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8. New Surgical Strategies

Author

Andreasi, Valentina, Partelli, Stefano, Muffatti, Francesca, Falconi, Massimo, Beretta, Giordano, editor, Berruti, Alfredo, editor, Bombardieri, Emilio, editor, Fazio, Nicola, editor, and Goletti, Orlando, editor

Published
2021
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13. A Single-center Prospective Observational Study Investigating the Accuracy of Preoperative Diagnostic Procedures in the Assessment of Lymph Node Metastases in Nonfunctioning Pancreatic Neuroendocrine Tumors

Author

Partelli, Stefano, Muffatti, Francesca, Andreasi, Valentina, Giannone, Fabio, Rossi, Gemma, Palumbo, Diego, Mapelli, Paola, Schiavo Lena, Marco, Arcidiacono, Paolo Giorgio, De Cobelli, Francesco, Picchio, Maria, Doglioni, Claudio, and Falconi, Massimo

Published
2022
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15. Critical appraisal of the adequacy of surgical indications for non-functioning pancreatic neuroendocrine tumours.

Author

Partelli, Stefano, Battistella, Anna, Andreasi, Valentina, Muffatti, Francesca, Tamburrino, Domenico, Pecorelli, Nicolò, Crippa, Stefano, Balzano, Gianpaolo, and Falconi, Massimo

Subjects
ISLANDS of Langerhans tumors, NEUROENDOCRINE tumors, PROGNOSIS, SURGICAL indications, PREOPERATIVE care, PANCREATIC surgery
Abstract

Background The lack of preoperative prognostic factors to accurately predict tumour aggressiveness in non-functioning pancreatic neuroendocrine tumours may result in inappropriate management decisions. This study aimed to critically evaluate the adequacy of surgical treatment in patients with resectable non-functioning pancreatic neuroendocrine tumours and investigate preoperative features of surgical appropriateness. Methods A retrospective study was conducted on patients who underwent curative surgery for non-functioning pancreatic neuroendocrine tumours at San Raffaele Hospital (2002–2022). The appropriateness of surgical treatment was categorized as appropriate, potential overtreatment and potential undertreatment based on histologic features of aggressiveness and disease relapse within 1 year from surgery (early relapse). Results A total of 384 patients were included. Among them, 230 (60%) received appropriate surgical treatment, whereas the remaining 154 (40%) underwent potentially inadequate treatment: 129 (34%) experienced potential overtreatment and 25 (6%) received potential undertreatment. The appropriateness of surgical treatment was significantly associated with radiological tumour size (P < 0.001), tumour site (P = 0.012), surgical technique (P < 0.001) and year of surgical resection (P < 0.001). Surgery performed before 2015 (OR 2.580, 95% c.i. 1.570 to 4.242; P < 0.001), radiological tumour diameter < 25.5 mm (OR 6.566, 95% c.i. 4.010 to 10.751; P < 0.001) and pancreatic body/tail localization (OR 1.908, 95% c.i. 1.119 to 3.253; P = 0.018) were identified as independent predictors of potential overtreatment. Radiological tumour size was the only independent determinant of potential undertreatment (OR 0.291, 95% c.i. 0.107 to 0.791; P = 0.016). Patients subjected to potential undertreatment exhibited significantly poorer disease-free survival (P < 0.001), overall survival (P < 0.001) and disease-specific survival (P < 0.001). Conclusions Potential overtreatment occurs in nearly one-third of patients undergoing surgery for non-functioning pancreatic neuroendocrine tumours. Tumour diameter emerges as the sole variable capable of predicting the risk of both potential surgical overtreatment and undertreatment. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Preoperative assessment of lymph nodal metastases with [68Ga]Ga-DOTATOC PET radiomics for improved surgical planning in well-differentiated pancreatic neuroendocrine tumours.

Author

Mapelli, Paola, Bezzi, Carolina, Muffatti, Francesca, Ghezzo, Samuele, Canevari, Carla, Magnani, Patrizia, Schiavo Lena, Marco, Battistella, Anna, Scifo, Paola, Andreasi, Valentina, Partelli, Stefano, Chiti, Arturo, Falconi, Massimo, and Picchio, Maria

Subjects
NEUROENDOCRINE tumors, MACHINE learning, RADIOMICS, POSITRON emission tomography, SOMATOSTATIN receptors, METASTASIS, HOLMIUM
Abstract

