Browsing by Author "Besselink, Marc G."

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    Global Survey on Pancreatic Surgery During the COVID-19 Pandemic
    (Lippincott Williams & Wilkins, 2020-06-24) Oba, Atsushi; Stoop, Thomas F.; Löhr, Matthias; Hackert, Thilo; Zyromski, Nicholas; Nealon, William H.; Unno, Michiaki; Schulick, Richard D.; Al-Musawi, Mohammed H.; Wu, Wenming; Zhao, Yupei; Satoi, Sohei; Wolfgang, Christopher L.; Hilal, Mohammad Abu; Besselink, Marc G.; Del Chiaro, Marco; Surgery, School of Medicine
    This global survey among members of seven international pancreatic associations and study groups elucidates the role of pancreatic surgery during the COVID-19 pandemic, regarding patient selection for the surgical and oncological treatment of pancreatic diseases to support clinical decision-making and creating a starting point for further discussion.
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    Pathological Complete Response in Patients With Resected Pancreatic Adenocarcinoma After Preoperative Chemotherapy
    (American Medical Association, 2024-06-03) Stoop, Thomas F.; Oba, Atsushi; Wu, Y. H. Andrew; Beaty, Laurel E.; Colborn, Kathryn L.; Janssen, Boris V.; Al-Musawi, Mohammed H.; Rodriguez Franco, Salvador; Sugawara, Toshitaka; Franklin, Oskar; Jain, Ajay; Saiura, Akio; Sauvanet, Alain; Coppola, Alessandro; Javed, Ammar A.; Groot Koerkamp, Bas; Miller, Braden N.; Mack, Claudia E.; Hashimoto, Daisuke; Caputo, Damiano; Kleive, Dyre; Sereni, Elisabetta; Belfiori, Giulio; Ichida, Hirofumi; van Dam, Jacob L.; Dembinski, Jeanne; Akahoshi, Keiichi; Roberts, Keith J.; Tanaka, Kimitaka; Labori, Knut J.; Falconi, Massimo; House, Michael G.; Sugimoto, Motokazu; Tanabe, Minoru; Gotohda, Naoto; Krohn, Paul S.; Burkhart, Richard A.; Thakkar, Rohan G.; Pande, Rupaly; Dokmak, Safi; Hirano, Satoshi; Burgdorf, Stefan K.; Crippa, Stefano; van Roessel, Stijn; Satoi, Sohei; White, Steven A.; Hackert, Thilo; Nguyen, Trang K.; Yamamoto, Tomohisa; Nakamura, Toru; Bachu, Vismaya; Burns, William R.; Inoue, Yosuke; Takahashi, Yu; Ushida, Yuta; Aslami, Zohra V.; Verbeke, Caroline S.; Fariña, Arantza; He, Jin; Wilmink, Johanna W.; Messersmith, Wells; Verheij, Joanne; Kaplan, Jeffrey; Schulick, Richard D.; Besselink, Marc G.; Del Chiaro, Marco; Surgery, School of Medicine
    Importance: Preoperative chemo(radio)therapy is increasingly used in patients with localized pancreatic adenocarcinoma, leading to pathological complete response (pCR) in a small subset of patients. However, multicenter studies with in-depth data about pCR are lacking. Objective: To investigate the incidence, outcome, and risk factors of pCR after preoperative chemo(radio)therapy. Design, setting, and participants: This observational, international, multicenter cohort study assessed all consecutive patients with pathology-proven localized pancreatic adenocarcinoma who underwent resection after 2 or more cycles of chemotherapy (with or without radiotherapy) in 19 centers from 8 countries (January 1, 2010, to December 31, 2018). Data collection was performed from February 1, 2020, to April 30, 2022, and analyses from January 1, 2022, to December 31, 2023. Median follow-up was 19 months. Exposures: Preoperative chemotherapy (with or without radiotherapy) followed by resection. Main outcomes and measures: The incidence of pCR (defined as absence of vital tumor cells in the sampled pancreas specimen after resection), its association with OS from surgery, and factors associated with pCR. Factors associated with overall survival (OS) and pCR were investigated with Cox proportional hazards and logistic regression models, respectively. Results: Overall, 1758 patients (mean [SD] age, 64 [9] years; 879 [50.0%] male) were studied. The rate of pCR was 4.8% (n = 85), and pCR was associated with OS (hazard ratio, 0.46; 95% CI, 0.26-0.83). The 1-, 3-, and 5-year OS rates were 95%, 82%, and 63% in patients with pCR vs 80%, 46%, and 30% in patients without pCR, respectively (P < .001). Factors associated with pCR included preoperative multiagent chemotherapy other than (m)FOLFIRINOX ([modified] leucovorin calcium [folinic acid], fluorouracil, irinotecan hydrochloride, and oxaliplatin) (odds ratio [OR], 0.48; 95% CI, 0.26-0.87), preoperative conventional radiotherapy (OR, 2.03; 95% CI, 1.00-4.10), preoperative stereotactic body radiotherapy (OR, 8.91; 95% CI, 4.17-19.05), radiologic response (OR, 13.00; 95% CI, 7.02-24.08), and normal(ized) serum carbohydrate antigen 19-9 after preoperative therapy (OR, 3.76; 95% CI, 1.79-7.89). Conclusions and relevance: This international, retrospective cohort study found that pCR occurred in 4.8% of patients with resected localized pancreatic adenocarcinoma after preoperative chemo(radio)therapy. Although pCR does not reflect cure, it is associated with improved OS, with a doubled 5-year OS of 63% compared with 30% in patients without pCR. Factors associated with pCR related to preoperative chemo(radio)therapy regimens and anatomical and biological disease response features may have implications for treatment strategies that require validation in prospective studies because they may not universally apply to all patients with pancreatic adenocarcinoma.
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    REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer
    (Wolters Kluwer, 2024) Boggi, Ugo; Kauffmann, Emanuele; Napoli, Niccolò; Barreto, George; Besselink, Marc G.; Fusai, Giuseppe K.; Hackert, Thilo; Hilal, Mohammad Abu; Marchegiani, Giovanni; Salvia, Roberto; Shrikhande, Shailesh V.; Truty, Mark; Werner, Jens; Wolfgang, Christopher L.; Bannone, Elisa; Capretti, Giovanni; Cattelani, Alice; Coppola, Alessandro; Cucchetti, Alessandro; De Sio, Davide; Di Dato, Armando; Di Meo, Giovanna; Fiorillo, Claudio; Gianfaldoni, Cesare; Ginesini, Michael; Hidalgo Salinas, Camila; Lai, Quirino; Miccoli, Mario; Montorsi, Roberto; Pagnanelli, Michele; Poli, Andrea; Ricci, Claudio; Sucameli, Francesco; Tamburrino, Domenico; Viti, Virginia; Addeo, Pietro F.; Alfieri, Sergio; Bachellier, Philippe; Baiocchi, Gian Luca; Balzano, Gianpaolo; Barbarello, Linda; Brolese, Alberto; Busquets, Juli; Butturini, Giovanni; Caniglia, Fabio; Caputo, Damiano; Casadei, Riccardo; Chunhua, Xi; Colangelo, Ettore; Coratti, Andrea; Costa, Francesca; Crafa, Francesco; Dalla Valle, Raffaele; De Carlis, Luciano; de Wilde, Roeland F.; Del Chiaro, Marco; Di Benedetto, Fabrizio; Di Sebastiano, Pierluigi; Dokmak, Safi; Hogg, Melissa; Egorov, Vyacheslav I.; Ercolani, Giorgio; Ettorre, Giuseppe Maria; Falconi, Massimo; Ferrari, Giovanni; Ferrero, Alessandro; Filauro, Marco; Giardino, Alessandro; Grazi, Gian Luca; Gruttadauria, Salvatore; Izbicki, Jakob R.; Jovine, Elio; Katz, Matthew; Keck, Tobias; Khatkov, Igor; Kiguchi, Gozo; Kooby, David; Lang, Hauke; Lombardo, Carlo; Malleo, Giuseppe; Massani, Marco; Mazzaferro, Vincenzo; Memeo, Riccardo; Miao, Yi; Mishima, Kohei; Molino, Carlo; Nagakawa, Yuichi; Nakamura, Masafumi; Nardo, Bruno; Panaro, Fabrizio; Pasquali, Claudio; Perrone, Vittorio; Rangelova, Elena; Liu, Rong; Romagnoli, Renato; Romito, Raffaele; Rosso, Edoardo; Schulick, Richard; Siriwardena, Ajith; Spampinato, Marcello Giuseppe; Strobel, Oliver; Testini, Mario; Troisi, Roberto Ivan; Uzunoglo, Faik G.; Valente, Roberto; Veneroni, Luigi; Zerbi, Alessandro; Vicente, Emilio; Vistoli, Fabio; Vivarelli, Marco; Wakabayashi, Go; Zanus, Giacomo; Zureikat, Amer; Zyromski, Nicholas J.; Coppola, Roberto; D'Andrea, Vito; Davide, José; Dervenis, Christos; Frigerio, Isabella; Konlon, Kevin C.; Michelassi, Fabrizio; Montorsi, Marco; Nealon, William; Portolani, Nazario; Sousa Silva, Donzília; Bozzi, Giuseppe; Ferrari, Viviana; Trivella, Maria G.; Cameron, John; Clavien, Pierre-Alain; Asbun, Horacio J.; REDISCOVER Multidisciplinary Advisory Board; Surgery, School of Medicine
