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Borderline resecta.le pa.crea.ic ca.cer:Certa.nties a.d controversies

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World Journa. of Ga.trointestina. Surgery 2021年第6期13卷 516-528页

作者： Genna.o Na.po Greta.Donisi a.essa.dro zerbi Pa.crea.ic Surgery Unit Humanitas Clinical and Research Center-IRCCSRozzano 20089Italy

Borderline resecta.le(BR)pa.crea.ic ducta. a.enoca.cinoma.PDa.)is currently a.well-recognized entity,cha.a.terized by some specific a.a.omic,biologica. a.d conditiona. fea.ures:It includes pa.ients with a.sta.e of disea.e intermedia.e between the resecta.le a.d the loca.ly a.va.ced ones.The term BR identifies a.tumour with a. a.gressive biologica. beha.iour,on which a.neoa.juva.t a.proa.h instea. of a. upfront surgery one should be preferred,in order to obta.n a.ra.ica. resection(R0)a.d to a.oid a. ea.ly recurrence a.ter surgery.Even if during the la.t deca.es severa. studies on this topic ha.e been published,some a.pects of BR-PDa. still represent a.ma.ter of deba.e.The a.m of this review is to critica.ly a.a.yse the a.a.la.le litera.ure on this topic,pa.ticula.ly focusing on:The problem of the heterogeneity of definition of BR-PDa. a.opted,lea.ing to a.misinterpreta.ion of published da.a.its current ma.a.ement(neoa.juva.t vs upfront surgery);which neoa.juva.t regimen should be prefera.ly a.opted;the problem of ra.iologica. resta.ing a.d the determina.ion of resecta.ility a.ter neoa.juva.t thera.y;the post-opera.ive outcomes a.ter surgery;a.d the role a.d effica.y of a.juva.t trea.ment for resected pa.ients tha. a.rea.y underwent neoa.juva.t thera.y.

关键词： Borderline resecta.le pa.crea.ic ca.cer Pa.crea.ic ca.cer Neoa.juva.t trea.ment Chemothera.y Ra.iothera.y Pa.crea.ic tumour

Interna.iona. a.sessment a.d va.ida.ion of the prognostic role of lymph node ra.io in pa.ients with resected pa.crea.ic hea. ducta. a.enoca.cinoma

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Hepa.obilia.y Surgery a.d Nutrition 2022年第6期11卷 822-833页

作者： Ga.ta.-Roma.n Jolia. Isma.l La.ga. Jesse Sulzer Dionisios Vrochides a.essa.dro zerbi Genna.o Na.po Julie Perinel Musta.ha.a.ha. Stijn va. Roessel Ma.c G.Besselink JSven D.Mieog Jesse V.Groen Nicola. Dema.tines Ma.kus Scha.er Depa.tment of Viscera. Surgery Lausanne University Hospital CHUVLausanneSwitzerland Gra.ua.e School for Hea.th Sciences University of BernBernSwitzerland Division of Hepa.obilia.y a.d Pa.crea.ic Surgery Carolinas Medical CenterCharlotteNCUSA Huma.ita. Clinica. a.d Resea.ch Center-IRCCS MilanItaly Depa.tment of Biomedica. Sciences Humanitas UniversityMilanItaly Depa.tment of Digestive Surgery Edouard Herriot HospitalLyonFrance Depa.tment of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Depa.tment of Surgery Leiden University Medical CenterLeidenThe Netherlands

Ba.kground:Lymph node ra.io(LNR;positive/ha.vested lymph nodes)wa. identified a. overa.l surviva. predictor in severa. ca.cers,including pa.crea.ic a.enoca.cinoma.It rema.ns unclea. if LNR is predictive of overa.l surviva. in pa.crea.ic a.enoca.cinoma.pa.ients sta.ed pN2.This study a.sessed the prognostic overa.l surviva. role of LNR in pa.crea.ic a.enoca.cinoma.pa.ients in rela.ion with lymph node involvement.Methods:a.retrospective interna.iona. study in six different centers(Europe a.d United Sta.es)wa. performed.Pa.crea.ic a.enoca.cinoma.pa.ients who underwent pa.crea.oduodenectomy from 2000 to 2017 were included.Pa.ients with neoa.juva.t trea.ment,meta.ta.es,R2 resections,or missing da.a.rega.ding noda. sta.us were excluded.Surviva. curves were ca.cula.ed using Ka.la.-Meier method a.d compa.ed using log-ra.k test.Multiva.ia.le Cox regressions were performed to find independent overa.l surviva. predictors a.justed for potentia. confounders.Results:a.tota. of 1,327 pa.ients were included.Lymph node involvement(pN+)wa. found in 1,026 pa.ients(77%),561 pN1(55%)a.d 465 pN2(45%).Media. LNR in pN+pa.ients wa. 0.214[interqua.tile ra.ge(IQR):0.105-0.364].On multiva.ia.le a.a.ysis,LNR wa. the strongest overa.l surviva. predictor in the entire cohort[ha.a.d ra.io(HR)=5.5;95%confidence interva.(CI):3.1-9.9;Pa.d pN+pa.ients(HR=3.8;95%CI:2.2-6.6;Pa. overa.l surviva. wa. better in pa.ients with LNRa.ed to pa.ients with LNR≥0.225 in the entire cohort a.d pN+pa.ients.Simila. results were found in pN2 pa.ients(worse overa.l surviva. when LNR≥0.225).Conclusions:LNR a.pea.ed a. a. importa.t prognostic fa.tor in pa.ients undergoing surgery for pa.crea.ic a.enoca.cinoma.a.d permitted to stra.ify overa.l surviva. in pN2 pa.ients.LNR should be routinely used in complement to tumor-node-meta.ta.is(TNM)sta.e to better predict pa.ient prognosis.

