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Lucocq J, Hawkyard J, Haugk B, Mownah O, Menon K, Furukawa T, Inoue Y, Hirose Y, Sasahira N, Feretis M, Balakrishnan A, Ceresa C, Davidson B, Pande R, Dasari B, Tanno L, Karavias D, Helliwell J, Young A, Nunes Q, Urbonas T, Silva M, Gordon-Weeks A, Barrie J, Gomez D, Van Laarhoven S, Robertson F, Nawara H, Doyle J, Bhogal R, Harrison E, Roalso M, Ciprani D, Aroori S, Ratnayake B, Koea J, Capurso G, Bellotti R, Stättner S, Alsaoudi T, Bhardwaj N, Rajesh S, Jeffery F, Connor S, Cameron A, Jamieson N, Sheen A, Mittal A, Samra J, Gill A, Roberts K, Søreide K, Pandanaboyana S. Adjuvant chemotherapy for adenocarcinoma arising from intraductal papillary mucinous neoplasia: multicentre ADENO-IPMN study. Br J Surg 2024; 111:znae100. [PMID: 38659247 DOI: 10.1093/bjs/znae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The clinical impact of adjuvant chemotherapy after resection for adenocarcinoma arising from intraductal papillary mucinous neoplasia is unclear. The aim of this study was to identify factors related to receipt of adjuvant chemotherapy and its impact on recurrence and survival. METHODS This was a multicentre retrospective study of patients undergoing pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasia between January 2010 and December 2020 at 18 centres. Recurrence and survival outcomes for patients who did and did not receive adjuvant chemotherapy were compared using propensity score matching. RESULTS Of 459 patients who underwent pancreatic resection, 275 (59.9%) received adjuvant chemotherapy (gemcitabine 51.3%, gemcitabine-capecitabine 21.8%, FOLFIRINOX 8.0%, other 18.9%). Median follow-up was 78 months. The overall recurrence rate was 45.5% and the median time to recurrence was 33 months. In univariable analysis in the matched cohort, adjuvant chemotherapy was not associated with reduced overall (P = 0.713), locoregional (P = 0.283) or systemic (P = 0.592) recurrence, disease-free survival (P = 0.284) or overall survival (P = 0.455). Adjuvant chemotherapy was not associated with reduced site-specific recurrence. In multivariable analysis, there was no association between adjuvant chemotherapy and overall recurrence (HR 0.89, 95% c.i. 0.57 to 1.40), disease-free survival (HR 0.86, 0.59 to 1.30) or overall survival (HR 0.77, 0.50 to 1.20). Adjuvant chemotherapy was not associated with reduced recurrence in any high-risk subgroup (for example, lymph node-positive, higher AJCC stage, poor differentiation). No particular chemotherapy regimen resulted in superior outcomes. CONCLUSION Chemotherapy following resection of adenocarcinoma arising from intraductal papillary mucinous neoplasia does not appear to influence recurrence rates, recurrence patterns or survival.
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MESH Headings
- Humans
- Female
- Male
- Retrospective Studies
- Aged
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/therapy
- Pancreatic Neoplasms/surgery
- Chemotherapy, Adjuvant
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Pancreatectomy
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/therapy
- Adenocarcinoma, Mucinous/mortality
- Gemcitabine
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/therapeutic use
- Deoxycytidine/administration & dosage
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/mortality
- Carcinoma, Pancreatic Ductal/drug therapy
- Carcinoma, Pancreatic Ductal/therapy
- Carcinoma, Pancreatic Ductal/surgery
- Capecitabine/administration & dosage
- Capecitabine/therapeutic use
- Pancreatic Intraductal Neoplasms/pathology
- Pancreatic Intraductal Neoplasms/therapy
- Pancreatic Intraductal Neoplasms/mortality
- Pancreatic Intraductal Neoplasms/surgery
- Adenocarcinoma/pathology
- Adenocarcinoma/drug therapy
- Adenocarcinoma/mortality
- Adenocarcinoma/therapy
- Propensity Score
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Affiliation(s)
- James Lucocq
- Department of General Surgery, NHS Lothian, Edinburgh, UK
| | - Jake Hawkyard
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Beate Haugk
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Omar Mownah
- Department of Hepatobiliary and Pancreatic Surgery, King's College Hospital, London, UK
| | - Krishna Menon
- Department of Hepatobiliary and Pancreatic Surgery, King's College Hospital, London, UK
| | - Takaki Furukawa
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Inoue
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuki Hirose
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Sasahira
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Michael Feretis
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Anita Balakrishnan
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Carlo Ceresa
- Hepatobiliary and Pancreatic Surgery Unit, Royal Free Hospital, London, UK
| | - Brian Davidson
- Hepatobiliary and Pancreatic Surgery Unit, Royal Free Hospital, London, UK
| | - Rupaly Pande
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Bobby Dasari
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Lulu Tanno
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Dimitrios Karavias
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Jack Helliwell
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alistair Young
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Quentin Nunes
- Department of Hepatopancreatobiliary Surgery, East Lancashire Teaching Hospitals NHS Trust, Blackburn, UK
| | - Tomas Urbonas
- Oxford Hepato-Pancreato-Biliary Surgical Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael Silva
- Oxford Hepato-Pancreato-Biliary Surgical Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Gordon-Weeks
- Oxford Hepato-Pancreato-Biliary Surgical Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jenifer Barrie
- Nottingham Hepato-Pancreatico-Biliary Service, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Dhanny Gomez
- Nottingham Hepato-Pancreatico-Biliary Service, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Stijn Van Laarhoven
- Department of General Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Francis Robertson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hossain Nawara
- Department of General Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Joseph Doyle
- Gastrointestinal Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Ricky Bhogal
- Gastrointestinal Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Ewen Harrison
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Marcus Roalso
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Debora Ciprani
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Somaiah Aroori
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Bathiya Ratnayake
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, New Zealand
| | - Jonathan Koea
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, New Zealand
| | - Gabriele Capurso
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Ruben Bellotti
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Tareq Alsaoudi
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Neil Bhardwaj
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Srujan Rajesh
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fraser Jeffery
- Department of General and Vascular Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Saxon Connor
- Department of General and Vascular Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Andrew Cameron
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Nigel Jamieson
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Amy Sheen
- New South Wales Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Department of Hepatopancreatobiliary Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jas Samra
- Department of Hepatopancreatobiliary Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anthony Gill
- New South Wales Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Hepatopancreatobiliary Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Keith Roberts
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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2
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Lucocq J, Halle-Smith J, Haugk B, Joseph N, Hawkyard J, Lye J, Parkinson D, White S, Mownah O, Zen Y, Menon K, Furukawa T, Inoue Y, Hirose Y, Sasahira N, Mittal A, Samra J, Sheen A, Feretis M, Balakrishnan A, Ceresa C, Davidson B, Pande R, Dasari BVM, Tanno L, Karavias D, Helliwell J, Young A, Marks K, Nunes Q, Urbonas T, Silva M, Gordon-Weeks A, Barrie J, Gomez D, van Laarhoven S, Nawara H, Doyle J, Bhogal R, Harrison E, Roalso M, Ciprani D, Aroori S, Ratnayake B, Koea J, Capurso G, Bellotti R, Stättner S, Alsaoudi T, Bhardwaj N, Rajesh S, Jeffery F, Connor S, Cameron A, Jamieson N, Soreide K, Gill AJ, Roberts K, Pandanaboyana S. Long-term Outcomes following Resection of Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasm (A-IPMN) versus Pancreatic Ductal Adenocarcinoma (PDAC): A Propensity-score Matched Analysis. Ann Surg 2024:00000658-990000000-00822. [PMID: 38516777 DOI: 10.1097/sla.0000000000006272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE The aim of the present study was to compare long-term post-resection oncological outcomes between A-IPMN and PDAC. SUMMARY BACKGROUND DATA Knowledge of long term oncological outcomes (e.g recurrence and survival data) comparing between adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) and pancreatic ductal adenocarcinoma (PDAC) is scarce. METHODS Patients undergoing pancreatic resection (2010-2020) for A-IPMN were identified retrospectively from 18 academic pancreatic centres and compared with PDAC patients from the same time-period. Propensity-score matching (PSM) was performed and survival and recurrence were compared between A-IPMN and PDAC. RESULTS 459 A-IPMN patients (median age,70; M:F,250:209) were compared with 476 PDAC patients (median age,69; M:F,262:214). A-IPMN patients had lower T-stage, lymphovascular invasion (51.4%vs. 75.6%), perineural invasion (55.8%vs. 71.2%), lymph node positivity (47.3vs. 72.3%) and R1 resection (38.6%vs. 56.3%) compared to PDAC(P<0.001). The median survival and time-to-recurrence for A-IPMN versus PDAC were 39.0 versus19.5months (P<0.001) and 33.1 versus 14.8months (P<0.001), respectively (median follow-up,78 vs.73 months). Ten-year overall survival for A-IPMN was 34.6%(27/78) and PDAC was 9%(6/67). A-IPMN had higher rates of peritoneal (23.0 vs. 9.1%, P<0.001) and lung recurrence (27.8% vs. 15.6%, P<0.001) but lower rates of locoregional recurrence (39.7% vs. 57.8%; P<0.001). Matched analysis demonstrated inferior overall survival (P=0.005), inferior disease-free survival (P=0.003) and higher locoregional recurrence (P<0.001) in PDAC compared to A-IPMN but no significant difference in systemic recurrence rates (P=0.695). CONCLUSIONS PDACs have inferior survival and higher recurrence rates compared to A-IPMN in matched cohorts. Locoregional recurrence is higher in PDAC but systemic recurrence rates are comparable and constituted by their own distinctive site-specific recurrence patterns.