Purpose: Accurate identification of lymph node (LN) metastases is pivotal for surgical planning of pancreatic neuroendocrine tumours (PanNETs); however, current imaging techniques have sub-optimal diagnostic sensitivity. Aim of this study is to investigate whether [68Ga]Ga-DOTATOC PET radiomics might improve the identification of LN metastases in patients with non-functioning PanNET (NF-PanNET) referred to surgical intervention. Methods: Seventy-two patients who performed preoperative [68Ga]Ga-DOTATOC PET between December 2017 and March 2022 for NF-PanNET. [68Ga]Ga-DOTATOC PET qualitative assessment of LN metastases was measured using diagnostic balanced accuracy (bACC), sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV). SUVmax, SUVmean, Somatostatin receptor density (SRD), total lesion SRD (TLSRD) and IBSI-compliant radiomic features (RFs) were obtained from the primary tumours. To predict LN involvement, these parameters were engineered, selected and used to train different machine learning models. Models were validated using tenfold repeated cross-validation and control models were developed. Models' bACC, SN, SP, PPV and NPV were collected and compared (Kruskal–Wallis, Mann–Whitney). Results: LN metastases were detected in 29/72 patients at histology. [68Ga]Ga-DOTATOC PET qualitative examination of LN involvement provided bACC = 60%, SN = 24%, SP = 95%, PPV = 78% and NPV = 65%. The best-performing radiomic model provided a bACC = 70%, SN = 77%, SP = 61%, PPV = 60% and NPV = 83% (outperforming the control model, p < 0.05*). Conclusion: In this study, [68Ga]Ga-DOTATOC PET radiomics allowed to increase diagnostic sensitivity in detecting LN metastases from 24 to 77% in NF-PanNET patients candidate to surgery. Especially in case of micrometastatic involvement, this approach might assist clinicians in a better patients' stratification. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Short-term outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy used as treatment of colo-rectal carcinomatosis: a multicentric study

Author

Macrì, Antonio, Arcoraci, Vincenzo, Belgrano, Valerio, Caldana, Marina, Carbonari, Ludovica, Cioppa, Tommaso, De Cian, Franco, De Manzoni, Giovanni, De Simone, Michele, Giardina, Claudia, Muffatti, Francesca, Orsenigo, Elena, Robella, Manuela, Roviello, Franco, Saladino, Edoardo, Sammartino, Paolo, and Vaira, Marco

Published
2020
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27. Treatment challenges in and outside a specialist network setting: Pancreatic neuroendocrine tumours

Author

Hackl, Monika, Van Eycken, Elizabeth, Henau, Kris, Dimitrova, Nadya, Sekerija, Mario, Dušek, Ladislav, Mägi, Margit, Malila, Nea, Leinonen, Maarit, Velten, Michel, Troussard, Xavier, Bouvier, Veronique, Guizard, Anne-Valérie, Bouvier, Anne-Marie, Arveux, Patrick, Maynadié, Marc, Woronoff, Anne-Sophie, Robaszkiewicz, Michel, Baldi, Isabelle, Monnereau, Alain, Tretarre, Brigitte, Colonna, Marc, Molinié, Florence, Bara, Simona, Schvartz, Claire, Lapôtre-Ledoux, Bénédicte, Grosclaude, Pascale, Stabenow, Roland, Luttmann, Sabine, Nennecke, Alice, Engel, Jutta, Schubert-Fritschle, Gabriele, Heidrich, Jan, Holleczek, Bernd, Jónasson, Jón Gunnlaugur, Clough-Gorr, Kerri, Comber, Harry, Mazzoleni, Guido, Giacomin, Adriano, Sardo, Antonella Sutera, Barchielli, Alessandro, Serraino, Diego, De Angelis, Roberta, Mallone, Sandra, Tavilla, Andrea, Pierannunzio, Daniela, Rossi, Silvia, Santaquilani, Mariano, Knijn, Arnold, Pannozzo, Fabio, Gennaro, Valerio, Benfatto, Lucia, Ricci, Paolo, Autelitano, Mariangela, Spagnoli, Gianbattista, Fusco, Mario, Usala, Mario, Vitale, Francesco, Michiara, Maria, Tumino, Rosario, Mangone, Lucia, Falcini, Fabio, Ferretti, Stefano, Filiberti, Rosa Angela, Marani, Enza, Iannelli, Arturo, Sensi, Flavio, Piffer, Silvano, Gentilini, Maria, Madeddu, Anselmo, Ziino, Antonio, Maspero, Sergio, Candela, Pina, Stracci, Fabrizio, Tagliabue, Giovanna, Rugge, Massimo, Trama, Annalisa, Gatta, Gemma, Botta, Laura, Capocaccia, Riccardo, Pildava, Santa, Smailyte, Giedre, Calleja, Neville, Johannesen, Tom Børge, Rachtan, Jadwiga, Góźdź, Stanisław, Błaszczyk, Jerzy, Kępska, Kamila, de Lacerda, Gonçalo Forjaz, Bento, Maria José, Miranda, Ana, Diba, Chakameh Safaei, Almar, Enrique, Larrañaga, Nerea, de Munain, Arantza Lopez, Torrella-Ramos, Ana, Díaz García, José María, Marcos-Gragera, Rafael, Sanchez, Maria Josè, Navarro, Carmen, Salmeron, Diego, Moreno-Iribas, Conchi, Galceran, Jaume, Carulla, Marià, Mousavi, Mohsen, Bouchardy, Christine, Ess, Silvia M., Bordoni, Andrea, Konzelmann, Isabelle, Rashbass, Jem, Gavin, Anna, Brewster, David H., Huws, Dyfed Wyn, Visser, Otto, Bielska-Lasota, Magdalena, Primic-Zakelj, Maja, Kunkler, Ian, Benhamou, Ellen, Lykoudis, Panagis M., Partelli, Stefano, Muffatti, Francesca, Caplin, Martyn, Falconi, Massimo, and Fusai, Giuseppe K.

