functional pNENs overall had lower rates of recurrence and reoperation with major resection. There was no difference in the reoperation rates or survival outcomes after SE compared with major pancreatic resections at follow-up (pooled overall mean duration: 85 months). CONCLUSION: Major pancreatic resections for MEN1 associated pNENs have a lower risk of recurrence and a higher risk of postoperative endocrine insufficiency when compared to sole enucleation, but a similar rate of reoperation and survival.

14 Article Impact of preoperative sarcopenia on postoperative outcomes following pancreatic resection: A systematic review and meta-analysis. 2018

Ratnayake, Chathura Bb / Loveday, Benjamin Pt / Shrikhande, Shailesh V / Windsor, John A / Pandanaboyana, Sanjay. ·Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. · Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. · Department of GI and HPB Surgical Oncology, Tata Memorial Centre, Mumbai, India. · Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. Electronic address: spandanaboyana@adhb.govt.nz. ·Pancreatology · Pubmed #30287167.

ABSTRACT: BACKGROUND: Morphometric analysis of sarcopenia has garnered interest due to its putative role in predicting outcomes following surgery for a variety of pathologies, including resection for pancreatic disease. However, there are no standard recommendations on whether sarcopenia is a clinically relevant predictor of outcomes in this setting. The aim of this study was to review the prognostic impact of preoperatively diagnosed sarcopenia on postoperative outcomes following pancreatic resection. METHODS: A systematic review of published literature was performed using PRISMA guidelines, and included a search of PubMed, MEDLINE and SCOPUS databases until May 2018. RESULTS: Thirteen studies, including 3608 patients, were included. There was a significant increase in the mean duration of post-operative hospital stay (mean difference of 0.73 days, CI: 0.06-1.40, P = 0.033), there was no difference in the postoperative outcomes, including: clinically relevant postoperative pancreatic fistula, delayed gastric emptying, post-operative bile leak, surgical site infection, significant morbidity and overall morbidity. CONCLUSION: Preoperative sarcopenia is associated with prolonged hospital stay after pancreatic surgery. However, sarcopenia does not appear to be a significant negative predictive factor in postoperative morbidity although study heterogeneity and risk of bias limit the strength of these conclusions.

15 Article Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival. 2018

Ironside, N / Barreto, S G / Loveday, B / Shrikhande, S V / Windsor, J A / Pandanaboyana, S. ·Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. · Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia. · School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia. · Hepatobiliary and Pancreatic Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. · Gastrointestinal and Hepatopancreatobiliary Unit, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India. ·Br J Surg · Pubmed #29652079.

ABSTRACT: BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate perioperative outcomes and survival in patients undergoing an artery-first approach to pancreatoduodenectomy in comparison with those having standard pancreatoduodenectomy. METHODS: A systematic search of PubMed, MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed in accordance with PRISMA guidelines. Comparative studies including patients who underwent artery-first pancreatoduodenectomy and standard pancreatoduodenectomy were analysed. RESULTS: Seventeen studies were included in the final analysis. There were 16 retrospective cohort or case-control studies and one RCT. A total of 1472 patients were included in the meta-analysis, of whom 771 underwent artery-first pancreatoduodenectomy and 701 had standard pancreatoduodenectomy. Intraoperative blood loss (mean difference -389 ml; P < 0·001) and the proportion of patients requiring intraoperative transfusion (10·6 per cent (54 of 508) versus 40·1 per cent (186 of 464); P < 0·001) were significantly lower in the artery-first group. Although rates of perioperative mortality were comparable between the two groups, perioperative morbidity (35·5 per cent (263 of 741) versus 44·3 per cent (277 of 625); P = 0·002), and the incidence of grade B/C pancreatic fistula (7·4 per cent (26 of 353) versus 12·8 per cent (42 of 327); P = 0·031) were significantly lower in the artery-first group. The R0 resection rate (75·8 per cent (269 of 355) versus 67·0 per cent (280 of 418); P < 0·001) and overall survival (hazard ratio 0·72, 95 per cent c.i. 0·60 to 0·87; P < 0·001) were significantly higher in the artery-first group. CONCLUSION: The artery-first approach to pancreatoduodenectomy may be associated with improved perioperative outcomes and survival.