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Affiliation(s)
| | - James Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Beate Haugk
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Nejo Joseph
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jake Hawkyard
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jonathan Lye
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Daniel Parkinson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Steve White
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Omar Mownah
- Department of Hepatobiliary & Pancreatic Surgery, King's College Hospital, Denmark Hill, London, UK
| | - Yoh Zen
- Department of Hepatobiliary & Pancreatic Surgery, King's College Hospital, Denmark Hill, London, UK
| | - Krishna Menon
- Department of Hepatobiliary & Pancreatic Surgery, King's College Hospital, Denmark Hill, London, UK
| | - Takaki Furukawa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Yosuke Inoue
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Yuki Hirose
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Naoki Sasahira
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | | | - Jas Samra
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Amy Sheen
- New South Wales Health Pathology, Dept of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michael Feretis
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Anita Balakrishnan
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Carlo Ceresa
- HPB and Liver Transplant Surgery, Royal Free London NHS Foundation Trust
| | - Brian Davidson
- HPB and Liver Transplant Surgery, Royal Free London NHS Foundation Trust
| | - Rupaly Pande
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Bobby V M Dasari
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Lulu Tanno
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Dimitrios Karavias
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Jack Helliwell
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alistair Young
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Marks
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Quentin Nunes
- Department of Hepatopancreatobiliary Surgery, East Lancashire Teaching Hospitals NHS Trust, UK
| | - Tomas Urbonas
- Oxford Hepato-Pancreato-Biliary (HPB) surgical unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Michael Silva
- Oxford Hepato-Pancreato-Biliary (HPB) surgical unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Alex Gordon-Weeks
- Oxford Hepato-Pancreato-Biliary (HPB) surgical unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jenifer Barrie
- Nottingham Hepato-Pancreatico-Biliary (HPB) Service, Nottingham University Hospitals NHS Foundation Trust, UK
| | - Dhanny Gomez
- Nottingham Hepato-Pancreatico-Biliary (HPB) Service, Nottingham University Hospitals NHS Foundation Trust, UK
| | - Stijn van Laarhoven
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Bristol & Weston NHS Foundation trust, UK
| | - Hossam Nawara
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Bristol & Weston NHS Foundation trust, UK
| | - Joseph Doyle
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ricky Bhogal
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ewen Harrison
- Department of Clinical Surgery, University of Edinburgh, UK
| | - Marcus Roalso
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway
| | - Debora Ciprani
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Somaiah Aroori
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Bathiya Ratnayake
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, NZ
| | - Jonathan Koea
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, NZ
| | - Gabriele Capurso
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Ruben Bellotti
- Department of Visceral, Transplant and Thoracic Surgery, Centre of Operative Medicine, Medical University of Innsbrusk, 6020 Innsbruck, Austria
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Centre of Operative Medicine, Medical University of Innsbrusk, 6020 Innsbruck, Austria
| | - Tareq Alsaoudi
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, UK
| | - Neil Bhardwaj
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, UK
| | - Srujan Rajesh
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, UK
| | - Fraser Jeffery
- Department of General and Vascular Surgery, Christchurch Hospital, Canterbury District Health Board, NZ
| | - Saxon Connor
- Department of General and Vascular Surgery, Christchurch Hospital, Canterbury District Health Board, NZ
| | - Andrew Cameron
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, UK
| | - Nigel Jamieson
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, UK
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway
- Department of HPB surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anthony J Gill
- Royal North Shore Hospital, Sydney, NSW, Australia
- New South Wales Health Pathology, Dept of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney NSW Australia
| | - Keith Roberts
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
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3
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Lucocq J, Hawkyard J, Robertson FP, Haugk B, Lye J, Parkinson D, White S, Mownah O, Zen Y, Menon K, Furukawa T, Inoue Y, Hirose Y, Sasahira N, Feretis M, Balakrishnan A, Zelga P, Ceresa C, Davidson B, Pande R, Dasari B, Tanno L, Karavias D, Helliwell J, Young A, Nunes Q, Urbonas T, Silva M, Gordon-Weeks A, Barrie J, Gomez D, van Laarhoven S, Doyle J, Bhogal R, Harrison E, Roalso M, Ciprani D, Aroori S, Ratnayake B, Koea J, Capurso G, Bellotti R, Stättner S, Alsaoudi T, Bhardwaj N, Jeffery F, Connor S, Cameron A, Jamieson N, Sheen A, Mittal A, Samra J, Gill A, Roberts K, Soreide K, Pandanaboyana S. Risk of Recurrence after Surgical Resection for Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasia (IPMN) with Patterns of Distribution and Treatment: An International, Multicentre, Observational Study. Ann Surg 2023:00000658-990000000-00688. [PMID: 37873663 DOI: 10.1097/sla.0000000000006144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This international multicentre cohort study aims to identify recurrence patterns and treatment of first and second recurrence in a large cohort of patients after pancreatic resection for adenocarcinoma arising from IPMN. SUMMARY BACKGROUND DATA Recurrence patterns and treatment of recurrence post resection of adenocarcinoma arising from IPMN are poorly explored. METHOD Patients undergoing pancreatic resection for adenocarcinoma from IPMN between January 2010 to December 2020 at 18 pancreatic centres were identified. Survival analysis was performed by the Kaplan-Meier log rank test and multivariable logistic regression by Cox-Proportional Hazards modelling. Endpoints were recurrence (time-to, location, and pattern of recurrence) and survival (overall survival and adjusted for treatment provided). RESULTS Four hundred and fifty-nine patients were included (median, 70 y; IQR, 64-76; male, 54 percent) with a median follow-up of 26.3 months (IQR, 13.0-48.1 mo). Recurrence occurred in 209 patients (45.5 percent; median time to recurrence, 32.8 months, early recurrence [within 1 y], 23.2 percent). Eighty-three (18.1 percent) patients experienced a local regional recurrence and 164 (35.7 percent) patients experienced distant recurrence. Adjuvant chemotherapy was not associated with reduction in recurrence (HR 1.09;P=0.669) One hundred and twenty patients with recurrence received further treatment. The median survival with and without additional treatment was 27.0 and 14.6 months (P<0.001), with no significant difference between treatment modalities. There was no significant difference in survival between location of recurrence (P=0.401). CONCLUSION Recurrence after pancreatic resection for adenocarcinoma arising from IPMN is frequent with a quarter of patients recurring within 12 months. Treatment of recurrence is associated with improved overall survival and should be considered.
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Affiliation(s)
| | - Jake Hawkyard
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Francis P Robertson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Beate Haugk
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jonathan Lye
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Daniel Parkinson
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Steve White
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Omar Mownah
- Institute of Liver Studies, King's Healthcare Partners, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Yoh Zen
- Institute of Liver Studies, King's Healthcare Partners, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Krishna Menon
- Institute of Liver Studies, King's Healthcare Partners, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Takaaki Furukawa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Yosuke Inoue
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Yuki Hirose
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Naoki Sasahira
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Hepato-Biliary-Pancreatic Medicine Department, Tokyo, Japan
| | - Michael Feretis
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Anita Balakrishnan
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Piotr Zelga
- Cambridge Hepatobiliary and Pancreatic Surgery Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Carlo Ceresa
- Hepatobiliary and Pancreatic Surgery Unit, The Royal Free Hospital, London, UK
| | - Brian Davidson
- Hepatobiliary and Pancreatic Surgery Unit, The Royal Free Hospital, London, UK
| | - Rupaly Pande
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Bobby Dasari
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Lulu Tanno
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Dimitrios Karavias
- Hepatobiliary and Pancreatic Surgery Unit, University Hospital Southampton, Southampton, UK
| | - Jack Helliwell
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alistair Young
- Hepatobiliary and Pancreatic Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Quentin Nunes
- Department of Hepatopancreatobiliary Surgery, East Lancashire Teaching Hospitals NHS Trust, UK
| | - Tomas Urbonas
- Oxford Hepato-Pancreato-Biliary (HPB) surgical unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Michael Silva
- Oxford Hepato-Pancreato-Biliary (HPB) surgical unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Alex Gordon-Weeks
- Oxford Hepato-Pancreato-Biliary (HPB) surgical unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jenifer Barrie
- Nottingham Hepato-Pancreatico-Biliary (HPB) Service, Nottingham University Hospitals NHS Foundation Trust, UK
| | - Dhanny Gomez
- Nottingham Hepato-Pancreatico-Biliary (HPB) Service, Nottingham University Hospitals NHS Foundation Trust, UK
| | - Stijn van Laarhoven
- Department of General Surgery, University Hospitals Bristol & Weston NHS Foundation trust, UK
| | - Joseph Doyle
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ricky Bhogal
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ewen Harrison
- Department of Clinical Surgery, University of Edinburgh, UK
| | - Marcus Roalso
- Department of Gastrointestinal Surgery, HPB unit, Stavanger University Hospital, Norway
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Debora Ciprani
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Somaiah Aroori
- Hepatopancreatobiliary Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Bathiya Ratnayake
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, NZ
| | - Jonathan Koea
- Hepato-pancreatico-biliary/Upper Gastrointestinal Unit, North Shore Hospital, Auckland, NZ
| | - Gabriele Capurso
- San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy; Digestive and Liver Disease Unit, S. Andrea Hospital, Rome, Italy
| | - Ruben Bellotti
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria
| | - Tareq Alsaoudi
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, UK
| | - Neil Bhardwaj
- Leicester Hepatopancreatobiliary Unit, University Hospitals of Leicester NHS Trust, UK
| | - Fraser Jeffery
- Department of General and Vascular Surgery, Christchurch Hospital, New Zealand
| | - Saxon Connor
- Department of General and Vascular Surgery, Christchurch Hospital, New Zealand
| | - Andrew Cameron
- Wolfson Wohl Cancer Research Centre, University of Glasgow, UK
| | - Nigel Jamieson
- Wolfson Wohl Cancer Research Centre, University of Glasgow, UK
| | - Amy Sheen
- New South Wales Health Pathology, Dept of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Jas Samra
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Anthony Gill
- New South Wales Health Pathology, Dept of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney NSW Australia
| | - Keith Roberts
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, HPB unit, Stavanger University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Sanjay Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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4
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Trivedi DB, Aldulaimi N, Karydis I, Wheater M, Modi S, Stedman B, Karavias D, Primrose J, Pearce N, Takhar AS. Liver resection for metastatic uveal melanoma: experience from a supra-regional centre and review of literature. Melanoma Res 2023; 33:71-79. [PMID: 36409208 DOI: 10.1097/cmr.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Management of liver metastases from uveal melanoma (LMUM) requires multimodal approach. This study describes evolution of liver resection for LMUM, reviewing current literature and institutional outcomes. Records of patients referred to the Melanoma Multi-Disciplinary Team between February 2005 and August 2018 were reviewed. All publications describing surgery for LMUM were identified from PubMed, Embase, and Google Scholar. Thirty-one of 147 patients with LMUM underwent laparoscopic liver biopsy, and 29 (14 females) had liver resections. Nineteen liver resections were performed locally [7 major (≥3 seg), 14 laparoscopic] without major complications or mortality. Overall survival positively correlated with the time from uveal melanoma to LMUM (Spearman's rho rs = 0.859, P < 0.0001). Overall and recurrence-free survivals were comparable following R1 or R0 resections (OS 25 vs. 28 months, P = 0.404; RFS 13 vs. 6 months, P = 0.596). R1 resection cohort had longer lead-time (median 100 vs. 24 months, P = 0.0408). Eleven publications describing liver resection for LMUM were identified and included in the narrative review. Surgery for LMUM is safe and complements multidisciplinary management. Despite heterogeneity in literature, time from diagnosis of uveal melanoma to LMUM remains a key factor affecting survival after liver resection.
