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A comparison of laparoscopic to open pancreaticoduodenectomy for pancreatic adenocarcinoma by propensity score matching analysis

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Laparoscopic, Endoscopic and Robotic Surgery 2024年第4期7卷 141-146页

作者： Jared Mount Brandon Mount Katherine Poruk Mary Tice john A.stauffer Department of Surgery Mayo ClinicJacksonvilleFLUSA Medical Education Heritage College of Osteopathic MedicineOhio UniversityAthensOHUSA Medical Education The University of ToledoCollege of Medicine and Life SciencesToledoOHUSA

Objective:In previous studies,laparoscopic pancreaticoduodenectomy(LPD)has demonstrated safety and potential benefits over open pancreaticoduodenectomy(OPD)for pancreatic adenocarcinoma(PDAC).After performing both LPD and OPD procedures interchangeably in routine practice for a decade,the outcomes of LPD versus OPD for PDAC were analyzed and compared at a single *** primary aim was to compare features of LPD and OPD in PDAC patients so that the suitable surgical approach may be chosen for each ***:From January 2010 through December 2020,all patients undergoing pancreaticoduodenectomy(PD)were identified,and information was collected *** a single institution,PD was performed on 589 patients,of whom 347 were OPD patients and 242 were LPD *** excluding those who underwent pancreatectomy for indications other than PDAC,total pancreatectomy,major vascular or concomitant organ resection,there were 237 patients(OPD¼157,LPD¼80).Then propensity score matching was completed to analyze 77 OPD patients versus 77 LPD patients to create a similar group of patients who underwent either LPD or OPD for PDAC.A comparison of perioperative data and 90-day outcomes with subsequent statistical analysis was ***:Operative time(491 min vs.281 min,p<0.001)was longer for LPD than *** rates of pancreatic fistula(11.7%vs.0.0%,p<0.001)and delayed gastric emptying(15.6%vs.3.9%,p¼0.027)were higher for LPD than OPD respectively but overall morbidity was *** loss,mortality and postpancreatectomy hemorrhage were also similar for both groups,but total costs($60,245 vs.$50,900,p¼0.002)were significantly higher for LPD than *** and overall survival were similar for the two ***:In our experience,LPD does not offer any advantages over OPD for PDAC and is associated with a higher rate of complications and costs.

关键词： Pancreaticoduodenectomy Whipple Laparoscopy Pancreatic fistula Pancreatic ductal adenocarcinoma

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National trends in resection of the distal pancreas

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World Journal of Gastroenterology 2012年第32期18卷 4342-4349页

作者： Armando Rosales-Velderrain Steven P Bowers Ross F Goldberg Tatyan M Clarke Mauricia A Buchanan john A stauffer Horacio J Asbun Department of General Surgery Mayo Clinic FloridaJacksonvilleFL 32225United States

AIM:To investigate national trends in distal pancreatectomy(DP) through query of three national patient care ***:From the Nationwide Inpatient Sample(NIS,2003-2009),the National Surgical Quality Improvement Project(NSQIP,2005-2010),and the Surveillance Epidemiology and End Results(SEER,2003-2009) databases using appropriate diagnostic and procedural codes we identified all patients with a diagnosis of a benign or malignant lesion of the body and/or tail of the pancreas that had undergone a partial or distal *** of laparoscopy was defined in NIS by the International Classification of Diseases,Ninth Revision correspondent procedure code;and in NSQIP by the exploratory laparoscopy or unlisted procedure current procedural terminology *** SEER,patients were identified by the International Classification of Diseases for Oncology,Third Edition diagnosis codes and the SEER Program Code Manual,third edition procedure *** analyzed the databases with respect to trends of inpatient outcome metrics,oncologic outcomes,and hospital volumes in patients with lesions of the neck and body of the pancreas that underwent operative ***:NIS,NSQIP and SEER identified 4242,2681 and 11 082 DP resections,***,laparoscopy was utilized in 15%(NIS) and 27%(NSQIP).No significant increase was seen over the course of the *** was performed for malignancy in 59%(NIS) and 66%(NSQIP).Neither patient Body mass index nor comorbidities were associated with operative approach(P = 0.95 and P = 0.96,respectively).Mortality(3% vs 2%,P = 0.05) and reoperation(4% vs 4%,P = 1.0) was not different between laparoscopy and open *** complications(10% vs 15%,P < 0.001),hospital costs [44 741 dollars,interquartile range(IQR) 28 347-74 114 dollars vs 49 792 dollars,IQR 13 299-73 463,P = 0.02] and hospital length of stay(7 d,IQR 4-11 d vs 7 d,IQR 6-10,P < 0.001) were less when laparoscopy was *** and two year sur

关键词： Laparoscopic distal pancreatectomy Trends Nationwide Inpatient Sample National Surgical Quality Improvement Project Surveillance epidemiology and end results

