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2. First world consensus conference on pancreas transplantation: Part I—Methods and results of literature search

Author

Boggi, U, Vistoli, F, Marchetti, P, Kandaswamy, R, Berney, T, Andres, A, Arbogast, H, Badet, L, Baronti, W, Bartlett, S, Benedetti, E, Branchereau, J, Burke, G, Buron, F, Caldara, R, Cardillo, M, Casanova, D, Cipriani, F, Cooper, M, Cupisti, A, de Koning, E, Davide, J, Drachenberg, C, Ettorre, G, Fernandez Cruz, L, Fridell, J, Friend, P, Furian, L, Gaber, O, Gruessner, A, Gruessner, R, Gunton, J, Han, D, Iacopi, S, Kauffmann, E, Kaufman, D, Kenmochi, T, Khambalia, H, Lai, Q, Langer, R, Maffi, P, Marselli, L, Menichetti, F, Miccoli, M, Mittal, S, Morelon, E, Napoli, N, Neri, F, Oberholzer, J, Odorico, J, Ollinger, R, Oniscu, G, Orlando, G, Ortenzi, M, Perosa, M, Perrone, V, Redfield, R, Ricci, C, Rigotti, P, Robertson, R, Ross, L, Rossi, M, Saudek, F, Scalea, J, Schenker, P, Secchi, A, Socci, C, Sousa Silva, D, Squifflet, J, Stock, P, Stratta, R, Terrenzio, C, Uva, P, Watson, C, White, S, Boggi U., Vistoli F., Marchetti P., Kandaswamy R., Berney T., Andres A., Arbogast H. P., Badet L., Baronti W., Bartlett S. T., Benedetti E., Branchereau J., Burke G. W. 3., Buron F., Caldara R., Cardillo M., Casanova D., Cipriani F., Cooper M., Cupisti A., de Koning E. J. P., Davide J., Drachenberg C., Ettorre G. M., Fernandez Cruz L., Fridell J. A., Friend P. J., Furian L., Gaber O. A., Gruessner A. C., Gruessner R. W. G., Gunton J. E., Han D. -J., Iacopi S., Kauffmann E. F., Kaufman D., Kenmochi T., Khambalia H. A., Lai Q., Langer R. M., Maffi P., Marselli L., Menichetti F., Miccoli M., Mittal S., Morelon E., Napoli N., Neri F., Oberholzer J., Odorico J. S., Ollinger R., Oniscu G., Orlando G., Ortenzi M., Perosa M., Perrone V. G., Redfield R. R., Ricci C., Rigotti P., Robertson R. P., Ross L. F., Rossi M., Saudek F., Scalea J. R., Schenker P., Secchi A., Socci C., Sousa Silva D., Squifflet J. P., Stock P. G., Stratta R. J., Terrenzio C., Uva P., Watson C. C. E., White S. A., Boggi, U, Vistoli, F, Marchetti, P, Kandaswamy, R, Berney, T, Andres, A, Arbogast, H, Badet, L, Baronti, W, Bartlett, S, Benedetti, E, Branchereau, J, Burke, G, Buron, F, Caldara, R, Cardillo, M, Casanova, D, Cipriani, F, Cooper, M, Cupisti, A, de Koning, E, Davide, J, Drachenberg, C, Ettorre, G, Fernandez Cruz, L, Fridell, J, Friend, P, Furian, L, Gaber, O, Gruessner, A, Gruessner, R, Gunton, J, Han, D, Iacopi, S, Kauffmann, E, Kaufman, D, Kenmochi, T, Khambalia, H, Lai, Q, Langer, R, Maffi, P, Marselli, L, Menichetti, F, Miccoli, M, Mittal, S, Morelon, E, Napoli, N, Neri, F, Oberholzer, J, Odorico, J, Ollinger, R, Oniscu, G, Orlando, G, Ortenzi, M, Perosa, M, Perrone, V, Redfield, R, Ricci, C, Rigotti, P, Robertson, R, Ross, L, Rossi, M, Saudek, F, Scalea, J, Schenker, P, Secchi, A, Socci, C, Sousa Silva, D, Squifflet, J, Stock, P, Stratta, R, Terrenzio, C, Uva, P, Watson, C, White, S, Boggi U., Vistoli F., Marchetti P., Kandaswamy R., Berney T., Andres A., Arbogast H. P., Badet L., Baronti W., Bartlett S. T., Benedetti E., Branchereau J., Burke G. W. 3., Buron F., Caldara R., Cardillo M., Casanova D., Cipriani F., Cooper M., Cupisti A., de Koning E. J. P., Davide J., Drachenberg C., Ettorre G. M., Fernandez Cruz L., Fridell J. A., Friend P. J., Furian L., Gaber O. A., Gruessner A. C., Gruessner R. W. G., Gunton J. E., Han D. -J., Iacopi S., Kauffmann E. F., Kaufman D., Kenmochi T., Khambalia H. A., Lai Q., Langer R. M., Maffi P., Marselli L., Menichetti F., Miccoli M., Mittal S., Morelon E., Napoli N., Neri F., Oberholzer J., Odorico J. S., Ollinger R., Oniscu G., Orlando G., Ortenzi M., Perosa M., Perrone V. G., Redfield R. R., Ricci C., Rigotti P., Robertson R. P., Ross L. F., Rossi M., Saudek F., Scalea J. R., Schenker P., Secchi A., Socci C., Sousa Silva D., Squifflet J. P., Stock P. G., Stratta R. J., Terrenzio C., Uva P., Watson C. C. E., and White S. A.

