Browsing by Author "White, Steven A."

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    First World Consensus Conference on pancreas transplantation: Part II - recommendations
    (Wiley, 2021) Boggi, Ugo; Vistoli, Fabio; Andres, Axel; Arbogast, Helmut P.; Badet, Lionel; Baronti, Walter; Bartlett, Stephen T.; Benedetti, Enrico; Branchereau, Julien; Burke, George W., III; Buron, Fanny; Caldara, Rossana; Cardillo, Massimo; Casanova, Daniel; Cipriani, Federica; Cooper, Matthew; Cupisti, Adamasco; Davide, Josè; Drachenberg, Cinthia; de Koning, Eelco J. P.; Ettorre, Giuseppe Maria; Fernandez Cruz, Laureano; Fridell, Jonathan A.; Friend, Peter J.; Furian, Lucrezia; Gaber, Osama A.; Gruessner, Angelika C.; Gruessner, Rainer W. G.; Gunton, Jenny E.; Han, Duck-Jong; Iacopi, Sara; Kauffmann, Emanuele Federico; Kaufman, Dixon; Kenmochi, Takashi; Khambalia, Hussein A.; Lai, Quirino; Langer, Robert M.; Maffi, Paola; Marselli, Lorella; Menichetti, Francesco; Miccoli, Mario; Mittal, Shruti; Morelon, Emmanuel; Napoli, Niccolò; Neri, Flavia; Oberholzer, Jose; Odorico, Jon S.; Öllinger, Robert; Oniscu, Gabriel; Orlando, Giuseppe; Ortenzi, Monica; Perosa, Marcelo; Perrone, Vittorio Grazio; Pleass, Henry; Redfield, Robert R.; Ricci, Claudio; Rigotti, Paolo; Robertson, R. Paul; Ross, Lainie F.; Rossi, Massimo; Saudek, Frantisek; Scalea, Joseph R.; Schenker, Peter; Secchi, Antonio; Socci, Carlo; Sousa Silva, Donzilia; Squifflet, Jean Paul; Stock, Peter G.; Stratta, Robert J.; Terrenzio, Chiara; Uva, Pablo; Watson, Christopher J. E.; White, Steven A.; Marchetti, Piero; Kandaswamy, Raja; Berney, Thierry; Surgery, School of Medicine
    The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.
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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.