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Affiliation(s)
- Dharmadev B Trivedi
- Department of General Surgery, South Warwickshire NHS Foundation Trust, Warwick, Warwickshire
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Natasha Aldulaimi
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Ioannis Karydis
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Matthew Wheater
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Sachin Modi
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Brian Stedman
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Dimitrios Karavias
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - John Primrose
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Neil Pearce
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Arjun S Takhar
- Department of HPB Surgery, University Hospitals Southampton NHS Foundation Trust, Southampton, Hampshire, UK
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5
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Manuel-Vázquez A, Balakrishnan A, Agami P, Andersson B, Berrevoet F, Besselink MG, Boggi U, Caputo D, Carabias A, Carrion-Alvarez L, Franco CC, Coppola A, Dasari BVM, Diaz-Mercedes S, Feretis M, Fondevila C, Fusai GK, Garcea G, Gonzabay V, Bravo MÁG, Gorris M, Hendrikx B, Hidalgo-Salinas C, Kadam P, Karavias D, Kauffmann E, Kourdouli A, La Vaccara V, van Laarhoven S, Leighton J, Liem MSL, Machairas N, Magouliotis D, Mahmoud A, Marino MV, Massani M, Requena PM, Mentor K, Napoli N, Nijhuis JHT, Nikov A, Nistri C, Nunes V, Ruiz EO, Pandanaboyana S, Saborido BP, Pohnán R, Popa M, Pérez BS, Bueno FS, Serrablo A, Serradilla-Martín M, Skipworth JRA, Soreide K, Symeonidis D, Zacharoulis D, Zelga P, Aliseda D, Santiago MJC, Mancilla CF, Fragua RL, Hughes DL, Llorente CP, Lesurtel M, Gallagher T, Ramia JM. A scoring system for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: a multicenter EUROPEAN validation. Langenbecks Arch Surg 2022; 407:3447-3455. [PMID: 36198881 DOI: 10.1007/s00423-022-02687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. METHODS An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. RESULTS A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. CONCLUSION Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.
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Affiliation(s)
- Alba Manuel-Vázquez
- Department of General and Digestive Surgery, Hospital Universitario de Getafe, Carretera de Toledo, Km 12, 500, 28905, Madrid, Spain.
| | - Anita Balakrishnan
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Paul Agami
- Moscow Clinical Scientific Center, Moscow, Russia
| | - Bodil Andersson
- Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Damiano Caputo
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | - Alberto Carabias
- Department of General and Digestive Surgery, Hospital Universitario de Getafe, Carretera de Toledo, Km 12, 500, 28905, Madrid, Spain
| | | | - Carmen Cepeda Franco
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Team, Virgen del Rocio University Hospital, Seville, Spain
| | - Alessandro Coppola
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | | | - Sherley Diaz-Mercedes
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Michail Feretis
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Constantino Fondevila
- Department of General and Digestive Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERehd, Spain
| | - Giuseppe Kito Fusai
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Garcea
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Victor Gonzabay
- Department of General and Digestive Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERehd, Spain
| | - Miguel Ángel Gómez Bravo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Team, Virgen del Rocio University Hospital, Seville, Spain
| | - Myrte Gorris
- Academic Medical Center, Amsterdam, The Netherlands
| | - Bart Hendrikx
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - Camila Hidalgo-Salinas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Dimitrios Karavias
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emanuele Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Amar Kourdouli
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Vincenzo La Vaccara
- General Surgery Department, Medico University of Rome, Campus Bio, Rome, Italy
| | - Stijn van Laarhoven
- Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Mike S L Liem
- Division of HPB Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Adel Mahmoud
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Marco V Marino
- Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Marco Massani
- Department of Surgery, Regional Hospital "Ca Foncello"Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | | | | | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Jorieke H T Nijhuis
- Division of HPB Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Andrej Nikov
- Department of Surgery, Military University Hospital Prague, Prague, Czech Republic
| | - Cristina Nistri
- Department of Surgery, Regional Hospital "Ca Foncello"Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Victor Nunes
- HPB Surgery, Hospital Prof Dr Fernando Fonseca, Amadora, Portugal
| | - Eduardo Ortiz Ruiz
- Department of Pathology, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | | | - Baltasar Pérez Saborido
- Department of General and Digestive Surgery, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Radek Pohnán
- Department of Surgery, Military University Hospital Prague, Prague, Czech Republic
| | - Mariuca Popa
- Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | | | | | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Saragossa, Spain
| | | | - James R A Skipworth
- Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Piotr Zelga
- Department of Hepatopancreatobiliary Surgery, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | - Daniel Llwyd Hughes
- Department of HPB Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | | | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, Hospices Civils de Lyon, Lyon, France
| | - Tom Gallagher
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
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6
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Geramoutsou C, Nikou S, Karavias D, Arbi M, Tavlas P, Tzelepi V, Lygerou Z, Maroulis I, Bravou V. Focal adhesion proteins in hepatocellular carcinoma: RSU1 a novel tumour suppressor with prognostic significance. Pathol Res Pract 2022; 235:153950. [DOI: 10.1016/j.prp.2022.153950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022]
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7
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Nayar M, Varghese C, Kanwar A, Siriwardena AK, Haque AR, Awan A, Balakrishnan A, Rawashdeh A, Ivanov B, Parmar C, Halloran CM, Caruana C, Borg CM, Gomez D, Damaskos D, Karavias D, Finch G, Ebied H, Pine JK, Skipworth JRA, Milburn J, Latif J, Apollos J, El Kafsi J, Windsor JA, Roberts K, Wang K, Ravi K, Coats MV, Hollyman M, Phillips M, Okocha M, Wilson MS, Ameer NA, Kumar N, Shah N, Lapolla P, Magee C, Al-Sarireh B, Lunevicius R, Benhmida R, Singhal R, Balachandra S, Demirli Atıcı S, Jaunoo S, Dwerryhouse S, Boyce T, Charalampakis V, Kanakala V, Abbas Z, Tewari N, Pandanaboyana S. SARS-CoV-2 infection is associated with an increased risk of idiopathic acute pancreatitis but not pancreatic exocrine insufficiency or diabetes: long-term results of the COVIDPAN study. Gut 2022; 71:1444-1447. [PMID: 34764192 DOI: 10.1136/gutjnl-2021-326218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Manu Nayar
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK
- UK
| | - Chris Varghese
- Faculty of Medical and Health Sciences, Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Aditya Kanwar
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guy Finch
- Northampton General Hospital, Northampton, UK
| | | | | | | | | | | | | | | | | | | | - Kelvin Wang
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Krish Ravi
- Chesterfield Royal Hospital NHS Trust, Chesterfield, UK
| | | | | | | | | | | | - Nadeem A Ameer
- University Hospital of Coventry and Warwickshire, Coventry, UK
| | | | - Nehal Shah
- Northern General Hospital, Sheffield, UK
| | | | | | | | | | | | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Semra Demirli Atıcı
- Department of General Surgery, University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey
| | | | | | | | | | | | - Zaigham Abbas
- Dr. Ziauddin University Hospital, Clifton Karachi, Pakistan
| | | | - Sanjay Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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8
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Russell J, Stevens C, Bhome R, Karavias D, Arshad A, Takhar A, Armstrong T, Primrose J, Green B, Hamady Z. Long-term outcome after portal vein resection during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matched analysis. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2021.12.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Trivedi D, Aldulaimi N, Karydis I, Wheater M, Modi S, Stedman B, Karavias D, Primrose J, Pearce N, Takhar A. O-L07 Role of liver resection for metastases from uveal melanoma: Experience from a supra-regional centre, current evidence, and future prospects. Br J Surg 2021. [DOI: 10.1093/bjs/znab429.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Management of liver metastases from uveal melanoma (LMUM) requires a ‘multi-modal’ approach including surgical resection. This study aimed to evaluate the role, safety, and oncological effectiveness of liver surgery for patients with LMUM in the context multidisciplinary management. A comprehensive treatment pathway developed upon current published evidence, prevalent national guidelines and novel treatment options is presented (Figure 2)
Methods
Retrospective review of prospectively maintained database between February 2005 to August 2018 was performed using the institutional electronic patient record system from oncology and surgical department. Demographic data, MDT outcome letters, operative records, clinic letters, letters from referring hospitals, discharge summaries, radiology reports, and histology findings were reviewed. Focused literature review was conducted to identify all relevant publications. All advanced statistical analysis was performed using SPSS version 27.0 software (IBM Corp., Armonk, NY, USA). A p-value of < 0.05 was considered to be statistically significant. The work was approved by the institutional clinical governance department (Audit ID 6661).