Abstract

Comprehensive evidence-based guidelines for the practice of pancreas transplantation are yet to be established. The First World Consensus Conference on Pancreas Transplantation was convened for this purpose. A steering committee selected the participants and defined the questions to be addressed. A group of literature reviewers identified 597 studies to be included in summaries for guidelines production. Expert groups formulated the first draft of recommendations. Two rounds of discussion and voting occurred online, using the Delphi method (agreement rate ≥85%). After each round, critical responses of experts were reviewed, and recommendations were amended accordingly. Recommendations were finalized after live discussions. Each session was preceded by expert presentations and a summary of results of systematic literature review. Up to three voting rounds were allowed for each recommendation. To avoid potential conflicts of interest, deliberations on issues regarding the impact of pancreas transplantation on the management of diabetes were conducted by an independent jury. Recommendations on technical issues were determined by experts and validated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Quality of evidence was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology. Each recommendation received a GRADE rating (Grading of Recommendations, Assessment, Development and Evaluations).

Published
2021

3. First World Consensus Conference on pancreas transplantation: Part II – recommendations

Author

Boggi, U, Vistoli, F, Andres, A, Arbogast, H, Badet, L, Baronti, W, Bartlett, S, Benedetti, E, Branchereau, J, Burke, G, Buron, F, Caldara, R, Cardillo, M, Casanova, D, Cipriani, F, Cooper, M, Cupisti, A, Davide, J, Drachenberg, C, de Koning, E, Ettorre, G, Fernandez Cruz, L, Fridell, J, Friend, P, Furian, L, Gaber, O, Gruessner, A, Gruessner, R, Gunton, J, Han, D, Iacopi, S, Kauffmann, E, Kaufman, D, Kenmochi, T, Khambalia, H, Lai, Q, Langer, R, Maffi, P, Marselli, L, Menichetti, F, Miccoli, M, Mittal, S, Morelon, E, Napoli, N, Neri, F, Oberholzer, J, Odorico, J, Ollinger, R, Oniscu, G, Orlando, G, Ortenzi, M, Perosa, M, Perrone, V, Pleass, H, Redfield, R, Ricci, C, Rigotti, P, Paul Robertson, R, Ross, L, Rossi, M, Saudek, F, Scalea, J, Schenker, P, Secchi, A, Socci, C, Sousa Silva, D, Squifflet, J, Stock, P, Stratta, R, Terrenzio, C, Uva, P, Watson, C, White, S, Marchetti, P, Kandaswamy, R, Berney, T, Boggi U., Vistoli F., Andres A., Arbogast H. P., Badet L., Baronti W., Bartlett S. T., Benedetti E., Branchereau J., Burke G. W., Buron F., Caldara R., Cardillo M., Casanova D., Cipriani F., Cooper M., Cupisti A., Davide J., Drachenberg C., de Koning E. J. P., Ettorre G. M., Fernandez Cruz L., Fridell J. A., Friend P. J., Furian L., Gaber O. A., Gruessner A. C., Gruessner R. W. G., Gunton J. E., Han D. -J., Iacopi S., Kauffmann E. F., Kaufman D., Kenmochi T., Khambalia H. A., Lai Q., Langer R. M., Maffi P., Marselli