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Borderline resectable pancreatic cancer:Certainties and controversies

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World Journal of Gastrointestinal Surgery 2021年第6期13卷 516-528页

作者： Gennaro Nappo Greta Donisi alessandro zerbi Pancreatic Surgery Unit Humanitas Clinical and Research Center-IRCCSRozzano 20089Italy

Borderline resectable(BR)pancreatic ductal adenocarcinoma(PDAC)is currently a well-recognized entity,characterized by some specific anatomic,biological and conditional features:It includes patients with a stage of disease intermediate between the resectable and the locally advanced *** term BR identifies a tumour with an aggressive biological behaviour,on which a neoadjuvant approach instead of an upfront surgery one should be preferred,in order to obtain a radical resection(R0)and to avoid an early recurrence after *** if during the last decades several studies on this topic have been published,some aspects of BR-PDAC still represent a matter of *** aim of this review is to critically analyse the available literature on this topic,particularly focusing on:The problem of the heterogeneity of definition of BR-PDAC adopted,leading to a misinterpretation of published data;its current management(neoadjuvant vs upfront surgery);which neoadjuvant regimen should be preferably adopted;the problem of radiological restaging and the determination of resectability after neoadjuvant therapy;the post-operative outcomes after surgery;and the role and efficacy of adjuvant treatment for resected patients that already underwent neoadjuvant therapy.

关键词： Borderline resectable pancreatic cancer Pancreatic cancer Neoadjuvant treatment Chemotherapy Radiotherapy Pancreatic tumour

International assessment and validation of the prognostic role of lymph node ratio in patients with resected pancreatic head ductal adenocarcinoma

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Hepatobiliary Surgery and Nutrition 2022年第6期11卷 822-833页

作者： Gaetan-Romain Joliat Ismail Labgaa Jesse Sulzer Dionisios Vrochides alessandro zerbi Gennaro Nappo Julie Perinel Mustapha Adham Stijn van Roessel Marc G.Besselink JSven D.Mieog Jesse V.Groen Nicolas Demartines Markus Schafer Department of Visceral Surgery Lausanne University Hospital CHUVLausanneSwitzerland Graduate School for Health Sciences University of BernBernSwitzerland Division of Hepatobiliary and Pancreatic Surgery Carolinas Medical CenterCharlotteNCUSA Humanitas Clinical and Research Center-IRCCS MilanItaly Department of Biomedical Sciences Humanitas UniversityMilanItaly Department of Digestive Surgery Edouard Herriot HospitalLyonFrance Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Department of Surgery Leiden University Medical CenterLeidenThe Netherlands

Background:Lymph node ratio(LNR;positive/harvested lymph nodes)was identified as overall survival predictor in several cancers,including pancreatic *** remains unclear if LNR is predictive of overall survival in pancreatic adenocarcinoma patients staged *** study assessed the prognostic overall survival role of LNR in pancreatic adenocarcinoma patients in relation with lymph node ***:A retrospective international study in six different centers(Europe and United States)was *** adenocarcinoma patients who underwent pancreatoduodenectomy from 2000 to 2017 were *** with neoadjuvant treatment,metastases,R2 resections,or missing data regarding nodal status were *** curves were calculated using Kaplan-Meier method and compared using log-rank *** Cox regressions were performed to find independent overall survival predictors adjusted for potential ***:A total of 1,327 patients were *** node involvement(pN+)was found in 1,026 patients(77%),561 pN1(55%)and 465 pN2(45%).Median LNR in pN+patients was 0.214[interquartile range(IQR):0.105-0.364].On multivariable analysis,LNR was the strongest overall survival predictor in the entire cohort[hazard ratio(HR)=5.5;95%confidence interval(CI):3.1-9.9;P<0.001]and pN+patients(HR=3.8;95%CI:2.2-6.6;P<0.001).Median overall survival was better in patients with LNR<0.225 compared to patients with LNR≥0.225 in the entire cohort and pN+*** results were found in pN2 patients(worse overall survival when LNR≥0.225).Conclusions:LNR appeared as an important prognostic factor in patients undergoing surgery for pancreatic adenocarcinoma and permitted to stratify overall survival in pN2 *** should be routinely used in complement to tumor-node-metastasis(TNM)stage to better predict patient prognosis.