Results
31 patients underwent diagnostic laparoscopy and 17 patients received 19 liver resections locally (Figure 1). 7 major (≥ 3 seg) and 12 minor liver resections (14 laparoscopic) were done without any mortality or major complications. 10/19 (52.6%) were R0 resections. Overall survival positively correlated with the time from UM to LMUM (rs = 0.859, p<0.0001). R0 or R1 resection margin status did not significantly influence survival outcomes (OS 25 Vs 28, p = 0.404; RFS 13 Vs 6 months, p = 0.596), though R1 cohort had longer lead time (100 Vs 24 months, p = 0.0408).
Conclusions
Liver resection for LMUM is safe, effective and complements multimodal management. Lead time from development of UM to LMUM remains a key factor affecting survival outcomes. As novel treatment modalities for regional and systemic disease control for metastatic uveal melanoma continue to develop, surgical intervention will also continue to evolve as part of the multi-disciplinary management. We emphasise the need for developing a collaborative database at a national and international level. We present an evidence-based, multi-disciplinary management pathway for LMUM patients (Figure 2).
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Affiliation(s)
- Dharmadev Trivedi
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Ioannis Karydis
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Matthew Wheater
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Sachin Modi
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Brian Stedman
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Dimitrios Karavias
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - John Primrose
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
- University of Southampton, Southampton, United Kingdom
| | - Neil Pearce
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Arjun Takhar
- University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
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10
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Patel B, Fristedt R, Hamady Z, Takhar A, Armstrong T, Hilal MA, Karavias D, Arshad A. P-P44 Clinical outcomes of consecutive patients undergoing distal pancreatectomy over the last decade at a high volume tertiary pancreatic surgery unit. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Distal pancreatectomy (DP) enables resection of lesions in the body and tail of the pancreas. Over the past decade, the Laparoscopic approach has become frequently employed. There remains scarce outcome data available following laparoscopic distal pancreatectomy over a long time period from high volume centres. Postoperative pancreatic fistula (POPF) remains the main source of morbidity and mortality after DP. The causes of POPF are multifactorial and poorly understood. The optimal method of pancreatic stump closure is still debated with variation in clinical practice.
Methods
All patients that underwent distal pancreatectomy at a UK tertiary pancreatic surgery centre between January 2011 and January 2021 were identified and clinical outcomes examined. Patients undergoing completion pancreatectomies were excluded. Clinical, pathological and surgical data for the included patients was retrospectively collected from the electronic patient record. Clinically significant POPF was defined as Grade B or C as per the ISGPF guidelines. For stapled stump closure, the Compression Index (CI) was calculated using closed staple height (mm) divided by the pancreatic thickness (mm). High and low CI was defined around the median.
Results
233 patients (n = 90 open and n = 143 laparoscopic) were included in the final analysis. The laparoscopic approach was associated with comparable morbidity and significantly lower blood loss, shorter operative time and shorter length of stay. There were no significant differences in age, sex, final histology, closure technique, or ASA Score of 3 or more amongst patients with clinically relevant POPF (CR-POPF). The POPF group had a significantly higher BMI, drain duration and readmission rate. CI data was available for 78 cases (range 0.04-0.21). There was no significant difference in low vs high CI for patients with CR-POPF.
Conclusions
Laparoscopic distal pancreatectomy is associated with favourable clinical outcomes in this series. Stapled vs sutured closure of the pancreatic stump offered equivocal outcomes with relation to POPF. POPF continues to have a significant impact on a clinical recovery as evident from longer drain duration and high readmission rates. Further research is required to try to establish methods for reducing the incidence of POPF after distal pancreatectomy.
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Affiliation(s)
- Bhavik Patel
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Richard Fristedt
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Zaed Hamady
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Arjun Takhar
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Tom Armstrong
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mohammad Abu Hilal
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Dimitrios Karavias
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ali Arshad
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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11
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Stevens C, Chan CH, Karavias D, Takhar A, Arshad A, Hamady Z, Armstrong T, Pearce N, Primrose J. P-P29 The glycated haemoglobin (HbA1c) test is not a predictor of pancreatectomy specific complications or survival. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The glycated haemoglobin (HbA1c) test is a venous blood test used as a diagnostic test for diabetes mellitus and to monitor glucose control in patients known to have diabetes. The test has been recommended by National Institute for Health Care Excellence (NICE) clinical guidelines in the pre-operative setting since 2016. The purpose of testing is to reduce perioperative morbidity and mortality by optimising management of blood glucose levels in the perioperative period. The aim of this study was to assess the prognostic value of HbA1c in pancreatic cancer patients treated with pancreaticoduodenectomy.
Methods
This is a retrospective analysis of a prospectively managed database of pancreatic resections at a single institution from January 2016 to December 2020. Included patients had confirmed pancreatic adenocarcinoma and underwent a pancreaticoduodenectomy with preoperative measurement of their HbA1c. Patients who were already prescribed insulin were excluded. Demographic data, survival, operative and perioperative details were collected. Included patient records were assessed for the incidence of postoperative complications in accordance with International Study Group of Pancreatic Surgery guidelines for pancreatic fistula, delayed gastric emptying and post pancreatectomy haemorrhage. An HbA1c greater than 41 was deemed elevated.
Results
There were 145 patients who met the inclusion criteria. The HbA1c level was normal in 101/145 (70%) and elevated in 44/45 (30%). The postoperative pancreatic fistula rate was 18% in the patients with a normal HbA1c and 23% in those with elevated HbA1c (p = 0.499). The rate of delayed gastric emptying was 21 and 23% in the patients with normal and elevated HbA1c respectively. There were five relaparotomies overall, one of these patients had an elevated preoperative HbA1c. There were no perioperative deaths. Overall survival was 31months (95%CI 27-35) with a normal preoperative HbAlc and 32months (95%CI 27-38) if elevated.
Conclusions
There is little doubt that the preoperative HbA1c is helpful in the package of preoperative assessment tests to optimise patients for surgery. However, the preoperative HbA1c level in patients planned for pancreaticoduodenectomy is not predictive of pancreaticoduodenectomy specific complications such as postoperative pancreatic fistula, delayed gastric emptying, relaparotomy or mortality. In addition, long-term overall survival is not influenced by an elevated preoperative HbAlc.
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Affiliation(s)
- Claire Stevens
- University Hospital Southampton, Southampton, United Kingdom
| | | | | | - Arjun Takhar
- University Hospital Southampton, Southampton, United Kingdom
| | - Ali Arshad
- University Hospital Southampton, Southampton, United Kingdom
| | - Zaed Hamady
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Neil Pearce
- University Hospital Southampton, Southampton, United Kingdom
| | - John Primrose
- University Hospital Southampton, Southampton, United Kingdom
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12
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Tanno L, Davies C, Stevens C, Fristedt R, Arshad A, Hamady Z, Armstrong T, Primrose J, Karavias D, Takhar A. P-P47 Impact of neoadjuvant chemotherapy on postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Pancreatic adenocarcinoma (PDAC) is one of the most lethal tumours with a five-year survival rate of less than 7% for all stages. However, current evidence suggests neoadjuvant treatment (NAT) may have survival benefits in those with borderline resectable disease. Post-operative pancreatic fistula (POPF) is a potential complication after pancreaticoduodenectomy (PD) and is associated with long-term morbidity. The rate of developing POPF post-PD in those receiving NAT is currently unclear.
Methods
Patients undergoing PD (both classical and pylorus-preserving) were identified from a prospectively collected local database. Those who received NAT prior to surgery were identified, and case-matched controls based on their age and sex, were then identified from the database. Post-operative drain amylase levels were used to compare POPF between groups. For the analysis, drain amylase levels greater than three times the upper limit of normal at day five were consistent with biochemical POPF.
Results
A total of 34 patients (14 females, 20 males) underwent PD after receiving NAT at our unit from January 2013 to July 2021. The median age was 66 years at the time of surgery. Two patients (5.9%) in the NAC group had biochemical leaks on day five compared to 4 (11.8%) in the case-matched control group (p = 0.7).
Conclusions
Our early data suggest a possibility of a lower incidence of biochemical POPF in those undergoing PD post-NAT. Aetiology on the development of POPD post-NAT is still unclear, and this requires further study and long-term follow up.
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Affiliation(s)
- Lulu Tanno
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Claire Stevens
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Ali Arshad
- University Hospital Southampton, Southampton, United Kingdom
| | - Zaed Hamady
- University Hospital Southampton, Southampton, United Kingdom
| | | | - John Primrose
- University Hospital Southampton, Southampton, United Kingdom
- University of Southampton, Southampton, United Kingdom
| | | | - Arjun Takhar
- University Hospital Southampton, Southampton, United Kingdom
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13
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Russell J, Stevens C, Bhome R, Karavias D, Arshad A, Takhar A, Armstrong T, Primrose J, Green B, Hamady Z. P-P13 Long-term outcome after portal vein resection during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matched analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Portal vein resection (PVR) with pancreaticoduodenectomy (PD) is often performed to achieve clear margins for patients with vascular involvement in pancreatic ductal adenocarcinoma (PDAC). However, there is evidence to suggest that patients undergoing PVR often have more advanced cancers, therefore the impact of PVR on survival and recurrence remains unclear. The aim of this study is to assess overall (OS) and recurrence free (RFS) survival in patients who underwent PVR during PD, with particular attention to margin positivity.
Methods
A retrospective analysis was performed on 638 patients who underwent PD during a 12-year period. Exclusion criteria included PD for non-PDAC tumours, neoadjuvant chemotherapy or intra-operative radiotherapy. 374 patients were included in the study (90 PVR and 284 non-PVR). Patient characteristics and histopathological factors associated with OS and RFS were then evaluated using univariate and multivariate Cox regression analyses. 270 patients (90 PVR and 180 non-PVR), were matched by propensity score based on perineural invasion, pT and pN staging. The Kaplan-Meier method was used to calculate survival and log-rank tests.
