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Percutaneous ablation of pancreatic cancer

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World Journal of Gastroenterology 2016年第44期22卷 9661-9673页

作者： Mirko D'Onofrio Valentina Ciaravino Riccardo De Robertis Emilio Barbi Roberto Salvia Roberto Girelli Salvatore Paiella Camilla Gasparini Nicolò Cardobi claudio bassi Department of Radiology G.B. Rossi Hospital University of Verona Department of Radiology Casa di Cura Dott Pederzoli 37019 Peschiera del Garda (VR) Department of Surgery G.B. Rossi Hospital University of Verona Department of Surgery Casa di Cura Dott. Pederzoli 37019 Peschiera del Garda (VR)

Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of nonresectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques(radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review.

关键词： Irreversible electroporation Pancreatic cancer Pancreatic adenocarcinoma Percutaneous treatment Ablation treatment Microwave ablation Cryoablation Radiofrequency ablation

Radiofrequency ablation of locally advanced pancreatic adenocarcinoma:An overview

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World Journal of Gastroenterology 2010年第28期16卷 3478-3483页

作者： Mirko D’Onofrio Emilio Barbi Roberto Girelli Enrico Martone Anna Gallotti Roberto Salvia Paolo Tinazzi Martini claudio bassi Paolo Pederzoli Roberto Pozzi Mucelli Department of Radiology University Hospital G.B.RossiUniversity of Verona Department of Radiology Hospital"Casa di Cura Pederzoli"-Peschiera Department of Surgery Hospital"Casa di Cura Pederzoli"-Peschiera Department of Surgery University Hospital G.B.RossiUniversity of Verona

Radiofrequency ablation(RFA)of pancreatic neoplasms is restricted to locally advanced,non-resectable but nonmetastatic *** of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparotomy in open *** ultrasound covers the mandatory role of staging,evaluation of feasibility,guidance and monitoring of the *** types of needle can be *** first aim in the evaluation of RFA as a treatment for locally advanced pancreatic ductal adenocarcinoma,in order of evaluation but not of importance,is to determine the feasibility of the *** second aim is to establish the effect of RFA on tumoral mass in terms of necrosis *** most important aim,third in order of evaluation,is the potential improvement of quality of life and survival ***,only a few studies assess the feasibility of the *** present paper is an overview of RFA for pancreatic adenocarcinoma.

关键词： Radiofrequency ablation Pancreatic adenocarcinoma Intraoperative ultrasound Contrast-enhanced ultrasound Perfusion computed tomography

Computed tomography-based radiomic to predict resectability in locally advanced pancreatic cancer treated with chemotherapy and radiotherapy

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World Journal of Gastrointestinal Oncology 2022年第3期14卷 703-715页

作者： Gabriella Rossi Luisa Altabella Nicola Simoni Giulio Benetti Roberto Rossi Martina Venezia Salvatore Paiella Giuseppe Malleo Roberto Salvia Stefania Guariglia claudio bassi Carlo Cavedon Renzo Mazzarotto Department of Radiation Oncology University of Verona Hospital TrustVerona 37126Italy Department of Medical Physics University of Verona Hospital TrustVerona 37126Italy Department of General and Pancreatic Surgery Pancreas InstituteUniversity of Verona Hospital TrustVerona 37126Italy

BACKGROUND Surgical resection after neoadjuvant treatment is the main driver for improved survival in locally advanced pancreatic cancer(LAPC).However,the diagnostic performance of computed tomography(CT)imaging to evaluate the residual tumour burden at restaging after neoadjuvant therapy is low due to the difficulty in distinguishing neoplastic tissue from fibrous scar or *** this context,radiomics has gained popularity over conventional imaging as a complementary clinical tool capable of providing additional,unprecedented information regarding the intratumor heterogeneity and the residual neoplastic tissue,potentially serving in the therapeutic decision-making *** To assess the capability of radiomic features to predict surgical resection in LAPC treated with neoadjuvant chemotherapy and *** Patients with LAPC treated with intensive chemotherapy followed by ablative radiation therapy were retrospectively *** thousand six hundred and fifty-five radiomic features were extracted from planning CT inside the gross tumour *** extracted features and clinical data contribute to create and validate the predictive model of resectability *** were repeatedly divided into training and validation *** discriminating performance of each model,obtained applying a LASSO regression analysis,was assessed with the area under the receiver operating characteristic curve(AUC).The validated model was applied to the entire dataset to obtain the most significant *** Seventy-one patients were included in the *** age was 65 years and 57.8%of patients were *** patients underwent induction chemotherapy followed by ablative radiotherapy,and 19(26.8%)ultimately received surgical *** the first step of variable selections,a predictive model of resectability was developed with a median AUC for training and validation sets of 0.862(95%CI:0.792-0.921)and 0.853(95%CI:0.706-0.960),respectivel

