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Unmet needs in preoperative biliary stenting for patient candidates for pancreaticoduodenectomy: a viewpoint

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Hepatobiliary Surgery and Nutrition 2019年第4期8卷 426-427页

作者： salvatore paiella Matteo De Pastena Roberto Salvia General and Pancreatic Surgery Unit Pancreas Institute University of Verona Verona Italy

We read with great interest the article published in Annals of Surgery, "Preoperative Biliary Stenting and Major Morbidity After Pancreatoduodenectomy: Does Elapsed Time Matter? The FRAGERITA Study Group" (1). The timing of preoperative biliary stenting (PBS) and its impact on postoperative outcomes after pancreaticoduodenectomy (PD) are ever-burning issues for pancreatologists dealing with jaundice due to periampullary tumors.

关键词： Surgery preoperative stent

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

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

Neoadjuvant treatment:A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma

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World Journal of Gastrointestinal Surgery 2021年第9期13卷 885-903页

作者： Ilaria Trestini Marco Cintoni Emanuele Rinninella Futura Grassi salvatore paiella Roberto Salvia Emilio Bria Carmelo Pozzo Sergio Alfieri Antonio Gasbarrini Giampaolo Tortora Michele Milella Maria Cristina Mele Section of Oncology Department of MedicinePancreas InstituteUniversity of Verona Hospital TrustVerona 37126Italy Scuola di Specializzazione in Scienza dell’Alimentazione Universitàdi Roma Tor VergataRoma 00133Italy UOC Nutrizione Clinica Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico A.Gemelli IRCCSRoma 00168Italy Dipartimento di Medicina e Chirurgia Traslazionale UniversitàCattolica del Sacro CuoreRoma 00168Italy General and Pancreatic Surgery Unit Pancreas InstituteUniversity of Verona Hospital TrustVerona 37126Italy Oncologia Medica Unit Comprehensive Cancer CenterFondazione Policlinico Universitario A Gemelli IRCCSRoma 00167Italy Oncologia Medica Unit UniversitàCattolica del Sacro CuoreRoma 00168Italy Digestive Surgery Unit and Pancreatic Surgery Gemelli Center Director Fondazione Policlinico Universitario A Gemelli IRCCSRoma 00167Italy UOC di Medicina Interna e Gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario A Gemelli IRCCSRoma 00167Italy UOSD Nutrizione Avanzata in Oncologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario A Gemelli IRCCSRoma 00167Italy

Patients affected by pancreatic ductal adenocarcinoma(PDAC)frequently present with advanced disease at the time of diagnosis,limiting an upfront surgical *** treatment(NAT)has become the standard of care to downstage non-metastatic locally advanced ***,this treatment increases the risk of a nutritional status decline,which in turn,may impact therapeutic tolerance,postoperative outcomes,or even prevent the possibility of *** on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications,length of hospital stay,and readmission rate,while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still ***,appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical *** this regard,NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program,aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival *** these perspectives,this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.

关键词： Pancreatic cancer Neoadjuvant treatment Pancreatic cancer surgery Nutritional status Nutritional prehabilitation Malnutrition

Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors

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World Journal of Gastroenterology 2017年第17期23卷 3092-3098页

作者： salvatore paiella Harmony Impellizzeri Elisabetta Zanolin Giovanni Marchegiani Marco Miotto Anna Malpaga Riccardo De Robertis Mirko D'Onofrio Borislav Rusev Paola Capelli Sara Cingarlini Giovanni Butturini Maria Vittoria Davì Antonio Amodio Claudio BassiAldo Scarpa Roberto Salvia Luca Landoni General and Pancreatic Surgery Department Pancreas InstituteUniversity and Hospital Trust of Verona Department of Public Health and Community Medicine University and Hospital Trust of Verona Department of Radiology Casa di Cura Pederzoli Department of Radiology Pancreas InstituteUniversity and Hospital Trust of Verona Department of Diagnostics and Public Health Section of PathologyUniversity and Hospital Trust of Verona ARC-NET Research Center University and Hospital Trust of Verona Department of Oncology Pancreas InstituteUniversity and Hospital Trust of Verona Hepato-bilio-pancreatic Surgery Unit Casa di Cura Pederzoli Section of Endocrinology Medicina Generale e Malattie Aterotrombotiche e DegenerativeDepartment of MedicineUniversity and Hospital Trust of Verona Gastroenterology B Department Pancreas InstituteUniversity and Hospital Trust of Verona

AIM To establish the ability of magnetic resonance(MR) and computer tomography(CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors(Pan NET) in a caseload of a tertiary referral *** Patients submitted to surgery for Pan NET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination(MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman(BA) and Mountain-Plot(MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok(PB) regression analysis was used to check the agreement between MR and *** Our study population consisted of 292 patients. Seventy-nine(27.1%) were functioning Pan NET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning-Pan NET, respectively. Limits of agreement(LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-Pan NET, no statistical significance was found in the size estimation rate of MR and CT(P = 0.433). PBR analysis did not reveal significant differences between MR, CT and *** MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of Pan NET.

关键词： Pancreatic neoplasms Neuroendocrine tumors Magnetic resonance imaging Diagnostic imaging Pathological dimensions

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