Results
Resection margin positivity was associated with shorter OS and RFS (p < 0.0001), and the superior mesenteric vein (SMV) margin was the most significant risk factor for survival on competing risks analysis. Absent adjuvant chemotherapy, nodal metastasis and margin positivity were independent risk factors for OS and RFS on multivariate analysis. PVR was associated with higher intra-operative blood loss (p = 0.009), but was not associated with increased length of stay, complications or readmissions. PVR patients had increased pT staging, nodal metastasis and perineural invasion, however, there was no difference in OS (p = 0.551) or RFS (p = 0.256) between PVR and non-PVR after propensity matching.
Conclusions
Positive resection margins are associated with shorter survival times, and the SMV margin is the most significant prognostic indicator for overall survival and recurrence compared to other margins. PVR is a relatively safe procedure, however, it does not achieve the intended survival benefits of complete margin clearance. The impact on survival for margin positivity, particularly the SMV margin, and nodal metastasis should be considered when making decisions with regards to vein resection and adjuvant treatments.
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Affiliation(s)
- James Russell
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Claire Stevens
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Rahul Bhome
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | | | - Ali Arshad
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Arjun Takhar
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Thomas Armstrong
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - John Primrose
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Brian Green
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Zaed Hamady
- University Hospitals Southampton NHS Trust, Southampton, United Kingdom
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14
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Bhome R, Karavias D, Armstrong T, Hamady Z, Arshad A, Primrose J, Bateman A, Pearce N, Takhar A. Intraoperative radiotherapy for pancreatic cancer: implementation and initial experience. Br J Surg 2021; 108:e400-e401. [PMID: 34586375 DOI: 10.1093/bjs/znab335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022]
Abstract
This article reports on the first series of patients to receive intraoperative radiotherapy for pancreatic cancer in the UK. The data suggest that this treatment modality is feasible and safe, laying a platform for collaborative multicentre trials to better assess efficacy.
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Affiliation(s)
- R Bhome
- Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK.,Cancer Sciences, University of Southampton, Southampton, UK
| | - D Karavias
- Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
| | - T Armstrong
- Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
| | - Z Hamady
- Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
| | - A Arshad
- Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
| | - J Primrose
- Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK.,Cancer Sciences, University of Southampton, Southampton, UK
| | - A Bateman
- Clinical Oncology, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
| | - N Pearce
- Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
| | - A Takhar
- Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
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15
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Chhabra P, Maher B, Trivedi D, Karavias D, Arshad A, Wright M, Tehami N. Management of infected post-pancreatic resection fluid collections under endoscopic ultrasound guidance using lumen apposing metal stent: A case series and review of the literature. Ann Hepatobiliary Pancreat Surg 2021; 25:500-508. [PMID: 34845122 PMCID: PMC8639308 DOI: 10.14701/ahbps.2021.25.4.500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
Backgrounds/Aims Post-operative pancreatic fistulas (POPF) and fluid collections (POPFC) remain significant sources of morbidity and mortality after pancreatic resections. There remains a paucity of literature describing endoscopic ultrasound (EUS) guided drainage of POPFC using a Hot AXIOS™ lumen apposing metal stent (LAMS). Methods We conducted a retrospective study, encompassing all consecutive patients with POPFC managed using Hot AXIOS™ LAMS at our institution between January 2017 and December 2019. Primary outcome measures were technical and clinical success. Secondary outcome measures were adverse events and recurrence rates. Results Five patients underwent EUS guided drainage using Hot AXIOS™ LAMS during the study period. Mean age of patients was 67.8 ± 2.16 years. The majority (60.0%) of patients were males. Median duration of symptom onset after surgery was 9 days. All patients presented with abdominal pain. Median size of the collection measured on computed tomography was 91 mm. Median interval time between symptom onset and EUS drainage was 30 days. Two patients required percutaneous drainage prior to EUS guided drainage. Technical and clinical success were achieved for all patients. No adverse events were observed. Median duration of follow-up was 90 days. No recurrence of collection occurred during the follow-up period. Conclusions EUS guided drainage of POPFC using Hot AXIOS™ LAMS is a safe and effective treatment modality with technical and clinical success rates of 100% in our experience.
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Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Southampton General Hospital, Southampton, United Kingdom
| | - Ben Maher
- Department of Interventional Radiology, Southampton General Hospital, Southampton, United Kingdom
| | - Dharmadev Trivedi
- Department of Hepatobiliary and Pancreatic Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Dimitrios Karavias
- Department of Hepatobiliary and Pancreatic Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Ali Arshad
- Department of Hepatobiliary and Pancreatic Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Mark Wright
- Department of Gastroenterology, Southampton General Hospital, Southampton, United Kingdom
| | - Nadeem Tehami
- Department of Gastroenterology, Southampton General Hospital, Southampton, United Kingdom
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16
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Pandanaboyana S, Moir J, Leeds JS, Oppong K, Kanwar A, Marzouk A, Belgaumkar A, Gupta A, Siriwardena AK, Haque AR, Awan A, Balakrishnan A, Rawashdeh A, Ivanov B, Parmar C, M Halloran C, Caruana C, Borg CM, Gomez D, Damaskos D, Karavias D, Finch G, Ebied H, K Pine J, R A Skipworth J, Milburn J, Latif J, Ratnam Apollos J, El Kafsi J, Windsor JA, Roberts K, Wang K, Ravi K, V Coats M, Hollyman M, Phillips M, Okocha M, Sj Wilson M, A Ameer N, Kumar N, Shah N, Lapolla P, Magee C, Al-Sarireh B, Lunevicius R, Benhmida R, Singhal R, Balachandra S, Demirli Atıcı S, Jaunoo S, Dwerryhouse S, Boyce T, Charalampakis V, Kanakala V, Abbas Z, Nayar M. SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study. Gut 2021; 70:1061-1069. [PMID: 33547182 PMCID: PMC7871229 DOI: 10.1136/gutjnl-2020-323364] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection. DESIGN A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups. RESULTS 1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection. CONCLUSION Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.
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Affiliation(s)
- Sanjay Pandanaboyana
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Moir
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - John S Leeds
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kofi Oppong
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Aditya Kanwar
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | - Ajay Gupta
- South Bristol Community hospital, Bristol, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guy Finch
- Northampton General Hospital, Northampton, UK
| | | | | | | | | | | | | | | | | | | | - Kelvin Wang
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Krish Ravi
- Chesterfield Royal Hospital NHS Trust, Chesterfield, UK
| | | | | | | | | | | | - Nadeem A Ameer
- University Hospital of Coventry and Warwickshire, Coventry, UK
| | | | - Nehal Shah
- Northern General Hospital, Sheffield, UK
| | | | | | | | | | | | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Semra Demirli Atıcı
- University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, İzmir, Turkey
| | - Shameen Jaunoo
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | | | | | | - Zaigham Abbas
- Dr Ziauddin University Hospital, Clifton Karachi, Pakistan
| | - Manu Nayar
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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17
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Zygomalas A, Papachristou DJ, Katsiakis N, Karatzas A, Kourelis T, Georgostathis K, Karavias D. First report of clear cell renal carcinoma metastasizing to the ischiorectal fossa 17 years after radical nephrectomy: an additional reason for lifelong follow-up. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 32734776 DOI: 10.1308/rcsann.2020.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal cell carcinoma has a high propensity for metastatic spread. There are several case reports of metastatic renal cell carcinomas associated with rare metastatic sites, in many cases more than ten years after the initial diagnosis. We present a 60-year-old man with perianal pain and a mass in the ischiorectal space, revealed by computed tomography. The patient had a history of clear cell renal carcinoma operated on 17 years ago. A wire localization surgical excision of the ischiorectal fossa mass was performed. The pathological report revealed a metastatic clear cell renal carcinoma. To our knowledge, this is the first case of a clear cell renal carcinoma metastasizing to the ischiorectal fossa reported in the literature. We therefore recommend that any newly discovered mass in any site of a patient with a history of renal cell carcinoma should be carefully explored and biopsied.
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18
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Karavias D, Thomas P, Koh A, Irving G, Navarro AP, Cameron IC, Gomez D. Statin therapy does not influence the outcome of patients undergoing surgery for pancreatic cancer. ANZ J Surg 2019; 90:1671-1676. [PMID: 31845479 DOI: 10.1111/ans.15600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recently, statins have been associated with improved survival in certain cancers. The aim of this study was to evaluate the impact of statins on the outcome of patients undergoing surgery for pancreatic cancer. In addition, the effect of statins on the histopathological characteristics of the disease was assessed. METHODS A retrospective review of the prospectively maintained hepato-pancreatico-biliary database was performed and patients with pancreatic cancer who underwent surgery between January 2014 and December 2017 were included. Statistical analysis was performed to assess the impact of statins on histopathological characteristics and survival outcome. RESULTS A total of 151 patients were included, of whom 71 underwent pancreatic resections and 80 underwent trial dissection and bypass procedures. In the operated group, 20 patients were on statin therapy preoperatively. With respect to disease-free survival, tumour size (P = 0.023) and lymphatic invasion (P = 0.015) were significant variables on univariate analysis. Gender (P = 0.022), adjuvant chemotherapy (P < 0.001), lymphatic invasion (P = 0.021) and tumour size (P = 0.041) were significant variables on univariate analysis with respect to overall survival. Multivariate analysis identified adjuvant chemotherapy as the only independent predictor of overall survival (P < 0.001). No correlations between the use of statins and the histopathological characteristics were identified. CONCLUSION Adjuvant chemotherapy is an independent predictor of overall survival in patients undergoing surgery for pancreatic cancer. Statin therapy does not influence survival outcomes and histopathological characteristics following surgery for pancreatic cancer.