关键词： Computed tomography Radiomics Predictive model Resectability Locally advanced pancreatic cancer Radiation oncology

1. Preoperative biliary drainage for cancer of the head of the pancreas.

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中国肿瘤临床 2010年第6期37卷 364-364页

作者： claudio bassi University of Verona, Italy

van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, vander Harst E, Kubben FJ, Gerritsen JJ, Greve JW, GerhardsMF, de Hingh IH, Klinkenbijl JH, Nio CY, de Castro SM,Busch OR, van Gulik TM, Bossuyt PM, Gouma DJ N EngI J... 详细信息

关键词： der ERCP head

Pancreaticoduodenectomy in patients ≥ 75 years of age:Are there any differences with other age ranges in oncological and surgical outcomes? Results from a tertiary referral center

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World Journal of Gastroenterology 2017年第17期23卷 3077-3083页

作者： Salvatore Paiella Matteo De Pastena Tommaso Pollini Giovanni Zancan Debora Ciprani Giulia De Marchi Luca Landoni Alessandro Esposito Luca Casetti Giuseppe Malleo Giovanni Marchegiani Massimiliano Tuveri Enrico Marrano Laura Maggino Erica Secchettin Deborah Bonamini claudio bassi Roberto Salvia General and Pancreatic Surgery Department Pancreas InstituteUniversity and Hospital Trust of Verona Gastroenterology B Department Pancreas InstituteUniversity and Hospital Trust of Verona

AIM To compare surgical and oncological outcomes after pancreaticoduodenectomy(PD) in patients ≥ 75 years of age with two younger cohorts of patients. METHODS The prospectively maintained Institutional database of pancreatic resection was queried for patients aged ≥ 75 years(late elderly, LE) submitted to PD for any disease from January 2010 to June 2015. We compared clinical, demographic and pathological features and survival outcomes of LE patients with 2 exact matched cohorts of younger patients [≥ 40 to 64 years of age(adults, A) and ≥ 65 to 74 years of age(young elderly, YE)] submitted to PD, according to selected variables. RESULTS The final LE population, as well as the control groups, were made of 96 subjects. Up to 71% of patients was operated on for a periampullary malignancy and pancreatic cancer(PDAC) accounted for 79% of them. Intraoperative data(estimated blood loss and duration of surgery) did not differ among the groups. The overall complication rate was 65.6%, 61.5% and 58.3% for LE, YE and A patients, respectively, P = NS). Reoperation and cardiovascular complications were significantly more frequent in LE than in YE and A groups(P = 0.003 and P = 0.019, respectively). When considering either all malignancies and PDAC only, the three groups did not differ in survival. Considering all benign diseases, the estimated mean survival was 58 and 78 mo for ≥ and < 75 years of age(YE + A groups), respectively(P = 0.012). CONCLUSION Age is not a contraindication for PD. A careful selection of LE patients allows to obtain good surgical and oncological results.

关键词： Pancreatic cancer Periampullary cancer Pancreaticoduodenectomy Elderly Pancreatic surgery

Exocrine pancreatic insufficiency in adults:A shared position statement of the Italian association for the study of the pancreas

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World Journal of Gastroenterology 2013年第44期19卷 7930-7946页

作者： Raffaele Pezzilli Angelo Andriulli claudio bassi Gianpaolo Balzano Maurizio Cantore Gianfranco Delle Fave Massimo Falconi Luca Frulloni the Exocrine Pancreatic Insufficiency collaborative(EPIc) Group Department of Digestive Diseases Internal Medicine Sant’Orsola-Malpighi Hospital 40138 Bologna Italy

This is a medical position statement developed by the Exocrine Pancreatic Insufficiency collaborative group which is a part of the Italian Association for the Study of the Pancreas(AISP).We covered the main diseases associated with exocrine pancreatic insufficiency(EPI)which are of common interest to internists/gastroenterologists,oncologists and surgeons,fully aware that EPI may also occur together with many other diseases,but less frequently.A preliminary manuscript based on an extended literature search(Medline/PubMed,Cochrane Library and Google Scholar)of published reports was prepared,and key recommendations were *** evidence was discussed at a dedicated meeting in Bologna during the National Meeting of the Association in October *** of the proposed recommendations and algorithms was discussed and an initial consensus was *** final draft of the manuscript was then sent to the AISP Council for approval and/or *** concerned parties approved the final version of the manuscript in June 2013.