Published
2019
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29. Prognostic significance of nodal micrometastases of non-functioning pancreatic neuroendocrine tumours.

Author

Andreasi, Valentina, Partelli, Stefano, Schiavo Lena, Marco, Muffatti, Francesca, Battistella, Anna, Tamburrino, Domenico, Pecorelli, Nicolò, Crippa, Stefano, Balzano, Gianpaolo, Doglioni, Claudio, and Falconi, Massimo

Subjects
MICROMETASTASIS, NEUROENDOCRINE tumors, LYMPHADENECTOMY
Abstract

This article explores the presence and significance of nodal micrometastases in non-functioning pancreatic neuroendocrine tumors (NF-PanNETs). Nodal micrometastases are commonly found in patients with node-positive NF-PanNETs, but their role as a predictor of poor prognosis is uncertain. The study suggests that surveillance protocols for NF-PanNETs could be tailored based on the type of nodal metastases, with less intensive surveillance for patients with nodal micrometastases. However, currently, there is no way to identify these patients before surgery. [Extracted from the article]

Published
2024
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30. Recent developments in the diagnosis of pancreatic neuroendocrine neoplasms.

Author

Battistella, Anna, Tacelli, Matteo, Mapelli, Paola, Schiavo Lena, Marco, Andreasi, Valentina, Genova, Luana, Muffatti, Francesca, De Cobelli, Francesco, Partelli, Stefano, and Falconi, Massimo

Subjects
NEUROENDOCRINE tumors, PANCREATIC tumors, MAGNETIC resonance imaging, ENDOSCOPIC ultrasonography, COMPUTED tomography, BIOMARKERS
Abstract

Pancreatic Neuroendocrine Neoplasms (PanNENs) are characterized by a highly heterogeneous clinical and biological behavior, making their diagnosis challenging. PanNENs diagnostic work-up mainly relies on biochemical markers, pathological examination, and imaging evaluation. The latter includes radiological imaging (i.e. computed tomography [CT] and magnetic resonance imaging [MRI]), functional imaging (i.e. 68Gallium [68 Ga]Ga-DOTA-peptide PET/CT and Fluorine-18 fluorodeoxyglucose [18F]FDG PET/CT), and endoscopic ultrasound (EUS) with its associated procedures. This review provides a comprehensive assessment of the recent advancements in the PanNENs diagnostic field. PubMed and Embase databases were used for the research, performed from inception to October 2023. A deeper understanding of PanNENs biology, recent technological improvements in imaging modalities, as well as progresses achieved in molecular and cytological assays, are fundamental players for the achievement of early diagnosis and enhanced preoperative characterization of PanNENs. A multimodal diagnostic approach is required for a thorough disease assessment. [ABSTRACT FROM AUTHOR]

Published
2024
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31. Diagnostic work-up and surgical management of insulinoma - a retrospective analysis from a tertiary referral centre

Author

Andreasi, Valentina, primary, Partelli, Stefano, additional, Muffatti, Francesca, additional, Battistella, Anna, additional, Fermi, Francesca, additional, Balzano, Gianpaolo, additional, Crippa, Stefano, additional, Tamburrino, Domenico, additional, Pecorelli, Nicolò, additional, De Cobelli, Francesco, additional, Arcidiacono, Paolo Giorgio, additional, and Falconi, Massimo, additional