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Updated outcomes using clockwise technique for laparoscopic distal pancreatectomy:Optimal treatment of benign and malignant disease of the left pancreas

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Laparoscopic, Endoscopic and Robotic Surgery 2021年第1期4卷 9-13页

作者： Jordan S.Dutcher Domenech Asbun Mary P.Tice Horacio J.Asbun john A.stauffer Mayo Clinic Alix School of Medicine JacksonvilleFLUSA Department of General Surgery Mayo Clinic FloridaJacksonvilleFLUSA Hepatobiliary and Pancreas Surgery Miami Cancer InstituteMiamiFLUSA

Background:Laparoscopic distal pancreatectomy(LDP)has become the preferred approach for surgical management of left sided pancreas *** institution previously published its experience with distal pancreatectomies using a clockwise technique with good *** now reexamine our outcomes across a longer time ***:From August 2008 to November 2020,364 patients underwent LDP by hepatobiliary surgeons(HA and JS).All procedures were performed using the same clockwise approach,which includes the stepwise slow compression *** descriptive analysis of patient demographic,clinical,operative,and pathologic data was ***:Of the 364 patients who underwent LDP using this technique,clinically significant postoperative pancreatic fistula(POPF)was noted in 26(7.1%)patients,while major morbidity and mortality were reported in 9.9%and 0.3%,***-assisted method was required for 18(4.9%)patients and unplanned conversion in 20(5.5%)*** a subset analysis of patients with pancreatic adenocarcinoma(n¼90),POPF was noted in 13(14.4%),with minor complications occurring in 34.4%and major morbidity in 14.4%.Conclusion:LDP with a clockwise approach for dissection,combined with the stepwise slow compression technique results in excellent outcomes,with even lower POPF rates than originally *** analysis of patients with pancreatic adenocarcinoma shows acceptable perioperative outcomes with this technique.

关键词： Laparoscopic distal pancreatectomy Pancreatic ductal adenocarcinoma Outcomes

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麦尔维尔、奴隶制与美国困境（英文）

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英美文学研究论丛 2017年第1期 84-111页

作者： john stauffer Harvard University

For the state that today is made up of slaves,can not tomorrow transmute her bond into free;though lawlessness may transform them into brutes……And though all evils may be assuaged;all evils can not be done *** evil ... 详细信息

关键词：英语学习学习方法阅读知识阅读材料

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Feasibility of pancreatectomy following high-dose proton therapy for unresectable pancreatic cancer

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World Journal of Gastrointestinal Surgery 2017年第4期9卷 103-108页

作者： Kathryn E Hitchcock R Charles Nichols Christopher G Morris Debashish Bose Steven J Hughes john A stauffer Scott A Celinski Elizabeth A johnson Robert A Zaiden Nancy P Mendenhall Michael S Rutenberg Department of Radiation Oncology University of Florida Department of Surgical Oncology UF Health Cancer Center-Orlando Health Department of Surgery University of Florida Department of Surgery Mayo Clinic Department of Surgery Baylor University Medical Center at Dallas Department of Hematology/Oncology Mayo Clinic Department of Hematology/Oncology Baptist Health

AIM To review surgical outcomes for patients undergoing pancreatectomy after proton therapy with concomitant capecitabine for initially unresectable pancreatic *** From April 2010 to September 2013,15 patients with initially unresectable pancreatic cancer were treated withproton therapy with concomitant capecitabine at 1000 mg orally twice daily. All patients received 59.40 Gy(RBE) to the gross disease and 1 patient received 50.40 Gy(RBE) to high-risk nodal targets. There were no treatment interruptions and no chemotherapy dose reductions. Six patients achieved a radiographic response sufficient to justify surgical exploration,of whom 1 was identified as having intraperitoneal dissemination at the time of surgery and the planned pancreatectomy was aborted. Five patients underwent resection. Procedures included:Laparoscopic standard pancreaticoduodenectomy(n = 3),open pyloris-sparing pancreaticoduodenectomy(n = 1),and open distal pancreatectomy with irreversible electroporation(IRE) of a pancreatic head mass(n = 1). RESULTS The median patient age was 60 years(range,51-67). The median duration of surgery was 419 min(range,290-484),with a median estimated blood loss of 850 cm^3(range,300-2000),median ICU stay of 1 d(range,0-2),and median hospital stay of 10 d(range,5-14). Three patients were re-admitted to a hospital within 30 d after discharge for wound infection(n = 1),delayed gastric emptying(n = 1),and ischemic gastritis(n = 1). Two patients underwent R0 resections and demonstrated minimal residual disease in the final pathology specimen. One patient,after negative pancreatic head biopsies,underwent IRE followed by distal pancreatectomy with no tumor seen in the specimen. Two patients underwent R2 resections. Only 1 patient demonstrated ultimate local progression at the primary site. Median survival for the 5 resected patients was 24 mo(range,10-30).CONCLUSION Pancreatic resection for patients with initially unresectable cancers is feasible after