L., Menichetti F., Miccoli M., Mittal S., Morelon E., Napoli N., Neri F., Oberholzer J., Odorico J. S., Ollinger R., Oniscu G., Orlando G., Ortenzi M., Perosa M., Perrone V. G., Pleass H., Redfield R. R., Ricci C., Rigotti P., Paul Robertson R., Ross L. F., Rossi M., Saudek F., Scalea J. R., Schenker P., Secchi A., Socci C., Sousa Silva D., Squifflet J. P., Stock P. G., Stratta R. J., Terrenzio C., Uva P., Watson C. C. E., White S. A., Marchetti P., Kandaswamy R., Berney T., Boggi, U, Vistoli, F, Andres, A, Arbogast, H, Badet, L, Baronti, W, Bartlett, S, Benedetti, E, Branchereau, J, Burke, G, Buron, F, Caldara, R, Cardillo, M, Casanova, D, Cipriani, F, Cooper, M, Cupisti, A, Davide, J, Drachenberg, C, de Koning, E, Ettorre, G, Fernandez Cruz, L, Fridell, J, Friend, P, Furian, L, Gaber, O, Gruessner, A, Gruessner, R, Gunton, J, Han, D, Iacopi, S, Kauffmann, E, Kaufman, D, Kenmochi, T, Khambalia, H, Lai, Q, Langer, R, Maffi, P, Marselli, L, Menichetti, F, Miccoli, M, Mittal, S, Morelon, E, Napoli, N, Neri, F, Oberholzer, J, Odorico, J, Ollinger, R, Oniscu, G, Orlando, G, Ortenzi, M, Perosa, M, Perrone, V, Pleass, H, Redfield, R, Ricci, C, Rigotti, P, Paul Robertson, R, Ross, L, Rossi, M, Saudek, F, Scalea, J, Schenker, P, Secchi, A, Socci, C, Sousa Silva, D, Squifflet, J, Stock, P, Stratta, R, Terrenzio, C, Uva, P, Watson, C, White, S, Marchetti, P, Kandaswamy, R, Berney, T, Boggi U., Vistoli F., Andres A., Arbogast H. P., Badet L., Baronti W., Bartlett S. T., Benedetti E., Branchereau J., Burke G. W., Buron F., Caldara R., Cardillo M., Casanova D., Cipriani F., Cooper M., Cupisti A., Davide J., Drachenberg C., de Koning E. J. P., Ettorre G. M., Fernandez Cruz L., Fridell J. A., Friend P. J., Furian L., Gaber O. A., Gruessner A. C., Gruessner R. W. G., Gunton J. E., Han D. -J., Iacopi S., Kauffmann E. F., Kaufman D., Kenmochi T., Khambalia H. A., Lai Q., Langer R. M., Maffi P., Marselli L., Menichetti F., Miccoli M., Mittal S., Morelon E., Napoli N., Neri F., Oberholzer J., Odorico J. S., Ollinger R., Oniscu G., Orlando G., Ortenzi M., Perosa M., Perrone V. G., Pleass H., Redfield R. R., Ricci C., Rigotti P., Paul Robertson R., Ross L. F., Rossi M., Saudek F., Scalea J. R., Schenker P., Secchi A., Socci C., Sousa Silva D., Squifflet J. P., Stock P. G., Stratta R. J., Terrenzio C., Uva P., Watson C. C. E., White S. A., Marchetti P., Kandaswamy R., and Berney T.

Abstract

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.

Published
2021

4. The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: Part 2 (treatment)

Author

de-Madaria, E., Abad-González, A., Aparicio, J.R., Aparisi, L., Boadas, J., Boix, E., de-las-Heras, G., Domínguez-Muñoz, E., Farré, A., Fernández-Cruz, L., Gómez, L., Iglesias-García, J., García-Malpartida, K., Guarner, L., Lariño-Noia, J., Lluís, F., López, A., Molero, X., Moreno-Pérez, O., Navarro, S., Palazón, J.M., Pérez-Mateo, M., Sabater, L., Sastre, Y., Vaquero, E.C., and Martínez, J.