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Affiliation(s)
- Dimitrios Karavias
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul Thomas
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Amanda Koh
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Glen Irving
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alex P Navarro
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Iain C Cameron
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dhanny Gomez
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,NIHR Nottingham Digestive Disease Biomedical Research Unit, The University of Nottingham, Nottingham, UK
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19
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Koutsioumpa M, Hatziapostolou M, Polytarchou C, Tolosa EJ, Almada LL, Mahurkar-Joshi S, Williams J, Tirado-Rodriguez B, Huerta-Yepez S, Karavias D, Kourea H, Poultsides GA, Struhl K, Dawson DW, Donahue TR, Fernandez-Zapico ME, lliopoulos D. Lysine methyltransferase 2D regulates pancreatic carcinogenesis through metabolic reprogramming. Gut 2019; 68:1271-1286. [PMID: 30337373 PMCID: PMC6697184 DOI: 10.1136/gutjnl-2017-315690] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Despite advances in the identification of epigenetic alterations in pancreatic cancer, their biological roles in the pathobiology of this dismal neoplasm remain elusive. Here, we aimed to characterise the functional significance of histone lysine methyltransferases (KMTs) and demethylases (KDMs) in pancreatic tumourigenesis. DESIGN DNA methylation sequencing and gene expression microarrays were employed to investigate CpG methylation and expression patterns of KMTs and KDMs in pancreatic cancer tissues versus normal tissues. Gene expression was assessed in five cohorts of patients by reverse transcription quantitative-PCR. Molecular analysis and functional assays were conducted in genetically modified cell lines. Cellular metabolic rates were measured using an XF24-3 Analyzer, while quantitative evaluation of lipids was performed by liquid chromatography-mass spectrometry (LC-MS) analysis. Subcutaneous xenograft mouse models were used to evaluate pancreatic tumour growth in vivo. RESULTS We define a new antitumorous function of the histone lysine (K)-specific methyltransferase 2D (KMT2D) in pancreatic cancer. KMT2D is transcriptionally repressed in human pancreatic tumours through DNA methylation. Clinically, lower levels of this methyltransferase associate with poor prognosis and significant weight alterations. RNAi-based genetic inactivation of KMT2D promotes tumour growth and results in loss of H3K4me3 mark. In addition, KMT2D inhibition increases aerobic glycolysis and alters the lipidomic profiles of pancreatic cancer cells. Further analysis of this phenomenon identified the glucose transporter SLC2A3 as a mediator of KMT2D-induced changes in cellular, metabolic and proliferative rates. CONCLUSION Together our findings define a new tumour suppressor function of KMT2D through the regulation of glucose/fatty acid metabolism in pancreatic cancer.
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Affiliation(s)
- Marina Koutsioumpa
- Center for Systems Biomedicine, Vatche and Tamar Manoukian
Division of Digestive Diseases, David Geffen School of Medicine, University of
California at Los Angeles, Los Angeles, CA
| | - Maria Hatziapostolou
- Biological Sciences, University of Southampton,
Southampton, United Kingdom;,Biosciences, School of Science and Technology, Nottingham
Trent University, Nottingham, United Kingdom
| | - Christos Polytarchou
- Interdisciplinary Biomedical Research Centre, School of
Science and Technology, Nottingham Trent University, Nottingham, United
Kingdom
| | - Ezequiel J. Tolosa
- Schulze Center for Novel Therapeutics, Division of Oncology
Research, Mayo Clinic, Rochester, MN
| | - Luciana L. Almada
- Schulze Center for Novel Therapeutics, Division of Oncology
Research, Mayo Clinic, Rochester, MN
| | - Swapna Mahurkar-Joshi
- Center for Systems Biomedicine, Vatche and Tamar Manoukian
Division of Digestive Diseases, David Geffen School of Medicine, University of
California at Los Angeles, Los Angeles, CA
| | - Jennifer Williams
- Department of Surgery, Division of General Surgery, David
Geffen School of Medicine at University of California Los Angeles, Los Angeles,
CA
| | - Belen Tirado-Rodriguez
- Unidad de Investigacion en Enfermedades Oncologicas,
Hospital Infantil de Mexico, Mexico City, Mexico
| | - Sara Huerta-Yepez
- Unidad de Investigacion en Enfermedades Oncologicas,
Hospital Infantil de Mexico, Mexico City, Mexico
| | - Dimitrios Karavias
- Department of Pathology, School of Medicine, University of
Patras, Patras, Greece
| | - Helen Kourea
- Department of Pathology, School of Medicine, University of
Patras, Patras, Greece
| | | | - Kevin Struhl
- Department of Biological Chemistry and Molecular
Pharmacology, Harvard Medical School, Boston, MA
| | - David W. Dawson
- Department of Pathology and Laboratory Medicine, David
Geffen School of Medicine at University of California Los Angeles, Los Angeles,
CA
| | - Timothy R. Donahue
- Department of Surgery, Division of General Surgery, David
Geffen School of Medicine at University of California Los Angeles, Los Angeles,
CA
| | | | - Dimitrios lliopoulos
- Center for Systems Biomedicine, Vatche and Tamar Manoukian
Division of Digestive Diseases, David Geffen School of Medicine, University of
California at Los Angeles, Los Angeles, CA
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20
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Karavias D, Tsolakis I, Papadoulas S. Dialysis-associated steal syndrome with limb ischaemia. BMJ Case Rep 2017; 2017:bcr-2017-221436. [PMID: 28775113 DOI: 10.1136/bcr-2017-221436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dimitrios Karavias
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham, UK
| | - Ioannis Tsolakis
- Department of Vascular Surgery, University of Patras School of Medicine, Patras, Greece
| | - Spyros Papadoulas
- Department of Vascular Surgery, University of Patras School of Medicine, Patras, Greece
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21
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Kehagias I, Zygomalas A, Karavias D, Karamanakos S. Sleeve gastrectomy: have we finally found the holy grail of bariatric surgery? A review of the literature. Eur Rev Med Pharmacol Sci 2016; 20:4930-4942. [PMID: 27981540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Laparoscopic sleeve gastrectomy has become one of the most commonly performed bariatric operations. It is essentially a restrictive bariatric operation; however, a series of hormonal changes occurring postoperatively contribute to decreased appetite and reduced food intake. PATIENTS AND METHODS This is a literature review of recent articles published on Pubmed, Medline and Google Scholar databases in English. RESULTS Although, laparoscopic sleeve gastrectomy is commonly performed worldwide, there is still a lack of standardization regarding the surgical technique. Standardizing the surgical technique is essential in order to minimize postoperative complications and offer patients the best long-term weight loss. CONCLUSIONS Laparoscopic sleeve gastrectomy appears to be an effective bariatric operation. It is relatively easy to perform, well tolerated by the patients and very effective regarding long-term excessive weight loss and resolution of the comorbidities, with minimum nutritional deficiencies.
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Affiliation(s)
- I Kehagias
- Department of General Surgery, Nutrition Support and Morbid Obesity Unit, University Hospital of Patras, Greece.
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22
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Karavias D, Maroulis I, Papadaki H, Gogos C, Kakkos S, Karavias D, Bravou V. Overexpression of CDT1 Is a Predictor of Poor Survival in Patients with Hepatocellular Carcinoma. J Gastrointest Surg 2016; 20:568-79. [PMID: 26408331 DOI: 10.1007/s11605-015-2960-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/16/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Genomic instability is a common feature in hepatocellular carcinoma. Deregulation of replication licensing factors has been shown to trigger DNA damage response contributing to genomic instability. Overexpression of DNA replication licensing factors chromatin licensing and DNA replication factor 1 (CDT1) and minichromosome maintenance complex component 7 (MCM7) has been previously reported in several human cancers. The aim of the present study was to evaluate the expression and prognostic significance of CDT1 and MCM7 in association with DNA damage response markers and p53 in patients with hepatocellular carcinoma. METHODS Expression of CDT1, MCM7, p-H2A histone family member X (H2AX), phospho-ataxia telangiectasia-mutated (ATM)/ataxia telangiectasia rad3-related (ATR) substrate, and p53 was evaluated by immunohistochemistry on formalin-fixed paraffin-embedded surgical specimens from 111 patients who underwent hepatectomy for hepatocellular carcinoma. Statistical analysis was performed to evaluate associations between the studied proteins, clinicopathological parameters, and patient survival. RESULTS CDT1 expression correlated with p-H2AX (p = 0.038), while MCM7 correlated with p-H2AX and phospho-ATM/ATR substrate (p < 0.001). Increased CDT1 expression was associated with higher tumor grade (p = 0.006) and tumor-node-metastasis (TNM) stage (p = 0.033). High CDT1 expression correlated significantly with reduced overall survival (60.8 and 26.5 % vs 82.8 and 53.0 %, for low CDT1 expression, at 2 and 5 years, respectively, p = 0.012) and was identified by multivariate analysis as an independent predictor of poor overall survival (p = 0.049). CONCLUSIONS Overexpression of CDT1 and MCM7 in hepatocellular carcinoma correlates with DNA damage response, and CDT1 overexpression is a significant prognostic biomarker in hepatocellular carcinoma.
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Affiliation(s)
- Dimitrios Karavias
- Department of Surgery, University Hospital of Patras, Rio, 26500, Greece.
| | - Ioannis Maroulis
- Department of Surgery, University Hospital of Patras, Rio, 26500, Greece
| | - Helen Papadaki
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Patras, Rio, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Stavros Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Rio, Greece
| | | | - Vasiliki Bravou
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Patras, Rio, Greece
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Karavias D, Kourea H, Sotiriadi A, Karnabatidis D, Karavias D. Gangrenous Cholecystitis Related to Transcatheter Arterial Chemoembolization (TACE) Treatment for Hepatocellular Carcinoma. J Gastrointest Surg 2015; 19:2093-5. [PMID: 26242884 DOI: 10.1007/s11605-015-2896-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 07/18/2015] [Indexed: 01/31/2023]
Abstract
A 69-year-old male with a history of hepatitis B-induced cirrhosis underwent segmental liver resection for hepatocellular carcinoma. At his 12-month follow-up, local recurrence in segment VII was diagnosed, measuring 7.8 by 6.2 cm, with irregular margins and the presence of a tumor thrombus in the portal vein. After evaluation by the multidisciplinary liver team, the patient underwent transcatheter arterial chemoembolization with drug-eluting beads. Forty-eight hours after his discharge, the patient presented with gangrenous cholecystitis and he underwent an uneventful cholecystectomy. Cholecystitis is a well-documented complication of transcatheter arterial chemoembolization due to inadvertent reflux of the embolic material into the cystic artery. However, super selective embolization significantly reduces the risk of cholecystitis. In most cases, management is conservative and only severe cases require further intervention.
