Showing papers by "Pietro Addeo published in 2022"
TL;DR: This large-scale study is the first benchmark analysis of DP outcomes and provides robust and standardized data that may allow for comparisons between surgeons, centers, studies, and surgical techniques.
Abstract: Objective: Defining robust and standardized outcome references for distal pancreatectomy (DP) by using Benchmark analysis. Background: Outcomes after DP are recorded in medium or small-sized studies without standardized analysis. Therefore, the best results remain uncertain. Methods: This multicenter study included all patients undergoing DP for resectable benign or malignant tumors in 21 French expert centers in pancreas surgery from 2014 to 2018. A low-risk cohort defined by no significant comorbidities was analyzed to establish 18 outcome benchmarks for DP. These values were tested in high risk, minimally invasive and benign tumor cohorts. Results: A total of 1188 patients were identified and 749 low-risk patients were screened to establish Benchmark cut-offs. Therefore, Benchmark rate for mini-invasive approach was ≥36.8%. Benchmark cut-offs for postoperative mortality, major morbidity grade ≥3a and clinically significant pancreatic fistula rates were 0%, ≤27%, and ≤28%, respectively. The benchmark rate for readmission was ≤16%. For patients with pancreatic adenocarcinoma, cut-offs were ≥75%, ≥69.5%, and ≥66% for free resection margins (R0), 1-year disease-free survival and 3-year overall survival, respectively. The rate of mini-invasive approach in high-risk cohort was lower than the Benchmark cut-off (34.1% vs ≥36.8%). All Benchmark cut-offs were respected for benign tumor group. The proportion of benchmark cases was correlated to outcomes of DP. Centers with a majority of low-risk patients had worse results than those operating complex cases. Conclusion: This large-scale study is the first benchmark analysis of DP outcomes and provides robust and standardized data. This may allow for comparisons between surgeons, centers, studies, and surgical techniques.
5 citations
TL;DR: The resection of well-differentiated PNETs with LMs was characterized by the longest survival rates and the use of neoadjuvant/adjuvant chemotherapy in this category of patients remain to be further investigated.
Abstract: Simple Summary Up to half of all newly diagnosed pancreatic neuroendocrine tumors (PNET) present with liver metastases (LM). The surgical resection of PNETs and LMs can provide complete tumor clearance and improve long-term survival. However, the combination of liver and pancreatic resection simultaneously can theoretically cumulate the morbidity and mortality of two separate operations. In the current study, we analyzed the outcomes of the synchronous surgical resection of PNETs and LMs in 51 patients. There were no differences in the postoperative outcomes in terms of mortality and morbidity according to the type of pancreatic resection. The tumor grade was identified as the sole prognostic factor for survival. The resection of well-differentiated PNETs with LMs was characterized by the longest survival rates (median overall survival 128 months, 5-year overall survival 83%). The optimal sequential surgical strategies for PNETs with LM and the use of neoadjuvant/adjuvant chemotherapy in this category of patients remain to be further investigated. Abstract Whether the simultaneous resection of pancreatic neuroendocrine tumors (PNET) with synchronous liver metastases (LM) is safe and oncologically efficacious remains to be debated. We retrospectively reviewed clinical data from patients who underwent the simultaneous resection of PNETs with LMs over the last 25 years. Fifty-one consecutive patients with a median age of 54 years (range 27–80 years) underwent pancreaticoduodenectomy (PD) (n = 16), distal pancreatosplenectomy (DSP) (n = 32) or total pancreatectomy (n = 3) with synchronous LM resection. There were no differences in the postoperative outcomes in term of mortality (p = 0.33) and morbidity (p = 0.76) between PD and DSP. The median overall survival (OS) was 64.78 months (95% CI: 49.7–119.8), and the overall survival rates at 1, 3, and 5 years were 97.9%, 86.2% and 61%, respectively. The OS varied according to the tumor grade (G): G1 (OS 128 months, 5-year OS 83%) vs. G2 (OS 60.5 months, 5-year OS 58%) vs. G3 (OS 49.7 months, 5-year OS 0%) (p = 0.03). Multivariate Cox analysis identified G as the only prognostic factor (HR: 5.56; 95% CI: 0.91–9.60; p = 0.01). Simultaneous PNETS with LMs can be performed safely with acceptable morbidity and mortality at tertiary centers. Well-differentiated PNETs had longer survival and might benefit the most from these extended surgeries.
4 citations
TL;DR: In this article , the outcomes of upfront and resection after neoadjuvant chemotherapy (NAC) for pancreatic adenocarcinoma were compared, and the effect of perioperative transfusion on overall survival was investigated.