Published
2013
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5. The Spanish Pancreatic Club recommendations for the diagnosis and treatment of chronic pancreatitis: Part 1 (diagnosis)

Author

Martínez, J., Abad-González, A., Aparicio, J.R., Aparisi, L., Boadas, J., Boix, E., de las Heras, G., Domínguez-Muñoz, E., Farré, A., Fernández-Cruz, L., Gómez, L., Iglesias-García, J., García-Malpartida, K., Guarner, L., Lariño-Noia, J., Lluís, F., López, A., Molero, X., Moreno-Pérez, O., Navarro, S., Palazón, J.M., Pérez-Mateo, M., Sabater, L., Sastre, Y., Vaquero, E., and de-Madaria, E.

Published
2013
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7. First world consensus conference on pancreas transplantation: Part I-Methods and results of literature search

Author

Boggi, U., Vistoli, F., Marchetti, P., Kandaswamy, R., Berney, T., Andres, A., Arbogast, H. P., Badet, L., Baronti, W., Bartlett, S. T., Benedetti, E., Branchereau, J., Burke, G. W. 3., Buron, F., Caldara, R., Cardillo, M., Casanova, D., Cipriani, F., Cooper, M., Cupisti, A., de Koning, E. J. P., Davide, J., Drachenberg, C., Ettorre, G. M., Fernandez Cruz, L., Fridell, J. A., Friend, P. J., Furian, L., Gaber, O. A., Gruessner, A. C., Gruessner, R. W. G., Gunton, J. E., Han, D. -J., Iacopi, S., Kauffmann, E. F., Kaufman, D., Kenmochi, T., Khambalia, H. A., Lai, Q., Langer, R. M., Maffi, P., Marselli, L., Menichetti, F., Miccoli, M., Mittal, S., Morelon, E., Napoli, N., Neri, F., Oberholzer, J., Odorico, J. S., Ollinger, R., Oniscu, G., Orlando, G., Ortenzi, M., Perosa, M., Perrone, V. G., Redfield, R. R., Ricci, C., Rigotti, P., Robertson, R. P., Ross, L. F., Rossi, M., Saudek, F., Scalea, J. R., Schenker, P., Secchi, A., Socci, C., Sousa Silva, D., Squifflet, J. P., Stock, P. G., Stratta, R. J., Terrenzio, C., Uva, P., Watson, C. C. E., White, S. A., Boggi U., Vistoli F., Marchetti P., Kandaswamy R., Berney T., Andres A., Arbogast H.P., Badet L., Baronti W., Bartlett S.T., Benedetti E., Branchereau J., Burke G.W., Buron F., Caldara R., Cardillo M., Casanova D., Cipriani F., Cooper M., Cupisti A., de Koning E.J.P., Davide J., Drachenberg C., Ettorre G.M., Fernandez Cruz L., Fridell J.A., Friend P.J., Furian L., Gaber O.A., Gruessner A.C., Gruessner R.W.G., Gunton J.E., Han D.-J., Iacopi S., Kauffmann E.F., Kaufman D., Kenmochi T., Khambalia H.A., Lai Q., Langer R.M., Maffi P., Marselli L., Menichetti F., Miccoli M., Mittal S., Morelon E., Napoli N., Neri F., Oberholzer J., Odorico J.S., Ollinger R., Oniscu G., Orlando G., Ortenzi M., Perosa M., Perrone V.G., Redfield R.R., Ricci C., Rigotti P., Robertson R.P., Ross L.F., Rossi M., Saudek F., Scalea J.R., Schenker P., Secchi A., Socci C., Sousa Silva D., Squifflet J.P., Stock P.G., Stratta R.J., Terrenzio C., Uva P., Watson C.C.E., and White S.A.

Subjects
clinical research / practice, diabetes, pancreas / simultaneous pancreas-kidney transplantation, survey, Consensus, Humans, Pancreas Transplantation, medicine.medical_treatment, media_common.quotation_subject, Delphi method, Consensu, Pancreas transplantation, Session (web analytics), Jury, Voting, medicine, Immunology and Allergy, Pharmacology (medical), Grading (education), media_common, Transplantation, Medical education, business.industry, pancreas / simultaneous pancreas‐kidney transplantation, Systematic review, diabete, Special Articles, Original Article, First World, business, Human
Abstract

