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Selection criteria in resectable pancreatic cancer: A biological and morphological approach

World Journal of Gastroenterology 2014年第32期20卷 11210-11215页

作者： domenico tamburrino Stefano Partelli Stefano Crippa Alberto Manzoni Angela Maurizi Massimo Falconi Pancreatic Surgery Unit Department of Surgery Polytechnic University of Marche Region

Pancreatic ductal adenocarcinoma(PDA) remains one of the most aggressive tumors with a low rate of survival. Surgery is the only curative treatment for PDA, although only 20% of patients are resectable at diagnosis. During the last decade there was an improvement in survival in patients affected by PDA, possibly explained by the advances in cancer therapy and by improve patient selection by pancreatic surgeons. It is necessary to select patients not only on the basis of surgical resectability, but also on the basis of the biological nature of the tumor. Specific preoperative criteria can be identified in order to select patients who will benefit from surgical resection. Duration of symptoms and level of carbohydrate antigen 19.9 in resectable disease should be considered to avoid R1 resection and early relapse. Radiological assessment can help surgeons to distinguish resectable disease from borderline resectable disease and locally advanced pancreatic cancer. Better patient selection can increase survival rate and neoadjuvant treatment can help surgeons select patients who will benefit from surgery.

关键词： Pancreatic ductal adenocarcinoma Pancreatic cancer Borderline resectable pancreatic cancer Pancreatic surgery Pancreatic cancer staging

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molecular pathology of intraductal papillary mucinous neoplasms of the pancreas

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World Journal of Gastroenterology 2014年第29期20卷 10008-10023页

作者： Marina Paini Stefano Crippa Stefano Partelli Filippo Scopelliti domenico tamburrino Andrea Baldoni Massimo Falconi Department of Surgery University of Verona Division of Pancreatic Surgery Ospedali RiunitiUniversità Politecnica delle Marche Division of Pancreatic Surgery Casa di Cura Dott.Pederzoli37019 Peschiera del Garda (VR)Italy

Since the first description of intraductal papillary mucinous neoplasms(IPMNs)of the pancreas in the eighties,their identification has dramatically increased in the last decades,hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic ***,the heterogeneity of IPMNs and their malignant potential make difficult the management of these *** objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be *** briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms,identifying some genes,molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to *** knowledge of molecular biology of IPMNs has impressively developed over the last few years.A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified,in pancreatic juice or in blood or in the samples from the pancreatic resections,but further researches are required to use these informations for clinical intent,in order to better define the natural history of these diseases and to improve their management.

关键词： Intraductal papillary mucinous neoplasm Pancreas Pancreatic cancer Molecular pathology Oncogene Tumor suppressor gene Dysplasia Malignant transformation

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Feasibility of therapeutic endoscopic ultrasound in the bridge-to-surgery scenario:The example of pancreatic adenocarcinoma

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World Journal of Gastroenterology 2022年第10期28卷 976-984页

作者： Giuseppe Vanella domenico tamburrino Gabriele Capurso Michiel Bronswijk Michele Reni Giuseppe Dell'Anna Stefano Crippa Schalk Van der Merwe Massimo Falconi Paolo Giorgio Arcidiacono Pancreatobiliary Endoscopy and EUS Division Pancreas Translational&Clinical Research CenterIRCCS San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilan 20132Italy Pancreatic Surgery Unit Pancreas Translational&Clinical Research CenterIRCCS San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilan 20132Italy Department of Gastroenterology and Hepatology University Hospital GasthuisbergUniversity of LeuvenLeuven 3000Belgium Department of Gastroenterology and Hepatology Imelda HospitalBonheiden 2820Belgium Department of Medical Oncology Pancreas Translational&Clinical Research CenterIRCCS San Raffaele Scientific InstituteMilan 20132Italy

Upfront resection is becoming a rarer indication for pancreatic ductal adenocarcinoma,as biologic behavior and natural history of the disease has boosted indications for neoadjuvant ***,gastric outlet obstruction and acute cholecystitis can frequently complicate this window of opportunity,resulting in potentially deleterious chemotherapy discontinuation,whose resumption relies on effective,prompt and long-lasting management of these *** therapeutic endoscopic ultrasound(t-EUS)can potentially offer some advantages over comparators,its use in potentially resectable patients is primal and has unfairly been restricted for fear of potential technical difficulties during subsequent *** is a narrative review of available evidence regarding EUS-guided choledochoduodenostomy,gastrojejunostomy and gallbladder drainage in the bridge-to-surgery ***-ofconcept evidence suggests no influence of t-EUS procedures on outcomes of eventual subsequent ***,the very high efficacy-invasiveness ratio over comparators in managing pancreatic cancer-related symptoms or complications can provide a powerful weapon against chemotherapy discontinuation,potentially resulting in higher subsequent *** evidence is discussed in this short paper,together with technical notes that might be useful for endoscopists and surgeons operating in this *** published evidence supports restricting t-EUS in potential surgical candidates,especially in the setting of pancreatic cancer patients undergoing neoadjuvant ***-to-surgery tEUS deserves further prospective evaluation.

关键词： Endosonography Gastrojejunostomy Choledochoduodenostomy Gallbladder drainage Pancreatic cancer Pancreatic surgery

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Management of hepatic metastases of well/moderately differentiated neuroendocrine tumors of the digestive tract

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Journal of Cancer Metastasis and Treatment 2016年第1期2卷 294-303页

作者： Anna La Salvia Stefano Partelli Marco Tampellini domenico tamburrino Massimo Falconi Giorgio V.Scagliotti Maria Pia Brizzi Division of Medical Oncology Department of OncologyUniversity of TurinSan Luigi Gonzaga HospitalRegione Gonzole 1010043 OrbassanoItaly Pancreatic Surgery Unit San Raffaele HospitalVita-Salute San Raffaele University20132 MilanItaly HPB Unit Royal Free HospitalLondon NW32QGUK

In neuroendocrine tumors(NETs),liver metastases(LM)represent the most crucial prognostic factor,irrespective of the primary tumor *** diagnosis,about 65-95%of gastroenteropancreatic neuroendocrine tumors(GEP-NETs)show hepatic *** strategies of LM are heterogeneous and range from systemic therapy to liver-directed *** type of systemic therapy used is dependent on the grade and proliferation of the tumor and includes somatostatin analogues,interferon,m-Tor and tyrosine kinase inhibitors,and *** liver-directed techniques,such as transarterial embolization/chemoembolization and selective internal radiation therapy,offer excellent palliation for patients with liver-predominant *** highly selected cases,liver transplantation and peptide receptor radionuclide therapy are *** relatively low disease incidence and the diversity of presentation have led to a lack of well-conducted randomized controlled trials comparing the efficacy of different treatment *** indicates that surgery is the only treatment that offers potential for *** unresectable lesions,the absence of data from rigorous trials limits the validity of many publications that detail *** this review we will discuss the existing approaches for hepatic metastases from GEP-NETs.

关键词： Gastroenteropancreatic carcinoids metastases systemic treatment

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