3 citations
TL;DR: In this article , the authors compared the respective value of 68Ga-DOTATOC and 18F-DOPA PET/CT for initial staging or presurgical work-up of patients with small-intestine neuroendocrine tumors (SiNETs).
Abstract: Visual Abstract Our objective was to compare the respective value of 68Ga-DOTATOC and 18F-DOPA PET/CT for initial staging or presurgical work-up of patients with small-intestine neuroendocrine tumors (SiNETs). Methods: This was a retrospective, multicenter, noninterventional investigation involving 53 non–surgically treated SiNET patients who underwent both 68Ga-DOTATOC and 18F-DOPA PET/CT within a 6-mo interval without surgical intervention or therapeutic change between the 2 PET/CT studies. Percentage detection rate was calculated according to per-region and per-lesion analyses. Sensitivity for primary tumor detection was assessed in 37 surgically treated patients, taking surgical results (76 SiNETs) as the diagnostic gold standard. Results: 68Ga-DOTATOC PET/CT and 18F-DOPA PET/CT individually identified at least 1 primary SiNET in 92% (34/37) of the patients. Intestinal tumor multifocality was confirmed by histology in 8 patients. 68Ga-DOTATOC and 18F-DOPA PET/CT were concordantly positive for tumor multifocality in 5 patients, discordantly positive in 2 patients, and concordantly negative in 1 patient. The detection rate for subdiaphragmatic nodal metastases on per-region–based analysis was 91% and 98% for 68Ga-DOTATOC and 18F-DOPA PET/CT, respectively (P = 0.18). 18F-DOPA PET/CT detected a higher number of abnormal subdiaphragmatic nodes (P = 0.009). Regarding mesenteric nodes only, 18F-DOPA PET/CT detected more positive regions (P = 0.005) and nodal lesions (P = 0.003) than 68Ga-DOTATOC PET/CT, including nodes at the origin of mesenteric vessels. For detection of distant metastases, 68Ga-DOTATOC and 18F-DOPA PET/CT performed equally well on a per-region–based analysis. As compared with 68Ga-DOTATOC, 18F-DOPA PET/CT detected more hepatic (P < 0.001), peritoneal (P < 0.001), and lung metastases (P < 0.001). Conclusion: 18F-DOPA PET/CT detected more lesions than 68Ga-DOTATOC PET/CT in the studied patients. The respective roles of the two should be discussed in terms of disease staging and treatment selection.
3 citations
TL;DR: Management of immunosuppression in ACLF3 critically ill patients undergoing liver transplantation is challenging, and early introduction of mTOR inhibitor seems safe and efficient in this situation.
Abstract: Transplantation for patients with acute‐on‐chronic liver failure grade 3 (ACLF3) has encouraging results with 1‐year‐survival of 80‐90%. These patients with multiple organ failure meet the conditions for serious alterations of drug metabolism and increased toxicity. The goal of this study was to identify immunosuppression‐dependent factors that affect survival. This retrospective monocentric study was conducted in patients with ACLF3 consecutively transplanted between 2007 and 2019. The primary endpoint was 1‐year survival. Secondary endpoints were overall survival, treated rejection, and surgical complications. Immunosuppression was evaluated as to type of immunosuppression, post‐transplant introduction timing, trough levels, and trough level intra‐patient variability (IPV). One hundred patients were included. Tacrolimus IPV < 40% (P = .019), absence of early tacrolimus overdose (P = .033), use of anti‐IL2‐receptor antibodies (P = .034), and early mycophenolic acid introduction (P = .038) predicted 1‐year survival. Treated rejection was an independent predictor of survival (P = .001; HR 4.2 (CI 95%: 1.13‐15.6)). Early everolimus introduction was neither associated with higher rejection rates nor with more surgical complications. Management of immunosuppression in ACLF3 critically ill patients undergoing liver transplantation is challenging. Occurrence and treatment of rejection impacts on survival. Early introduction of mTOR inhibitor seems safe and efficient in this situation.
3 citations
TL;DR: In this article , the authors evaluated the feasibility and safety of liver transplantation using grafts with RLT from the nationwide CRISTAL registry of the Biomedicine Agency.