Published
2023
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33. Prognostic significance of nodal micrometastases in patients with non-functioning pancreatic neuroendocrine tumours (NF-PanNETs) - a survival analysis from a prospective observational study

Author

Andreasi, Valentina, primary, Partelli, Stefano, additional, Lena, Marco Schiavo, additional, Muffatti, Francesca, additional, Battistella, Anna, additional, Tamburrino, Domenico, additional, Pecorelli, Nicolò, additional, Crippa, Stefano, additional, Balzano, Gianpaolo, additional, Doglioni, Claudio, additional, and Falconi, Massimo, additional

Published
2023
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38. Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors – a multi-institutional study

Author

Sallinen, Ville J., Le Large, Tessa Y.S., Tieftrunk, Elke, Galeev, Shamil, Kovalenko, Zahar, Haugvik, Sven-Petter, Antila, Anne, Franklin, Oskar, Martinez-Moneo, Emma, Robinson, Stuart M., Panzuto, Francesco, Regenet, Nicolas, Muffatti, Francesca, Partelli, Stefano, Wiese, Dominik, Ruszniewski, Philippe, Dousset, Bertrand, Edwin, Bjørn, Bartsch, Detlef K., Sauvanet, Alain, Falconi, Massimo, Ceyhan, Güralp O., and Gaujoux, Sebastien

Published
2018
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49. Diagnostic work‐up and surgical management of insulinoma: A retrospective analysis from a tertiary referral center.

Author

Andreasi, Valentina, Partelli, Stefano, Muffatti, Francesca, Battistella, Anna, Fermi, Francesca, Balzano, Gianpaolo, Crippa, Stefano, Tamburrino, Domenico, Pecorelli, Nicolò, De Cobelli, Francesco, Arcidiacono, Paolo Giorgio, and Falconi, Massimo

Subjects
INSULINOMA, TREATMENT delay (Medicine), PANCREATIC duct, ENDOSCOPIC ultrasonography, MAGNETIC resonance imaging, DELAYED diagnosis, SYMPTOMS
Abstract

Insulinoma is a multifaceted disease that poses several challenges in terms of clinical presentation, diagnostic work‐up, and surgical management. The aim of this study was to describe diagnostic work‐up, surgical management, and postoperative outcomes of patients with insulinoma. All consecutive patients who underwent surgery for insulinoma at San Raffaele Hospital (Milan, Italy) between January 2008 and January 2022 were included. Overall, 98 patients were considered. The median delay between presenting symptoms and insulinoma diagnosis was 10 months (IQR, 4–21). Insulinoma diagnosis was made at our Institution in 45 patients, 20 of whom referred within 6 months from symptoms onset. In this subgroup, the median interval between symptoms presentation and insulinoma diagnosis was 4 months (IQR, 2–6), as compared to 14 months (IQR, 10–26) in patients (n = 25) who referred to our institution after 6 months from symptoms onset (p <.001). The insulinoma was localized preoperatively in all the cases. All patients underwent ≥1 high‐quality imaging: computed tomography (CT: n = 87, sensitivity 84%), magnetic resonance imaging (MRI: n = 55, sensitivity 85%) and endoscopic ultrasound (EUS: n = 79, sensitivity 100%). MRI identified the tumor in eight patients with negative CT. EUS localized the insulinoma in three patients with negative CT and negative MRI. Parenchyma‐sparing resections were performed in 41 patients. Contact with major vessels, lesion close to Wirsung duct and suspect of malignancy were the main reasons to perform a formal resection. An early referral to high‐volume centers is important for reducing diagnostic delay in patients with insulinoma. The diagnostic work‐up of insulinoma frequently requires several imaging modalities to be performed, with EUS being the most sensitive one. Parenchyma‐sparing surgery for insulinoma should be performed whenever technically and oncologically feasible. [ABSTRACT FROM AUTHOR]

Published
2023
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50. Infiltrative Growth Predicts the Risk of Recurrence After Surgery in Well-Differentiated Non-Functioning Pancreatic Neuroendocrine Tumors

Author

Schiavo Lena, Marco, primary, Partelli, Stefano, additional, Andreasi, Valentina, additional, Muffatti, Francesca, additional, Redegalli, Miriam, additional, Brunetto, Emanuela, additional, Maghini, Beatrice, additional, Falke, Monika, additional, Cangi, Maria Giulia, additional, Perren, Aurel, additional, Falconi, Massimo, additional, and Doglioni, Claudio, additional

Published
2022
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