    Objective: The REDISCOVER consensus conference aimed at developing and validating guidelines on the perioperative care of patients with borderline-resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Background: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports the resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. Methods: The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach a consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to nonsurgical guidelines. Results: Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis, and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive means to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ). Conclusions: The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR-PDAC and LA-PDAC, and serve as the basis of a new international registry for this patient population.
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    Surgical Outcome After Distal Pancreatectomy With and Without Portomesenteric Venous Resection in Patients with Pancreatic Adenocarcinoma: A Transatlantic Evaluation of Patients in North America, Germany, Sweden, and The Netherlands (GAPASURG)
    (Springer, 2024) Stoop, Thomas F.; Augustinus, Simone; Björnsson, Bergthor; Tingstedt, Bobby; Andersson, Bodil; Wolfgang, Christopher L.; Werner, Jens; Johansen, Karin; Stommel, Martijn W. J.; Katz, Matthew H. G.; Ghadimi, Michael; House, Michael G.; Ghorbani, Poya; Molenaar, I. Quintus; de Wilde, Roeland F.; Mieog, J. Sven D.; Keck, Tobias; Wellner, Ulrich F.; Uhl, Waldemar; Besselink, Marc G.; Pitt, Henry A.; Del Chiaro, Marco; Global Audits on Pancreatic Surgery Group (GAPASURG); Surgery, School of Medicine
    Background: Pancreatic adenocarcinoma located in the pancreatic body might require a portomesenteric venous resection (PVR), but data regarding surgical risks after distal pancreatectomy (DP) with PVR are sparse. Insight into additional surgical risks of DP-PVR could support preoperative counseling and intraoperative decision making. This study aimed to provide insight into the surgical outcome of DP-PVR, including its potential risk elevation over standard DP. Methods: We conducted a retrospective, multicenter study including all patients with pancreatic adenocarcinoma who underwent DP ± PVR (2018-2020), registered in four audits for pancreatic surgery from North America, Germany, Sweden, and The Netherlands. Patients who underwent concomitant arterial and/or multivisceral resection(s) were excluded. Predictors for in-hospital/30-day major morbidity and mortality were investigated by logistic regression, correcting for each audit. Results: Overall, 2924 patients after DP were included, of whom 241 patients (8.2%) underwent DP-PVR. Rates of major morbidity (24% vs. 18%; p = 0.024) and post-pancreatectomy hemorrhage grade B/C (10% vs. 3%; p = 0.041) were higher after DP-PVR compared with standard DP. Mortality after DP-PVR and standard DP did not differ significantly (2% vs. 1%; p = 0.542). Predictors for major morbidity were PVR (odds ratio [OR] 1.500, 95% confidence interval [CI] 1.086-2.071) and conversion from minimally invasive to open surgery (OR 1.420, 95% CI 1.032-1.970). Predictors for mortality were higher age (OR 1.087, 95% CI 1.045-1.132), chronic obstructive pulmonary disease (OR 4.167, 95% CI 1.852-9.374), and conversion from minimally invasive to open surgery (OR 2.919, 95% CI 1.197-7.118), whereas concomitant PVR was not associated with mortality. Conclusions: PVR during DP for pancreatic adenocarcinoma in the pancreatic body is associated with increased morbidity, but can be performed safely in terms of mortality.