Abstract: Background. In the current setting of organ shortage, brain-dead liver donors with recent liver trauma (RLT) represent a potential pool of donors. Yet, data on feasibility and safety of liver transplantation (LT) using grafts with RLT are lacking. Methods. All liver grafts from brain-dead donors with RLT proposed for LT between 2010 and 2018 were identified from the nationwide CRISTAL registry of the Biomedicine Agency. The current study aimed at evaluating 1-y survival as the primary endpoint. Results. Among 11 073 LTs, 142 LTs (1.3%) using grafts with RLT were performed. These 142 LTs, including 23 split LTs, were performed from 131 donors (46.1%) of 284 donors with RLT proposed for LT. Transplanted grafts were procured from donors with lower liver enzymes levels (P < 0.001) and less advanced liver trauma according to the American Association for the Surgery of Trauma liver grading system (P < 0.001) compared with not transplanted grafts. Before allocation procedures, 20 (7%) of 284 donors underwent damage control intervention. During transplantation, specific liver trauma management was needed in 19 patients (13%), consisting of local hemostatic control (n = 15), partial hepatic resection on back-table (n = 3), or perihepatic packing (n = 1). Ninety-day mortality and severe morbidity rates were 8.5% (n = 12) and 29.5% (n = 42), respectively. One-year overall and graft survival rates were 85% and 81%, and corresponding 5-y rates were 77% and 72%, respectively. Conclusions. Using liver grafts from donors with RLT seems safe with acceptable long-term outcomes. All brain-dead patients with multiorgan trauma, including liver injury, should be considered for organ allocation.
2 citations
TL;DR: In this paper , the results of synchronous liver resection for metastatic pancreatic ductal adenocarcinomas and to identify prognostic factors for overall survival were evaluated and Cox analyses were used to identify factors prognostic of overall survival.
2 citations
TL;DR: In this paper , a retrospective review of patients diagnosed with Eosinophilic oesophagitis between January 2010 to April 2021 within the Paediatric Gastro-Intestinal and Allergy department is presented.
2 citations
TL;DR: In this article , a 2-stage surgical approach for malignant disease with intracardiac extension in a high-risk patient was described, where atrial thrombectomy was performed first, followed by right portal vein embolization.
1 citations
TL;DR: Surgeons should be aware of the types of ALGV, its associated arterial variations, the presence of pseudolesion or not, and the potential atrophy of liver segment, bringing light to what surgeons should know when encountering an aberrant left gastric vein.
TL;DR: In this article , the outcomes of upfront (UR) and resections after neoadjuvant chemotherapy (NAC) for pancreatic adenocarcinomas with venous invasion were compared.
Abstract: Introduction: Current guidelines recommend neoadjuvant treatment before resection for pancreatic adenocarcinoma invading the splenomesentericoportal venous axis, but comparative studies are lacking. This study compared the outcomes of upfront (UR) and resections after neoadjuvant chemotherapy (NAC) for pancreatic adenocarcinomas with venous invasion. Methods: We retrospectively reviewed clinical data of patients who underwent pancreaticoduodenectomy(PD) with venous resection (VR) for pancreatic adenocarcinoma between January 1 2006, and December 31 2020. Operative, pathologic and survival outcomes were compared between upfront and resections after NAC. Results: There were 169 patients, preoperative chemotherapy was administered to 55 patients and 114 underwent UR. There were no differences in operative time, morbidity and mortality between the two groups of patients(p>0.05). At pathologic examination patients undergoing resection after NAC had statistically significant smaller tumor, higher rate of R0 resection , less lympnodes involvement and lower rate of pathologic venous invasion (p<0.05).The median overall survival was 27.96 months (95% CI: 23.4 -34.5). Overall survival rates at one, 3, 5, 10 years were 82%, 39%, 22% and 11%, respectively. Median overall survival was longer in patients undergoing preoperative treatment (36.1 vs 22.8months; p= 0.02) but similar from the time of resection (26.0 vs 22.8 months; p= 0.55). Multivariate Cox analysis found neoadjuvant treatment (HR: 0.60; 95% CI:0.38-0.97; p =0.03), and perioperative transfusion (HR: 2.25; 95% CI:1.47-3.46; p =0.0002), as independent prognostic factors for overall survival. Conclusions: Neoadjuvant chemotherapy improves the pathologic and survival outcomes of pancreaticoduodenctomy with venous resection for pancreatic adenocarcinomas.
TL;DR: In this paper , the authors evaluated the results of synchronous liver resection for metastatic pancreatic ductal adenocarcinomas and identified prognostic factors for overall survival.