16 Article Preoperative biliary drainage in resectable pancreatic cancer: a systematic review and network meta-analysis. 2018

Lee, Peter J / Podugu, Amareshwar / Wu, Dong / Lee, Arier C / Stevens, Tyler / Windsor, John A. ·Department of Gastroenterology and Hepatology, Digestive Health Institute, University Hospitals Cleveland Medical Center, OH, USA. Electronic address: Peter.Lee@uhhospitals.org. · Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Florida, Florida, OH, USA. · Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. · Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand. · Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, OH, USA. · Department of Surgery, The University of Auckland, Auckland, New Zealand. ·HPB (Oxford) · Pubmed #29526466.

ABSTRACT: BACKGROUND: Controversy remains about the best pre-operative management of jaundice in patients with resectable pancreatic head cancer (RPC) undergoing planned pancreaticoduodenectomy (PD). OBJECTIVE: The aim of this study was to compare rates of post-operative complications in patients undergoing four pre-operative approaches (POA): preoperative biliary drainage with plastic stent (PBD-PS), metal stent (PBD-MS), and percutaneous transhepatic drain (PBD-PT), or no pre-operative biliary drainage (NPBD). METHOD: A study was included in the systematic review if it assessed the effects of PBD on post-operative outcomes in jaundiced patients with RPC. Endpoints were the rate of any post-operative complication, wound infection, intra-abdominal infection and post-operative bleeding. A network meta-analysis (NMA) was performed to rank the POAs from the best to worst, for each outcome. RESULTS: Thirty-two studies were included in the systematic review. Ten out of 32 studies included in the systematic review reported at least one of the 4 outcomes of interest and thus were used for NMA. The calculated odds ratios and P-scores ranked NPBD as the best approach. There was insufficient evidence to determine the best modality of PBD among PBD-PS, PBD-MS and PBD-PT. CONCLUSIONS: No preoperative biliary drainage may be the best management of preoperative jaundice in patients with RPC before PD. Further studies are needed to determine the best modality in patients that need PBD.

17 Article International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. 2018

Isaji, Shuji / Mizuno, Shugo / Windsor, John A / Bassi, Claudio / Fernández-Del Castillo, Carlos / Hackert, Thilo / Hayasaki, Aoi / Katz, Matthew H G / Kim, Sun-Whe / Kishiwada, Masashi / Kitagawa, Hirohisa / Michalski, Christoph W / Wolfgang, Christopher L. ·Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Japan. Electronic address: shujiisaji1@mac.com. · Hepatobiliary-Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Japan. · HBP/Upper GI Unit, Auckland City Hospital/Department of Surgery, University of Auckland, New Zealand. · Pancreas Surgery Unit, Pancreas Institute, Verona University Hospital, Verona, Italy. · Department of General and Gastrointestinal Surgery, Massachusetts General Hospital/Harvard Medical School, USA. · Department of Surgery, University of Heidelberg, Germany. · Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, USA. · Department of Surgery, Seoul National University Hospital, South Korea. · Department of Gastroenterologic Surgery, Toyama City Hospital/Department of Gastroenterological Surgery, Kanazawa University, Japan. · Department of Surgery, Johns Hopkins University School of Medicine, USA. ·Pancreatology · Pubmed #29191513.

ABSTRACT: This statement was developed to promote international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) which was adopted by the National Comprehensive Cancer Network (NCCN) in 2006, but which has changed yearly and become more complicated. Based on a symposium held during the 20th meeting of the International Association of Pancreatology (IAP) in Sendai, Japan, in 2016, the presenters sought consensus on issues related to BR-PDAC. We defined patients with BR-PDAC according to the three distinct dimensions: anatomical (A), biological (B), and conditional (C). Anatomic factors include tumor contact with the superior mesenteric artery and/or celiac artery of less than 180° without showing stenosis or deformity, tumor contact with the common hepatic artery without showing tumor contact with the proper hepatic artery and/or celiac artery, and tumor contact with the superior mesenteric vein and/or portal vein including bilateral narrowing or occlusion without extending beyond the inferior border of the duodenum. Biological factors include potentially resectable disease based on anatomic criteria but with clinical findings suspicious for (but unproven) distant metastases or regional lymph nodes metastases diagnosed by biopsy or positron emission tomography-computed tomography. This also includes a serum carbohydrate antigen (CA) 19-9 level more than 500 units/ml. Conditional factors include the patients with potentially resectable disease based on anatomic and biologic criteria and with Eastern Cooperative Oncology Group (ECOG) performance status of 2 or more. The definition of BR-PDAC requires one or more positive dimensions (e.g. A, B, C, AB, AC, BC or ABC). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumor and vessels, but that biological and conditional dimensions are also important. The aim in presenting this consensus definition is also to highlight issues which remain controversial and require further research.