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Affiliation(s)
- Dimitrios Karavias
- Department of General Surgery, University Hospital of Patras, Rio, Greece.
| | - Helen Kourea
- Department of Pathology, University Hospital of Patras, Rio, Greece
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24
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Karamouzos V, Karavias D, Siagris D, Kalogeropoulou C, Kosmopoulou F, Gogos C, Velissaris D. Pancreatic mediastinal pseudocyst presenting as a posterior mediastinal mass with recurrent pleural effusions: a case report and review of the literature. J Med Case Rep 2015; 9:110. [PMID: 25962880 PMCID: PMC4481071 DOI: 10.1186/s13256-015-0582-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/30/2015] [Indexed: 12/30/2022] Open
Abstract
Introduction A rare complication of chronic pancreatitis is the formation of single or multiple mediastinal pseudocysts, which are fueled from the pancreas through anatomical openings of the diaphragm. We present a rare case with a difficult diagnosis, treatment and potentially catastrophic complications. Case presentation A 53-year-old Caucasian man was referred to our hospital for further investigation and treatment of a large heterogeneous mass situated in the posterior mediastinum, and bilateral pleural effusions which had developed after recent multiple episodes of pancreatitis. He had a history of chronic alcoholism. Laboratory and imaging modalities established the diagnosis of a pancreatic mediastinal pseudocyst. Conclusions Despite successful initial conservative treatment, our patient had a relapse and underwent emergency surgical intervention due to internal hemorrhage. We present his diagnostic and imaging workup, along with the multidisciplinary intervention, and a literature review referring to the diagnosis and treatment of mediastinal pancreatic pseudocysts.
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Affiliation(s)
- Vasilis Karamouzos
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Karavias
- General Surgery Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Siagris
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | | | - Fay Kosmopoulou
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Charalampos Gogos
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
| | - Dimitrios Velissaris
- Internal Medicine Department, University Hospital of Patras, Rion, 26500, Greece.
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25
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Karavias D, Habeos I, Maroulis I, Kalogeropoulou C, Tsamandas A, Chaveles I, Karavias D. Giant malignant insulinoma. Ann Surg Treat Res 2015; 88:289-93. [PMID: 25960993 PMCID: PMC4422883 DOI: 10.4174/astr.2015.88.5.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 12/03/2022] Open
Abstract
Insulinomas are the most common pancreatic neuroendocrine tumors. Most insulinomas are benign, small, intrapancreatic solid tumors and only large tumors have a tendency for malignancy. Most patients present with symptoms of hypoglycemia that are relieved with the administration of glucose. We herein present the case of a 75-year-old woman who presented with an acute hypoglycemic episode. Subsequent laboratory and radiological studies established the diagnosis of a 17-cm malignant insulinoma, with local invasion to the left kidney, lymph node metastasis, and hepatic metastases. Patient symptoms, diagnostic and imaging work-up and surgical management of both the primary and the metastatic disease are reviewed.
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Affiliation(s)
| | - Ioannis Habeos
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital of Patras, Rion, Greece
| | - Ioannis Maroulis
- Department of Surgery, University Hospital of Patras, Rion, Greece
| | | | | | - Ioannis Chaveles
- Department of Surgery, University Hospital of Patras, Rion, Greece
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26
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Savvidaki E, Kazakopoulos P, Papachristou E, Karavias D, Zavvos V, Voliotis G, Kalliakmani P, Marangos M, Goumenos DS. Replacement of mycophenolate acid with everolimus in patients who became neutropenic after renal transplant. EXP CLIN TRANSPLANT 2015; 12:31-6. [PMID: 24471721 DOI: 10.6002/ect.2013.0109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Neutropenia after kidney transplant is an adverse event usually treated with a dosage reduction of mycophenolic acid. We evaluated the efficacy and safety of substituting mycophenolic acid with everolimus in patients with persistent neutropenia after kidney transplant. MATERIALS AND METHODS This study was a retrospective analysis. A total of 17 patients who were initially treated with mycophenolic acid (1912 ± 196 mg/d), calcineurin inhibitors, and methylprednisolone for kidney transplant were included. RESULTS In 15 patients, neutropenia occurred within the first 3 months (during valganciclovir administration), and in 2 patients between the fourth and sixth month after transplant. One hundred eighteen episodes of neutropenia were recorded, originally treated by reducing the dosage of mycophenolic acid (765 ± 390 mg/d) and administering granulocyte colony-stimulating factor. Three patients experienced acute rejection 5 to 10 days after reducing the dosage of mycophenolic acid, and they were successfully treated with pulse steroids. Five patients developed cytomegalovirus infection 108 ± 65 days after the onset of neutropenia. After replacing mycophenolic acid with everolimus, episodes of neutropenia were observed in 6 patients. In 1 patient, discontinuing everolimus was necessary after 1.5 months of treatment. In 5 patients with cytomegalovirus infection, neutropenia subsided after termination of valganciclovir treatment. In the remaining 11 patients, no episodes of neutropenia were observed. No episodes of acute rejection occurred, and renal function remained stable during a followup of 47 ± 30 months (estimated glomerular filtration rate [eGFRMDRD6]: 45 ± 14 mL/min/1.73 m2→47 ± 22 mL/min/1.73 m2]. CONCLUSIONS Replacing mycophenolic acid with everolimus appears to be a safe and effective alternative treatment in neutropenic renal transplant recipients.
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27
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Kalantzi M, Kalliakmani P, Papachristou E, Papasotiriou M, Savvidaki E, Zavvos V, Karavias D, Goumenos DS, Vlachojannis JG. Parameters influencing blood erythropoietin levels of renal transplant recipients during the early post-transplantation period. Transplant Proc 2014; 46:3179-82. [PMID: 25420853 DOI: 10.1016/j.transproceed.2014.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM Renal transplantation is accompanied by restoration of renal function and endogenous erythropoietin production. The purpose of this study was to investigate the time-related changes of endogenous erythropoietin secretion in the early renal post-transplant period and the influence of various parameters to this process. METHODS Fifty-eight patients were enrolled in the study and followed up for 3 months after successful renal transplantation. Erythropoietin levels were measured at regular intervals and correlated with renal function, cold ischemia time and immunosuppressive regimen used. RESULTS Two peaks of serum erythropoietin levels were observed: an early peak that occurred within two days after transplantation and a late one, between weeks 2 and 4, which resulted in increased blood hemoglobin levels. Factors that were found to correlate with erythropoietin levels were delayed graft function, cyclosporine use and prolonged cold ischemia time. Serum creatinine did not correlate to erythropoietin levels although the reduction of serum creatinine preceded the rise of erythropoietin levels. Normal hemoglobin values were restored about three months after successful renal transplantation. CONCLUSION Serum erythropoietin levels increase during the early post-transplantation period resulting in correction of anemia three months after a successful renal transplantation. Restoration of allograft function is a prerequisite for erythropoietin secretion, while cold ischemia time and immunosuppressive regimen affect graft function.
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Affiliation(s)
- M Kalantzi
- University Hospital of Patras, Transplantation Center, Patras, Greece
| | - P Kalliakmani
- University Hospital of Patras, Transplantation Center, Patras, Greece
| | - E Papachristou
- University Hospital of Patras, Transplantation Center, Patras, Greece
| | - M Papasotiriou
- University Hospital of Patras, Transplantation Center, Patras, Greece
| | - E Savvidaki
- University Hospital of Patras, Transplantation Center, Patras, Greece
| | - V Zavvos
- University Hospital of Patras, Transplantation Center, Patras, Greece
| | - D Karavias
- University Hospital of Patras, Transplantation Center, Patras, Greece
| | - D S Goumenos
- University Hospital of Patras, Transplantation Center, Patras, Greece.
| | - J G Vlachojannis
- University Hospital of Patras, Transplantation Center, Patras, Greece
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28
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Papachristou E, Provatopoulou S, Savvidaki E, Kaplanis N, Kalliakmani P, Papasotiriou M, Fyssa L, Tsamantas A, Fokaefs E, Marangos M, Mira N, Maroulis I, Karavias D, Goumenos D, Vlachogajannis J. Outcome of Transplantation in Renal Allograft Recipients From Cadaveric Donors With Standard and Expanded Criteria: A Single-Center Experience. Transplant Proc 2014; 46:3172-4. [DOI: 10.1016/j.transproceed.2014.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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29
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Affiliation(s)
- D Karavias
- University Hospital of Patras, Rio, Greece
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30
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Maroulis I, Spyropoulos C, Kalogeropoulou C, Karavias D. Use of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literature. ULUS TRAVMA ACIL CER 2013; 19:167-72. [PMID: 23599203 DOI: 10.5505/tjtes.2013.22567] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Active liver hemorrhage with hemodynamic instability is a serious situation often requiring surgical intervention. The most common causes of hepatic bleeding are trauma and tumors of the liver parenchyma: mainly hepatocellular carcinoma and adenoma. Liver hemorrhage from blunt trauma or spontaneous tumor rupture is sometimes difficult to control with traditional methods and postoperative complications are frequent. Recently, the radiofrequency ablation system (RF) has been used for obtaining haemostasis of ruptured hepatic tumors or for controlling hemorrhage due to liver trauma in experimental models. We report two cases where the radiofrequency ablation system (RF) has been efficiently used during emergency laparotomy in humans in order to control massive hemorrhage from spontaneous rupture of a liver metastatic testicular germ cell tumor and from a Grade IV blunt liver trauma. RF ablation system combined with traditional techniques was effective in controlling liver bleeding during laparotomy in both cases. No recurrence of the hemorrhage or any side effects associated with the RF system were recorded postoperatively. RF system is an effective strategy for achieving hemostasis in patients with active liver hemorrhage. In cases of bleeding liver tumors, RFA could also be helpful in synchronous tumor elimination, maximizing the chances of longer term survival.