Abstract: Introduction: This study aimed to evaluate the results of synchronous liver resection for metastatic pancreatic ductal adenocarcinomas and to identify prognostic factors for overall survival. Methods: We retrospectively reviewed a clinical data of patients who underwent synchronous resection of pancreatic adenocarcinoma with liver metastases (LMs) between January 1 2008, and December 31 2020. Cox analyses were used to assess prognostic factors for survival. Results: There were 92 patients and preoperative chemotherapy was administered to 52 patients while the remaining underwent upfront surgery. The median overall survival was 18.26 months (95% CI: 14.7 -22.7) with overall survival rates at one, 3, 5 years were 70%, 10%, and 0%, respectively. Median recurrence-free survival was 5.44 months (95% CI: 4.5-6.9). Median overall survival was longer after neoadjuvant chemotherapy (22.7 vs 13.8 months; p= 0.01) but similar after pancreaticoduodenectomy or distal pancreatectomy, (20.8 vs18.2months; p=0.65) and resection of a single or multiple LM (18.9 vs.18.2; p=0.68). Multivariate Cox analysis found CA19-9 levels <500 kU/l (HR: 0.26; 95% CI:0.13-0.53; p =0.0002), R0 resection (HR: 0.28; 95% CI:0.13-0.58; p =0.0006), histologic venous invasion (HR: 2.83; 95% CI:1.35-5.92; p =0.0006) and neoadjuvant chemotherapy (HR: 0.41; 95% CI:0.21-0.78; p =0.007) as independent prognostic factors for overall survival. Conclusions: Oligometasatic liver disease can be resected safely at the time of pancreatic resection. Neoadjuvant chemotherapy and preresectional CA 19-9 serum values could select optimal candidate for surgery. Further experience and comparative studies with exclusive medical treatment are needed to validate surgery for oligometastatic patients.
TL;DR: In this paper , the authors compare the performance of the TEP/TDM with the 18F-FDOPA and the 68Ga-DOTATOC in terms of métastases.
Abstract: Les tumeurs neuroendocrines de l’intestin grêle (TNEg) sont des tumeurs de progression lente souvent découvertes au stade métastatique. La chirurgie curative, même au stade métastatique, permet une amélioration en survie globale. Une cartographie la plus exhaustive possible de l’atteinte métastatique est donc primordiale pour guider la décision thérapeutique. De plus, le niveau de l’atteinte ganglionnaire conditionne la longueur d’intestin grêle à réséquer. Plusieurs études ont montré que la TEP/TDM à la 18F-FDOPA retrouve plus de métastases que la TEP/TDM au 68Ga-DOTATOC dans les TNEg. Cependant, elles ne différenciaient pas les indications préchirurgicales et de suivi évolutif. L’objectif principal de cette étude était de comparer les performances diagnostiques de la TEP/TDM au 68Ga-DOTATOC et à la 18F-FDOPA. dans le bilan préchirurgical des TNEg. Il s’agit d’une étude observationnelle rétrospective multicentrique incluant tous les patients adressés entre octobre 2017 et février 2021 pour un bilan préchirurgical de TNEg ayant bénéficié d’une TEP/TDM au 68Ga-DOTATOC et à la 18F-FDOPA. Pour chaque examen, le nombre de primitifs, d’adénopathies et de métastases était compté. Une analyse par lésions et par région du niveau de l’atteinte ganglionnaire mésentérique (selon la classification de Pasquer et al., qui distingue les ganglions le long de l’intestin grêle, le long des vaisseaux mésentériques et autour de l’origine des vaisseaux mésentériques) était ensuite réalisée en utilisant le test de MC. Nemar. Les taux de détection de la 18F-FDOPA (88 %) et du 68Ga-DOTATOC (92 %) pour les lésions primitives ne différaient pas significativement ( p = 0,549). Concernant les ganglions mésentériques, la 18F-FDOPA détectait significativement plus d’adénopathies (100 %) que le 68Ga-DOTATOC (87 % ; p = 0,003). Cependant, la comparaison en analyse par région selon Pasquer et al. ne retrouvait pas de différence significative malgré un nombre de positifs légèrement supérieur en 18F-FDOPA. Le taux de détection de métastases de la 18F-FDOPA (97 %) était significativement supérieur à celui du 68Ga-DOTATOC (77 % ; p < 0,001). La TEP/TDM à la 18F-FDOPA détecte plus de métastases que le 68Ga-DOTATOC et semble donc utile dans le bilan préchirurgical des TNEg pour juger de l’opérabilité dans une stratégie curative. Elle retrouve également plus de ganglions mésentériques que le 68Ga-DOTATOC mais l’impact chirurgical reste à évaluer.
TL;DR: There was a heterogeneous management of SPSS during LT in the literature and Ligation of SPPS did not reduce vascular complications neither improved survival, so a randomized prospective study might contribute to identify best management ofSPSS at time of LT.
TL;DR: In this article , the authors tested the predictive value of six radiological classification methods for predicting pathologic venous invasion in patients undergoing pancreatectomy with venous resection for pancreatic adenocarcinomas.