关键词： Pancreatic cancer Pancreatectomy Pancreas Proton therapy Radiotherapy

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Total pancreatectomy: Short- and long-term outcomes at a high-volume pancreas center

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World Journal of Gastrointestinal Surgery 2016年第9期8卷 634-642页

作者： Hazem M Zakaria john A stauffer Massimo Raimondo Timothy A Woodward Michael B Wallace Horacio J Asbun Department of Hepatopancreatobiliary and Liver Transplantation Surgery National Liver Institute Menoufia University Al-Minufya 22732 Egypt Department of Surgery Mayo Clinic Jacksonville FL 32224 United States Department of Gastroenterology Mayo Clinic Jacksonville FL 32224 United States

AIM To identify the current indications and outcomes of total pancreatectomy at a high-volume center. METHODS A single institutional retrospective study of patients undergoing total pancreatectomy from 1995 to 2014 was *** One hundred and three patients underwent totalpancreatectomy for indications including: Pancreatic ductal adenocarcinoma(n = 42, 40.8%), intraductal papillary mucinous neoplasms(n = 40, 38.8%), chronic pancreatitis(n = 8, 7.8%), pancreatic neuroendocrine tumors(n = 7, 6.8%), and miscellaneous(n = 6, 5.8%). The mean age was 66.2 years, and 59(57.3%) were female. Twenty-four patients(23.3%) underwent a laparoscopic total pancreatectomy. Splenic preservation and portal vein resection and reconstruction were performed in 24(23.3%) and 18 patients(17.5%), respectively. The 90 d major complications, readmission, and mortality rates were 32%, 17.5%, and 6.8% respectively. The 1-, 3-, 5-, and 7-year survival for patients with benign indications were 84%, 82%, 79.5%, and 75.9%, and for malignant indications were 64%, 40.4%, 34.7% and 30.9%, *** Total pancreatectomy, including laparoscopic total pancreatectomy, appears to be an appropriate option for selected patients when treated at a high-volume pancreatic center and through a multispecialty approach.

关键词： Intraductal papillary mucinous neoplasms Laparoscopic total pancreatectomy Pancreatic ductal adenocarcinoma Laparoscopy Pancreas cyst Pancreas cancer

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Targeting KRAS in pancreatic adenocarcinoma:Progress in demystifying the holy grail

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World Journal of Clinical Oncology 2023年第8期14卷 285-296页

作者： Ahmed Elhariri Ahmed Alhaj Daniel Ahn Mohamad Bassam Sonbol Tanios Bekaii-Saab Christina Wu Michael Scott Rutenberg john stauffer Jason Starr Umair Majeed Jeremy Jones Mitesh Borad Hani Babiker Division of Hematology-Oncology Department of MedicineMayo Clinic FloridaMayo Clinic Cancer CenterJacksonvilleFL 32224United States Division of Hematology-Oncology Department of MedicineMayo Clinic ArizonaMayo Clinic Cancer CenterPhoenixAZ 85054United States Department of Radiation-Oncology Mayo Clinic FloridaMayo Clinic Cancer CenterJacksonvilleFL 32224United States Department of Surgical Oncology Hepatopancreatobiliary SurgeryMayo Clinic FloridaJacksonvilleFL 32224United States

Pancreatic cancer(PC)remains one of the most challenging diseases,with a very poor 5-year overall survival of around 11.5%.Kirsten rat sarcoma virus(KRAS)mutation is seen in 90%-95%of PC patients and plays an important role in cancer cell proliferation,differentiation,metabolism,and survival,making it an essential mutation for targeted *** extensive efforts in studying this oncogene,there has been little success in finding a drug to target this pathway,labelling it for decades as“undruggable”.In this article we summarize some of the efforts made to target the KRAS pathway in PC,discuss the challenges,and shed light on promising clinical trials.

关键词： Kirsten rat sarcoma virus Targeted therapy Pancreatic cancer Drug resistance Next generation sequencing Clustered regularly interspaced short palindromic repeats

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Unusual causes of intrahepatic cholestatic liver disease

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World Journal of Gastroenterology 2007年第12期13卷 1879-1882页

作者： Elias E Mazokopakis john A Papadakis Diamantis P Kofteridis Department of Internal Medicine University Hospital of Heraklion Crete Greece Department of Internal Medicine NavalHospital of Crete Greece Department of Internal Medicine University Hospital of Heraklion Crete Greece

We report five cases with unusual causes of intrahepatic cholestasis, including consumption of Teucrium polium （family Lamiaceae） in the form of tea, stauffer＇s syndrome, treatment with tamoxifen citrate for breast cancer, infection with Coxiella Burnetii （acute Q fever）, and infection with Brucella rnelitensis （acute brucellosis）.

关键词： Brucella melitensis Coxiella Burnetii Cholestasis Hepatitis stauffer's syndrome Tamoxifen Teucrium polium

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