Comprehensive evidence‐based guidelines for the practice of pancreas transplantation are yet to be established. The First World Consensus Conference on Pancreas Transplantation was convened for this purpose. A steering committee selected the participants and defined the questions to be addressed. A group of literature reviewers identified 597 studies to be included in summaries for guidelines production. Expert groups formulated the first draft of recommendations. Two rounds of discussion and voting occurred online, using the Delphi method (agreement rate ≥85%). After each round, critical responses of experts were reviewed, and recommendations were amended accordingly. Recommendations were finalized after live discussions. Each session was preceded by expert presentations and a summary of results of systematic literature review. Up to three voting rounds were allowed for each recommendation. To avoid potential conflicts of interest, deliberations on issues regarding the impact of pancreas transplantation on the management of diabetes were conducted by an independent jury. Recommendations on technical issues were determined by experts and validated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Quality of evidence was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology. Each recommendation received a GRADE rating (Grading of Recommendations, Assessment, Development and Evaluations)., This article presents the results of literature search and the methods used to provide evidence‐based guidelines for the practice of pancreas transplantation at the First World Consensus Conference on Pancreas Transplantation.

Published
2021

8. Opinion from Spain

Author

Fernández-Cruz, L., Navarro, S., Sáenz, A., Pederzoli, Paolo, editor, Cavallini, Giorgio, editor, Bassi, Claudio, editor, and Falconi, Massimo, editor

Published
1994
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16. Chernotherapie, nicht jedoch Radiotherapie verbessert die Prognose des resezierten Pankreaskarzinoms: Ergebnisse einer prospektiven randomisierten Multizenterstudie (ESPAC-1) / Chemotherapy — Not Radiotherapy — Improves the Prognosis of Resected Pancreatic Cancer: Results of a Prospective Randomized Multicenter Study (ESPAC-1)

Author

Friess, H., Beger, H. G., Neoptolemos, J., Bassi, C., Fernandez-Cruz, L., Büchler, M. W., and Hartel, W., editor

Published
2001
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23. Hepatic involvement in pancreatitis-induced lung damage

Author

Closa, D., Bardaji, M., Hotter, G., Prats, N., Gelpi, E., Fernandez-Cruz, L., and Rosello-Catafau, J.

Subjects
Lungs -- Inflammation, Liver -- Physiological aspects, Pancreatitis -- Physiological aspects, Biological sciences
Abstract

The liver participates in acute pancreatitis-induced inflammatory changes in lung arachidonic acid metabolism and oxidative stress. Histopathological analysis indicates that liver activation enhances plasma phospholipase A2 activity. Lung prostacyclin and thromboxane B2 synthesis increase, whereas lung superoxide dismutase activity reduces, 12 hrs after the initiation of pancreatitis. The portocaval shunt inhibits metabolic alterations and improves inflammatory activities in lungs.

Published
1996

28. Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)

Author

van Hilst, J, de Rooij, T, Klompmaker, S, Rawashdeh, M, Aleotti, F, Al-Sarireh, B, Alseidi, A, Ateeb, Z, Balzano, G, Berrevoet, F, Bjornsson, B, Boggi, U, Busch, Or, Butturini, G, Casadei, R, Del Chiaro, M, Chikhladze, S, Cipriani, F, van Dam, R, Damoli, I, van Dieren, S, Dokmak, S, Edwin, B, van Eijck, C, Fabre, Jm, Falconi, M, Farges, O, Fernandez-Cruz, L, Forgione, A, Frigerio, I, Fuks, D, Gavazzi, F, Gayet, B, Giardino, A, Koerkamp, Bg, Hackert, T, Hassenpflug, M, Kabir, I, Keck, T, Khatkov, I, Kusar, M, Lombardo, C, Marchegiani, G, Marshall, R, Menon, Kv, Montorsi, M, Orville, M, de Pastena, M, Pietrabissa, A, Poves, I, Primrose, J, Pugliese, R, Ricci, C, Roberts, K, Rosok, B, Sahakyan, Ma, Sanchez-Cabus, S, Sandstrom, P, Scovel, L, Solaini, L, Soonawalla, Z, Souche, Fr, Sutcliffe, Rp, Tiberio, Ga, Tomazic, A, Troisi, R, Wellner, U, White, S, Wittel, Ua, Zerbi, A, Bassi, C, Besselink, Mg, and Abu Hilal, M

Subjects
Male, robot-assisted, laparoscopic, Pancreatectomy, Postoperative Complications, Robotic Surgical Procedures, Humans, Minimally Invasive Surgical Procedures, distal pancreatectomy, Propensity Score, Aged, Neoplasm Staging, Retrospective Studies, Incidence, Carcinoma, Length of Stay, left pancreatectomy, minimally invasive, Pancreatic Ductal, Europe, Female, Laparoscopy, Pancreatic Neoplasms, Survival Rate, Treatment Outcome, Carcinoma, Pancreatic Ductal
Published
2019