关键词： Exocrine pancreatic insufficiency Chronic pancreatitis Gastric surgery Pancreatic surgery Pancreatic neoplasms Risk factors Clinical studies

Prognostication and response assessment in liver and pancreatic tumors:The new imaging

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World Journal of Gastroenterology 2015年第22期21卷 6794-6808页

作者： Riccardo De Robertis Paolo Tinazzi Martini Emanuele Demozzi Gino Puntel Silvia Ortolani Sara Cingarlini Andrea Ruzzenente Alfredo Guglielmi Giampaolo Tortora claudio bassi Paolo Pederzoli Mirko D'Onofrio Department of Radiology Verona Comprehensive Cancer Network G.B. Rossi Hospital University of Verona Department of Radiology Casa di Cura Pederzoli Department of Oncology Verona Comprehensive Cancer Network G.B.Rossi Hospital University of Verona Department of Hepato-Biliary Surgery Verona Comprehensive Cancer NetworkG.B. Rossi Hospital University of Verona Department of Pancreatic Surgery Verona Comprehensive Cancer Network G.B. Rossi Hospital University of Verona Department of Pancreatic Surgery Casa di Cura Pederzoli

Diffusion-weighted imaging(DWI), dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) and perfusion computed tomography(CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT ***, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography(PET)CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging,therefore these techniques could be used also for posttreatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart frommolecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations,prognostic stratification and post-treatment monitoring.

关键词： Diffusion magnetic resonance imaging Perfusion imaging Hepatocellular carcinoma Liverneoplasms Pancreatic neoplasms

Differences between main-duct and branch-duct intraductal papillary mucinous neoplasms of the pancreas

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World Journal of Gastrointestinal Surgery 2010年第10期2卷 342-346页

作者： Roberto Salvia Stefano Crippa Stefano Partelli Giulia Armatura Giuseppe Malleo Marina Paini Antonio Pea claudio bassi Department of Surgery-General Surgery B "GB Rossi" HospitalUniversity of Verona

In the last decade,intraductal papillary mucinous neoplasms(IPMNs) have become commonly *** a morphological standpoint,they are classified in main-duct IPMNs(MD-IPMNs) and branch-duct IPMNs(BD-IPMNs),depending on the type of involvement of the pancreatic ductal system by the *** the fact that our understanding of their natural history is still incomplete,recent data indicate that MD-IPMNs and BD-IPMNs show significant differences in terms of biological behaviour with MD-IPMNs at higher risk of malignant *** the present paper,clinical and epidemiological characteristics,rates of malignancy and the natural history of MD-IPMNs and BD-IPMNs are *** profile of IPMNs involving both the main pancreatic duct and its side branches(combined-IPMNs) are also ***,general recommendations for management based on these differences are given.

关键词： Intraductal papillary mucinous neoplasms Branch-duct Main-duct Malignancy Surgery Followup Nodules Combined type

Diffusion-weighted imaging of pancreatic cancer

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World Journal of Radiology 2015年第10期7卷 319-328页

作者： Riccardo De Robertis Paolo Tinazzi Martini Emanuele Demozzi Flavia Dal Corso claudio bassi Paolo Pederzoli Mirko D'Onofrio Department of Radiology Verona Comprehensive Cancer Network Department of RadiologyG.B.Rossi Hospital-University of Verona Verona Comprehensive Cancer Network-Department of Pancreatic Surgery G.B.Rossi Hospital-University of Verona Department of Pancreatic Surgery

Magnetic resonance imaging(MRI) is a reliable and accurate imaging method for the evaluation of patients with pancreatic ductal adenocarcinoma(PDAC). Diffusion-weighted imaging(DWI) is a relatively recent technological improvement that expanded MRI capabilities, having brought functional aspects into conventional morphologic MRI evaluation. DWI can depict the random diffusion of water molecules within tissues(the so-called Brownian motions). Modifications of water diffusion induced by different factors acting on the extracellular and intracellular spaces, as increased cell density, edema, fibrosis, or altered functionality of cell membranes, can be detected using this MR sequence. The intravoxel incoherent motion(IVIM) model is an advanced DWI technique that consent a separate quantitative evaluation of all the microscopic random motions that contribute to DWI, which are essentially represented by molecular diffusion and blood microcirculation(perfusion). Technological improvements have made possible the routine use of DWI during abdominal MRI study. Several authors have reported that the addition of DWI sequence can be of value for the evaluation of patients with PDAC, especially improving the staging; nevertheless, it is still unclear whether and how DWI could be helpful for identification, characterization, prognostic stratification and follow-up during treatment. The aim of this paper is to review up-to-date literature data regarding the applications of DWI and IVIM to PDACs.

关键词： Pancreas Pancreatic neoplasms Pancreatic ductal ca