关键词： Pa.crea.ectomy ca.cer lympha.ic involvement

Pa.crea.ic meta.ta.es:a. increa.ing clinica. entity

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World Journa. of Ga.trointestina. Surgery 2010年第8期2卷 255-259页

作者： a.essa.dro zerbi Nicolò Pecorelli Pa.crea.ic Surgery Section Third Department of SurgeryIRCCS Istituto Clinico Humanitas Pa.crea. Unit Department of SurgeryIRCCS San Raffaele Hospital

Pa.crea.ic meta.ta.es,a.though uncommon,ha.e been observed with increa.ing frequency recently,especia.ly by high-volume pa.crea.ic surgery centers.They a.e often a.ymptoma.ic a.d detected incidenta.ly or during follow-up investiga.ions even severa. yea.s a.ter the re-mova. of the prima.y tumor.Rena. cell ca.cer represents the most common prima.y tumor by fa.,followed by colorecta. ca.cer,mela.oma.sa.coma.a.d lung ca.cer.Pa.crea.ic meta.ta.ectomy is indica.ed for a. isola.ed a.d resecta.le meta.ta.is in a.pa.ient fit to tolera.e pa.crea.ectomy.Both sta.da.d a.d a.ypica. pa.crea.ic resection ca. be performed:a.resection stra.egy providing a.equa.e resection ma.gins a.d ma.ima. tissue preserva.ion of the pa.crea. should be pursued.The effectiveness of resection for pa.crea.ic meta.ta.es is ma.nly dependent on the tumor biology of the prima.y ca.cer;rena. cell ca.cer is a.socia.ed with the best outcome with a.5-yea. surviva. ra.e grea.er tha. 70%.

关键词： Pa.crea. Pa.crea.ic ca.cer Seconda.y tumor Pa.crea.ic resection Rena. cell ca.cer

ERCP in a.ute pa.crea.itis:Wha. ta.es pla.e in routine clinica. pra.tice?

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World Journa. of Ga.trointestina. Endoscopy 2010年第9期2卷 308-313页

作者： a.ma.do Ga.brielli Ra.fa.le Pezzilli Generoso Uomo a.essa.dro zerbi Luca.Frulloni Pa.lo De Ra. La.ra.Ca.toldi Guido Costa.a.na.Cla.dio Ba.si Va.erio Di Ca.lo Depa.tment of Surgica. a.d Ga.troenterologica. Sciences University of Verona Depa.tment of Digestive Disea.es a.d Interna. Medicine S.Orsola-Malpighi Hospital Depa.tment of Interna. Medicine Depa.tment of Surgery Humanitas Hospital Depa.tment of Emergency Surgery Fondazione IRCCS MaggioreMangiagalli and Regina Elena Hospital Digestive Endoscopy Unit "Agostino Gemelli" University HospitalCatholic University of Rome Rome 00100 Italy Depa.tment of Surgery University Vita e Salute

a.M:To eva.ua.e the da.a.from a.survey ca.ried out in Ita.y rega.ding the endoscopic a.proa.h to a.ute pa.crea.itis in order to obta.n a.picture of wha. ta.es pla.e a.ter the relea.e of a. educa.iona. project on a.ute pa.crea.itis sponsored by the Ita.ia. a.socia.ion for the Study of the Pa.crea..METHODS:Of the 1 173 pa.ients enrolled in our survey,the most frequent etiologica. ca.egory wa. bilia.y forms(69.3%) a.d most pa.ients ha. mild pa.crea.itis(85.8%).RESULTS:344/1 173(29.3%) underwent endoscopic retrogra.e chola.giopa.crea.ogra.hy(ERCP).The mea. interva. between the onset of symptoms a.d ERCP wa. 6.7 ± 5.0 d;only 89 exa.ina.ions(25.9%) were performed within 72 h from the onset of symptoms.The ma.n indica.ions for ERCP were suspicion of common bile duct stones(90.3%),ja.ndice(44.5%),clini ca. worsening of a.ute pa.crea.itis(14.2%) a.d cho la.gitis(6.1%).Bilia.y a.d pa.crea.ic ducts were visua.lized in 305 pa.ients(88.7%) a.d in 93 pa.ients(27.0%) respectively.The success ra.e in obta.ning a.chola.gio gra. wa. sta.istica.ly higher(P = 0.003) in pa.ients with mild a.ute pa.crea.itis(90.6%) tha. in pa.ients with severe disea.e(72.2%).Bilia.y endoscopic sphinc terotomy wa. performed in 295 of the 305 pa.ients(96.7%) with no difference between mild a.d severe disea.e(P = 0.985).ERCP morbidity wa. 6.1% a.d morta.ity wa. 1.7%;the morta.ity wa. due to the complica.ions of a.ute pa.crea.itis a.d not the endoscopic procedure.CONCLUSION:The results of this survey,a. with those ca.ried out in other countries,indica.e a.la.k of complia.ce with the guidelines for the indica.ions for interventiona. endoscopy.

关键词： a.ute pa.crea.itis Epidemiology,Endoscopic retrogra.e chola.giopa.crea.ogra.hy Da.a collection