18 Article Borderline Resectable Pancreatic Cancer: Answering the Most Important Question First. 2016

Windsor, John A. ·Faculty of Medical and Health Sciences, Department of Surgery, University of Auckland, Auckland, New Zealand. ·JAMA Surg · Pubmed #27276510.

ABSTRACT: -- No abstract --

19 Article Total pancreatectomy and islet autotransplantation in chronic pancreatitis: recommendations from PancreasFest. 2014

Bellin, Melena D / Freeman, Martin L / Gelrud, Andres / Slivka, Adam / Clavel, Alfred / Humar, Abhinav / Schwarzenberg, Sarah J / Lowe, Mark E / Rickels, Michael R / Whitcomb, David C / Matthews, Jeffrey B / Anonymous9700785 / Amann, Stephen / Andersen, Dana K / Anderson, Michelle A / Baillie, John / Block, Geoffrey / Brand, Randall / Chari, Suresh / Cook, Marie / Cote, Gregory A / Dunn, Ty / Frulloni, Luca / Greer, Julia B / Hollingsworth, Michael A / Kim, Kyung Mo / Larson, Alexander / Lerch, Markus M / Lin, Tom / Muniraj, Thiruvengadam / Robertson, R Paul / Sclair, Seth / Singh, Shalinender / Stopczynski, Rachelle / Toledo, Frederico G S / Wilcox, Charles Melbern / Windsor, John / Yadav, Dhiraj. ·Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. Electronic address: bell0130@umn.edu. · Department of Medicine, University of Minnesota, Minneapolis, MN, USA. · Department of Medicine, University of Chicago, Chicago, IL, USA. · Department of Medicine, University of Pittsburgh, PA, USA. · Department of Neurology, University of Minnesota, Minneapolis, MN, USA. · Department of Surgery, University of Pittsburgh, PA, USA. · Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. · Department of Pediatrics, University of Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, PA, USA. · Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. · Department of Medicine, University of Pittsburgh, PA, USA. Electronic address: whitcomb@pitt.edu. · Department of Surgery, University of Chicago, Chicago, IL, USA. ·Pancreatology · Pubmed #24555976.

ABSTRACT: DESCRIPTION: Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical procedure used to treat severe complications of chronic pancreatitis or very high risk of pancreatic cancer while reducing the risk of severe diabetes mellitus. However, clear guidance on indications, contraindications, evaluation, timing, and follow-up are lacking. METHODS: A working group reviewed the medical, psychological, and surgical options and supporting literature related to TPIAT for a consensus meeting during PancreasFest. RESULTS: Five major areas requiring clinical evaluation and management were addressed: These included: 1) indications for TPIAT; 2) contraindications for TPIAT; 3) optimal timing of the procedure; 4) need for a multi-disciplinary team and the roles of the members; 5) life-long management issues following TPIAP including diabetes monitoring and nutrition evaluation. CONCLUSIONS: TPIAT is an effective method of managing the disabling complications of chronic pancreatitis and risk of pancreatic cancer in very high risk patients. Careful evaluation and long-term management of candidate patients by qualified multidisciplinary teams is required. Multiple recommendations for further research were also identified.

20 Minor Re: Is there an alternative to centralization for pancreatic resection in New Zealand? 2016

Windsor, John A / Pandanaboyana, Sanjay / Bartlett, Adam S J R. ·HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. · Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. ·ANZ J Surg · Pubmed #27586576.

ABSTRACT: -- No abstract --

21 Minor Justifying vein resection with pancreatoduodenectomy - Author's reply. 2016

Barreto, Savio G / Windsor, John A. ·Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India. · Hepatobiliary Pancreatic and Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand. Electronic address: j.windsor@auckland.ac.nz. ·Lancet Oncol · Pubmed #27301042.

ABSTRACT: -- No abstract --