43. Pancreatic Anastomosis After Pancreatoduodenectomy: A Position Statement By The International Study Group Of Pancreatic Surgery (ISGPS)

Author

Shrikhande, SV, Sivasanker, M, Vollmer, CM, Friess, H, Besselink, MG, Fingerhut, A, Yeo, CJ, Fernandez-delCastillo, C, Dervenis, C, Halloran, C, Gouma, DJ, Radenkovic, D, Asbun, HJ, Neoptolemos, JP, Izbicki, JR, Lillemoe, KD, Conlon, KC, Fernandez-Cruz, L, Montorsi, M, Bockhorn, M, Adham, M, Charnley, R, Carter, R, Hackert, T, Hartwig, W, Miao, Y, Sarr, M, Bassi, C, Büchler, MW, International Study Group of Pancreatic Surgery (ISGPS), AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Surgery, CCA -Cancer Center Amsterdam, and APH - Methodology

Subjects
medicine.medical_specialty, pancreatico-enteric anastomosis, medicine.medical_treatment, Fistula, Clinically relevant postoperative pancreatic fistula, pancreatoduodenectomy, management pancreatic remnant, pancreatico-enteric anastomosis, 030230 surgery, Anastomosis, Pancreaticoduodenectomy, 03 medical and health sciences, 0302 clinical medicine, management pancreatic remnant, medicine, Humans, Pancreatic duct, pancreatoduodenectomy, Framingham Risk Score, business.industry, General surgery, Patient Selection, Anastomosis, Surgical, Perioperative, medicine.disease, 3. Good health, Surgery, Clinically relevant postoperative pancreatic fistula, medicine.anatomical_structure, Pancreatic fistula, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, business, Complication
Abstract

Background Clinically relevant postoperative pancreatic fistula (grades B and C of the ISGPS definition) remains the most troublesome complication after pancreatoduodenectomy. The approach to management of the pancreatic remnant via some form of pancreatico-enteric anastomosis determines the incidence and severity of clinically relevant postoperative pancreatic fistula. Despite numerous trials comparing diverse pancreatico-enteric anastomosis techniques and other adjunctive strategies (pancreatic duct stenting, somatostatin analogues, etc), currently, there is no clear consensus regarding the ideal method of pancreatico-enteric anastomosis. Methods An international panel of pancreatic surgeons working in well-known, high-volume centers reviewed the best contemporary literature concerning pancreatico-enteric anastomosis and worked to develop a position statement on pancreatic anastomosis after pancreatoduodenectomy. Results There is inherent risk assumed by creating a pancreatico-enteric anastomosis based on factors related to the gland (eg, parenchymal texture, disease pathology). None of the technical variations of pancreaticojejunal or pancreaticogastric anastomosis, such as duct-mucosa, invagination method, and binding technique, have been found to be consistently superior to another. Randomized trials and meta-analyses comparing pancreaticogastrostomy versus pancreaticojejunostomy yield conflicting results and are inherently prone to bias due to marked heterogeneity in the studies. The benefit of stenting the pancreatico-enteric anastomosis to decrease clinically relevant postoperative pancreatic fistula is not supported by high-level evidence. While controversial, somatostatin analogues appear to decrease perioperative complications but not mortality, although consistent data across the more than 20 studies addressing this topic are lacking. The Fistula Risk Score is useful for predicting postoperative pancreatic fistula as well as for comparing outcomes of pancreatico-enteric anastomosis across studies. Conclusion Currently, no specific technique can eliminate development of clinically relevant postoperative pancreatic fistula. While consistent practice of any standardized technique may decrease the rate of clinically relevant postoperative pancreatic fistula, experienced surgeons can have lower postoperative pancreatic fistula rates performing a variety of techniques depending on the clinical situation. There is no clear evidence on the benefit of internal or external stenting after pancreatico-enteric anastomosis. The use of somatostatin analogues may be important in decreasing morbidity after pancreatoduodenectomy, but it remains controversial. Future studies should focus on novel approaches to decrease the rate of clinically relevant postoperative pancreatic fistula with appropriate risk adjustment.