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Affiliation(s)
- Ioannis Maroulis
- Department of Surgery, University Hospital of Patras Rion, Patras, Greece
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31
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Savvidaki E, Voliotis G, Papachristou E, Kalliakmani P, Maragos M, Karavias D, Goumenos D. Replacement of Mycophenolic Acid by Everolimus in Patients Who Become Neutropenic after Renal Transplantation. Transplantation 2012. [DOI: 10.1097/00007890-201211271-01706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Abstract
Hepatic resection for colorectal liver metastases remains the only therapeutic option that improves long-term survival and offers potential cure. By conventional resectability criteria, only a limited number of patients with metastatic disease can be subjected to surgical intervention. In the past decade, better understanding of the natural history of the disease, the introduction of new chemotherapy agents and the advances in surgical techniques have led to more patients being eligible for surgery. Neoadjuvant chemotherapy can reduce the size of the metastases, allowing operation on patients who were previously considered inoperable. Major resections can nowadays be safely performed with the development of new less-invasive techniques and with the use of supplementary tools like ablation techniques. Using portal vein embolization to induce hypertrophy of future liver remnant and combining it with two-staged hepatectomy allow more patients with advanced disease to undergo potentially curative surgery. Careful selection of patients and aggressive surgery in experienced centers improve survival rates.
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Affiliation(s)
- I Maroulis
- Department of Surgery, University Hospital of Patras, 26504 Rion, Greece
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33
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Tepetes K, Karavias D, Felekouras E, Jabour N, Tzakis A, Starzl E. Bile leakage following T-tube removal in orthotopic liver transplantation. Hepatogastroenterology 1999; 46:425-7. [PMID: 10228834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND/AIMS Biliary tract complications constitute a common cause of post-operative morbidity after orthotopic liver transplantation. Bile leakage following T-tube removal, even if uncommon, can also seriously influence post-operative recovery. This report outlines the diagnostic and therapeutic policy used to treat this complication in a large liver transplantation center. METHODOLOGY Fourteen consecutive cases of bile leakage after T-tube removal are presented. Abdominal pain was the most common symptom and acute abdomen developed in one third of the patients. Ultrasonography was the most common imaging technique used. RESULTS Five patients were treated conservatively with or without percutaneous drainage of the biloma and 9 patients underwent an exploratory laparotomy. Ligation of the T-tube tract was the most common technique used. All patients had an uneventful clinical course. CONCLUSIONS Clinical signs are the most important factor in the diagnosis of this complication, and should be treated surgically if the patient does not improve within 24-48 hours under conservative management. Inadequate fibrous T-tube tract formation due to immunosuppression or the underlying disease could be an explanation for the development of this complication.
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Affiliation(s)
- K Tepetes
- Transplant Institute, University of Pittsburgh School of Medicine, Pennsylvania, USA
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34
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Krokos N, Karavias D, Tzakis A, Tepetes K, Ramos E, Todo S, Fung J, Starzl T. Acute pancreatitis after liver transplantation: incidence and contributing factors. Transpl Int 1995. [DOI: 10.1111/j.1432-2277.1995.tb01698.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Krokos NV, Karavias D, Tzakis A, Tepetes K, Ramos E, Todo S, Fung JJ, Starzl TE. Acute pancreatitis after liver transplantation: incidence and contributing factors. Transpl Int 1995; 8:1-7. [PMID: 7534081 PMCID: PMC2950630 DOI: 10.1007/bf00366703] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In order to assess the incidence and possible predisposing and contributing factors in the development of acute pancreatitis after liver transplantation, we reviewed the medical records of all 1832 adult patients who underwent 2161 orthotopic liver transplantation (OLTx) procedures in our center between January 1987 and September 1992. Of these patients, 55 (3% incidence) developed clinical pancreatitis and 247 (13.4% incidence) developed hyperamylasemia (biochemical pancratitis). Overall mortality in cases of clinical pancreatitis was 63.6%. The mortality in cases of hyperamylasemia was similar to that found in the general liver transplant population (i.e., 23%). A strong correlation was found between pancreatitis after liver transplantation and end-stage liver disease due to hepatitis B (30% of the cases, P = 0.00001). Extensive surgical dissection around the pancreas (P < 0.05), the type of biliary reconstruction following liver transplantation (P < 0.05), and the number of liver grafts received by the same patient (P = 0.00001) appeared to be possible contributing factors as did the duration of venovenous bypass and the quantity of IV calcium chloride administered intraoperatively.
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Affiliation(s)
- N V Krokos
- Department of Surgery, Pittsburgh Transplantation Institute, University of Pittsburgh School of Medicine, PA 15213
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36
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Jabbour N, Karavias D, Van Thiel DH. Acute cerebral edema as part of the syndrome of hepatic encephalopathy in an individual with chronic liver disease: a case report. J Okla State Med Assoc 1994; 87:501-503. [PMID: 7815183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
An unusual case of acute cerebral edema as part of the syndrome of portal systemic encephalopathy in an individual with established chronic liver disease is reported. Several episodes of edema occurred with clinically important increases in the blood ammonia level.
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Affiliation(s)
- N Jabbour
- Pittsburgh Transplant Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pa
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37
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Tsamandas AC, Tzanakakis GN, Karatzas T, Repandi M, Karavias D. Mesenteric fibromatosis. Br J Clin Pract 1994; 48:79-81. [PMID: 8024997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Mesenteric fibromatosis is commonly associated with Gardner's syndrome and familial polyposis. These lesions may have an insidious onset via compression of the small or large intestines, or may be noted for the first time during abdominal exploration for some other cause. Differential diagnosis may be difficult. We report a case of mesenteric fibromatosis with two recurrences, and two cases with no evidence of tumour recurrence.
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Affiliation(s)
- A C Tsamandas
- Department of Pathology, Patras University School of Medicine, Greece
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38
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Jabbour N, Ramos H, Wright H, Felekouras E, Karavias D, Todo S, Van Thiel DH. Transluminal ligation of bleeding angiodysplasia of the small bowel without need for surgical resection. Dig Dis Sci 1993; 38:2305-6. [PMID: 8261838 DOI: 10.1007/bf01299913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- N Jabbour
- Department of Surgery, University of Pittsburgh Medical Center, Pennsylvania 15213
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39
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Vagianos C, Karavias D, Dragotis C, Kalofonos H, Androulakis J. Obstructive jaundice due to intracholedochal blood clot: an unusual early presentation of primary hepatic carcinoma. Br J Clin Pract 1993; 47:222-223. [PMID: 8260348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We report a case of early presentation of a hepatocellular carcinoma with obstructive jaundice, due to obstruction of the common bile duct by a blood clot. The possibility of preoperative diagnosis, the surgical treatment and the postoperative outcome are discussed.
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Affiliation(s)
- C Vagianos
- Department of Surgery, University of Patras, Greece
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40
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Abstract
Seventeen patients, aged 11-67 years (mean, 32.6), with major vascular injuries associated with traumatic orthopaedic injuries, were treated operatively in the authors' institution over a 4-year period. The most common mechanism of trauma was a high-energy injury (70.8%), and the rate of open injuries was 88.2%; 64.9% of the injuries were located in the lower extremities. The treatment protocol consisted of aggressive resuscitation; Doppler imaging and, when necessary, angiography; stable bone fixation with subsequent vascular repair; and extended wound debridement. The vascular repair for arterial lacerations consisted of (a) end-to-end anastomosis (47.2%); (b) interpositional homologous vein graft (23.6%); (c) vascular decompression through fracture distraction in one patient (5.9%); (d) xenograft interposition (in one patient; 5.9%); (e) venous repair (in three patients; 17.7%); and (f) embolectomy (in all patients). Three vascular reoperations (17.7%) were necessary because of rupture of the anastomosis. The authors' preferred bone stabilization method was external fixation, which was used in 47.2% of cases. Amputation was performed in three cases (17.7%) as a salvage operation. Although six patients (35.4%) were admitted with delayed shock (mean duration, 73.6 +/- 27.8 min), this led to a lethal outcome due to shock lung in only one patient. Another patient developed massive lung embolism 3 months postoperatively and died. The authors believe that this well-organized approach, based on a specific treatment protocol, for patients with severe orthopaedic trauma and concomitant vascular injury, not only improves outcome but gives good to excellent functional results in the majority of patients.
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Affiliation(s)
- D Karavias
- Department of Surgery, University of Patras, School of Medicine, Greece
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41
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Abstract
Twenty-one cases of hepatic abscesses treated during a period of four years (from 1981 to 1985) at the University of Patras, Greece, are presented. This material includes 10 cases with abscesses caused by suppurated echinococcal cysts, corresponding to 21% of the total number of 47 cases of echinococcal cysts of the liver treated at our department during the same period. A preoperative diagnosis of the suppurated echinococcal cysts by conventional laboratory methods was not reliable. Because of the high frequency of echinococcal disease in our region and the risk of contamination of the peritoneal cavity from echinococcal parasites if the cyst is punctured, the new therapeutic techniques of treating hepatic abscesses by percutaneous drainage have not been applied. The exclusive method of treatment used was surgical drainage which had a satisfactory outcome and a mortality rate as low as 9%.
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Affiliation(s)
- D Karavias
- Department of Surgery, University Hospital, Patras, Greece
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42
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Karavias D, Johansson H, Rastad J, Akerström G. Recurrent laryngeal nerve paralysis contralateral to hemithyroidectomy. Case report. Acta Chir Scand 1987; 153:235-7. [PMID: 3604527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Two cases with transient paralysis of the recurrent laryngeal nerve contralateral to hemithyroidectomy are presented. The literature is summarized and possible causes of this rare complication are discussed.
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43
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Passas V, Karavias D, Grilias D, Birbas A. Computed tomography of left paraduodenal hernia. J Comput Assist Tomogr 1986; 10:542-3. [PMID: 3700766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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