关键词： Pancreatectomy cancer lymphatic involvement

Pancreatic metastases:An increasing clinical entity

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World Journal of Gastrointestinal Surgery 2010年第8期2卷 255-259页

作者： alessandro zerbi Nicolò Pecorelli Pancreatic Surgery Section Third Department of SurgeryIRCCS Istituto Clinico Humanitas Pancreas Unit Department of SurgeryIRCCS San Raffaele Hospital

Pancreatic metastases,although uncommon,have been observed with increasing frequency recently,especially by high-volume pancreatic surgery *** are often asymptomatic and detected incidentally or during follow-up investigations even several years after the re-moval of the primary *** cell cancer represents the most common primary tumor by far,followed by colorectal cancer,melanoma,sarcoma and lung *** metastasectomy is indicated for an isolated and resectable metastasis in a patient fit to tolerate *** standard and atypical pancreatic resection can be performed:a resection strategy providing adequate resection margins and maximal tissue preservation of the pancreas should be *** effectiveness of resection for pancreatic metastases is mainly dependent on the tumor biology of the primary cancer;renal cell cancer is associated with the best outcome with a 5-year survival rate greater than 70%.

关键词： Pancreas Pancreatic cancer Secondary tumor Pancreatic resection Renal cell cancer

ERCP in acute pancreatitis:What takes place in routine clinical practice?

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World Journal of Gastrointestinal Endoscopy 2010年第9期2卷 308-313页

作者： Armando Gabbrielli Raffaele Pezzilli Generoso Uomo alessandro zerbi Luca Frulloni Paolo De Rai Laura Castoldi Guido Costamagna Claudio Bassi Valerio Di Carlo Department of Surgical and Gastroenterological Sciences University of Verona Department of Digestive Diseases and Internal Medicine S.Orsola-Malpighi Hospital Department of Internal Medicine Department of Surgery Humanitas Hospital Department of Emergency Surgery Fondazione IRCCS MaggioreMangiagalli and Regina Elena Hospital Digestive Endoscopy Unit "Agostino Gemelli" University HospitalCatholic University of Rome Rome 00100 Italy Department of Surgery University Vita e Salute

AIM:To evaluate the data from a survey carried out in Italy regarding the endoscopic approach to acute pancreatitis in order to obtain a picture of what takes place after the release of an educational project on acute pancreatitis sponsored by the Italian Association for the Study of the ***:Of the 1 173 patients enrolled in our survey,the most frequent etiological category was biliary forms(69.3%) and most patients had mild pancreatitis(85.8%).RESULTS:344/1 173(29.3%) underwent endoscopic retrograde cholangiopancreatography(ERCP).The mean interval between the onset of symptoms and ERCP was 6.7 ± 5.0 d;only 89 examinations(25.9%) were performed within 72 h from the onset of *** main indications for ERCP were suspicion of common bile duct stones(90.3%),jaundice(44.5%),clini cal worsening of acute pancreatitis(14.2%) and cho langitis(6.1%).Biliary and pancreatic ducts were visua lized in 305 patients(88.7%) and in 93 patients(27.0%) *** success rate in obtaining a cholangio gram was statistically higher(P = 0.003) in patients with mild acute pancreatitis(90.6%) than in patients with severe disease(72.2%).Biliary endoscopic sphinc terotomy was performed in 295 of the 305 patients(96.7%) with no difference between mild and severe disease(P = 0.985).ERCP morbidity was 6.1% and mortality was 1.7%;the mortality was due to the complications of acute pancreatitis and not the endoscopic ***:The results of this survey,as with those carried out in other countries,indicate a lack of compliance with the guidelines for the indications for interventional endoscopy.

关键词： Acute pancreatitis Epidemiology,Endoscopic retrograde cholangiopancreatography Data collection