Published
2017

46. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After

Author

Bassi, C. Marchegiani, G. Dervenis, C. Sarr, M. Abu Hilal, M. Adham, M. Allen, P. Andersson, R. Asbun, H.J. Besselink, M.G. Conlon, K. Del Chiaro, M. Falconi, M. Fernandez-Cruz, L. Fernandez-del Castillo, C. Fingerhut, A. Friess, H. Gouma, D.J. Hackert, T. Izbicki, J. Lillemoe, K.D. Neoptolemos, J.P. Olah, A. Schulick, R. Shrikhande, S.V. Takada, T. Takaori, K. Traverso, W. Vollmer, C.R. Wolfgang, C.L. Yeo, C.J. Salvia, R. Buchler, M. International Study Group on Pancreatic Surgery (ISGPS)

Abstract

Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of the present report is to verify the value of the International Study Group of Pancreatic Fistula definition and grading of postoperative pancreatic fistula and to update the International Study Group of Pancreatic Fistula classification in light of recent evidence that has emerged, as well as to address the lingering controversies about the original definition and grading of postoperative pancreatic fistula. Methods The International Study Group of Pancreatic Fistula reconvened as the International Study Group in Pancreatic Surgery in order to perform a review of the recent literature and consequently to update and revise the grading system of postoperative pancreatic fistula. Results Based on the literature since 2005 investigating the validity and clinical use of the original International Study Group of Pancreatic Fistula classification, a clinically relevant postoperative pancreatic fistula is now redefined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula. Consequently, the former “grade A postoperative pancreatic fistula” is now redefined and called a “biochemical leak,” because it has no clinical importance and is no longer referred to a true pancreatic fistula. Postoperative pancreatic fistula grades B and C are confirmed but defined more strictly. In particular, grade B requires a change in the postoperative management; drains are either left in place >3 weeks or repositioned through endoscopic or percutaneous procedures. Grade C postoperative pancreatic fistula refers to those postoperative pancreatic fistula that require reoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula. Conclusion This new definition and grading system of postoperative pancreatic fistula should lead to a more universally consistent evaluation of operative outcomes after pancreatic operation and will allow for a better comparison of techniques used to mitigate the rate and clinical impact of a pancreatic fistula. Use of this updated classification will also allow for more precise comparisons of surgical quality between surgeons and units who perform pancreatic surgery. © 2016 Elsevier Inc.

Published
2017

47. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study

Author

van Hilst, J., de Rooij, T., Klompmaker, S., Rawashdeh, M., Aleotti, F., Al-Sarireh, B., Alseidi, A., Ateeb, Z., Balzano, G., Berrevoet, F., Björnsson, B., Boggi, U., Busch, O., Butturini, G., Casadei, R., del Chiaro, M., Cipriani, F., van Dam, R., Damoli, I., Dokmak, S., Edwin, B., van Eijck, C., Fabre, J., Falconi, M., Farges, O., Fernández-Cruz, L., Forgione, A., Frigerio, I., Fuks, D., Gavazzi, F., Gayet, B., Giardino, A., Groot Koerkamp, B., Hackert, T., Hassenpflug, M., Kabir, I., Keck, T., Khatkov, I., Klock, A., Kusar, M., Lombardo, C., Marchegiani, G., Marshall, R., Menon, K., Montorsi, M., Nowbray, N., Orville, M., Pietrabissa, A., Poves, I., Primrose, J., Pugliese, R., Ricci, C., Roberts, K., Røsok, B., Sahakyan, M., Sánchez-Cabús, S., Sandström, P., Scovel, L., Solaini, L., Soonawalla, Z., Souche, R., Sutcliffe, R., Tiberio, G., Tomazic, A., Troisi, R., Wellner, U., White, S., Wittel, U., Zerbi, A., Bassi, C., Besselink, M., and Abu Hilal, M.

Published
2019
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49. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomized controlled trial

Author

Neoptolemos JP, Dunn JA, Stocken DD, Almond J, Link K, Beger H, Bassi C, Pederzoli P, Dervenis C, Fernandez Cruz L, Lacaine F, Pap A, Spooner D, Kerr DJ, Friess H, Büchler MW, FALCONI , MASSIMO, Neoptolemos, Jp, Dunn, Ja, Stocken, Dd, Almond, J, Link, K, Beger, H, Bassi, C, Falconi, Massimo, Pederzoli, P, Dervenis, C, Fernandez Cruz, L, Lacaine, F, Pap, A, Spooner, D, Kerr, Dj, Friess, H, and Büchler, Mw

Published
2001

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