245 results on '"Vollmer CM"'
Search Results
2. Sclerosing pancreatitis presenting as a periampullary tumour
- Author
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Sahajpal, Ak, Vollmer, Cm, Pollett, A., and Gallinger, S.
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- 2003
- Full Text
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3. Pancreatic Anastomosis After Pancreatoduodenectomy: A Position Statement By The International Study Group Of Pancreatic Surgery (ISGPS)
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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
4. A Root-Cause Analysis of Mortality Following Major Pancreatectomy
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Vollmer, Cm, Sanchez, N, Gondek, S, Mcauliffe, J, Kent, Ts, Christein, Jd, Callery, Mp, Adams, D, Allendorf, J, Bassi, Claudio, Bathe, O, Behrman, S, Butturini, Giovanni, Cameron, J, Chan, C, Choti, M, Demirjian, A, Dixon, E, Eckhauser, F, Edil, B, Falconi, Massimo, Hawkins, W, Hoffman, J, Howard, Tj, Jury, R, Kennedy, E, Lavu, H, Linehan, D, Makary, M, Marchegiani, Giovanni, Morgan, K, Paiella, Salvatore, Pawlik, T, Pederzolli, P, Riall, T, Salvia, Roberto, Schulick, R, Schrope, B, Strasberg, S, Sutherland, F, Wolfgang, C, and Yeo, C.
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,Adolescent ,Critical Care ,medicine.medical_treatment ,Blood Loss, Surgical ,Decision Support Techniques ,law.invention ,Young Adult ,Pancreatectomy ,Postoperative Complications ,law ,Cause of Death ,Surgical ,80 and over ,medicine ,Humans ,Blood Transfusion ,Blood Loss ,Aged ,Aged, 80 and over ,Blood Volume ,Disease Progression ,Female ,Medical Errors ,Middle Aged ,Pancreatic Neoplasms ,Patient Selection ,Retrospective Studies ,Root Cause Analysis ,Young adult ,Cause of death ,business.industry ,Mortality rate ,Gastroenterology ,Retrospective cohort study ,medicine.disease ,Intensive care unit ,Surgery ,Pancreatic fistula ,Cohort ,business - Abstract
Although mortality rates from pancreatectomy have decreased worldwide, death remains an infrequent but profound event at an individual practice level. Root-cause analysis is a retrospective method commonly employed to understand adverse events. We evaluate whether emerging mortality risk assessment tools sufficiently predict and account for actual clinical events that are often identified by root-cause analysis. We assembled a Pancreatic Surgery Mortality Study Group comprised of 36 pancreatic surgeons from 15 institutions in 4 countries. Mortalities after pancreatectomy (30 and 90 days) were accrued from 2000 to 2010. For root-cause analysis, each surgeon “deconstructed” the clinical events preceding a death to determine cause. We next tested whether mortality risk assessment tools (ASA, POSSUM, Charlson, SOAR, and NSQIP) could predict those patients who would die (n = 218) and compared their prognostic accuracy against a cohort of resections in which no patient died (n = 1,177). Two hundred eighteen deaths (184 Whipple’s resection, 18 distal pancreatectomies, and 16 total pancreatectomies) were identified from 11,559 pancreatectomies performed by surgeons whose experience averaged 14.5 years. Overall 30- and 90-day mortalities were 0.96% and 1.89%, respectively. Individual surgeon rates ranged from 0% to 4.7%. Only 5 patients died intraoperatively, while the other 213 succumbed at a median of 29 days. Mean patient age was 70 years old (38% were >75 years old). Malignancy was the indication in 90% of cases, mostly pancreatic cancer (57%). Median operative time was 365 min and estimated blood loss was 700 cc (range, 100–16,000 cc). Vascular repair or multivisceral resections were required for 19.7% and 15.1%, respectively. Seventy-seven percent had a variety of major complications before death. Eighty-seven percent required intensive care unit care, 55% were transfused, and 35% were reoperated upon. Fifty percent died during the index admission, while another 11% died after a readmission. Almost half (n = 107) expired between 31 and 90 days. Only 11% had autopsies. Operation-related complications contributed to 40% of deaths, with pancreatic fistula being the most evident (14%). Technical errors (21%) and poor patient selection (15%) were cited by surgeons. Of deaths, 5.5% had associated cancer progression—all occurring between 31 and 90 days. Even after root-cause scrutiny, the ultimate cause of death could not be determined for a quarter of the patients—most often between 31 and 90 days. While assorted risk models predicted mortality with variable discrimination from nonmortalities, they consistently underestimated the actual mortality events we report. Root-cause analysis suggests that risk prediction should include, if not emphasize, operative factors related to pancreatectomy. While risk models can distinguish between mortalities and nonmortalities in a collective fashion, they vastly miscalculate the actual chance of death on an individual basis. This study reveals the contributions of both comorbidities and aggressive surgical decisions to mortality.
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- 2011
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5. Discordance Between Perioperative Antibiotic Treatment and Wound Infection Cultures in Patients Undergoing Pancreaticoduodenectomy: A Multicenter 5-Year Study
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Fong, Zv, Mcmillan, Mt, Marchegiani, G, Sahora, K, Malleo, G, De Pastena, M, Ferrone, Cr, Bassi, C, Lillemoe, Kd, Vollmer, Cm, and Fernandez-del Castillo, C
- Published
- 2015
6. A root-cause analysis of mortality following major pancreatectomy
- Author
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Vollmer CM Jr, Sanchez, N, Gondek, S, Mcauliffe, J, Kent, Ts, Christein, Jd, Callery, Mp, Marchegiani, G, and of Pancreatic Surgery Mortality Study Group
- Published
- 2012
7. Predicting in-hospital mortality in patients undergoing complex gastrointestinal surgery: determining the optimal risk adjustment method.
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Grendar J, Shaheen AA, Myers RP, Parker R, Vollmer CM Jr, Ball CG, Quan ML, Kaplan GG, Al-Manasra T, and Dixon E
- Published
- 2012
8. Development of an evidence-based protocol for reduction of indwelling urinary catheter usage.
- Author
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Robinson S, Allen L, Barnes MR, Berry TA, Foster TA, Friedrich LA, Holmes JM, Mercer S, Plunkett D, Vollmer CM, and Weitzel T
- Published
- 2007
9. Doing it better. To cath or not to cath?
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Weitzel T, Vollmer CM, Plunkett D, Mercer S, Holmes JM, Friedrich LA, Foster TA, Berry TA, Barnes MR, Allen L, and Robinson S
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- 2008
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10. The image of trauma. Tramatic colonic hematoma.
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Vollmer CM Jr., Schmieg RE, Freeman BD, and Balfe DM
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- 2000
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11. Genome-Derived Ampullary Adenocarcinoma Classifier and Postresection Prognostication.
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Ecker BL, Seier K, Eckhoff AM, Tortorello GN, Allen PJ, Balachandran VP, Blackburn N, D'Angelica MI, DeMatteo RP, Blazer DG 3rd, Drebin JA, Fisher WE, Fortuna D, Gill AJ, Gingras MC, Kingham TP, Lee MK 4th, Lidsky ME, Nussbaum DP, Overman MJ, Samra JS, Shen R, Sigel CS, Soares KC, Vollmer CM Jr, Wei AC, Zani S, Roses RE, Gonen M, and Jarnagin WR
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Colorectal Neoplasms genetics, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Colorectal Neoplasms mortality, Genomics, Pancreatic Neoplasms genetics, Pancreatic Neoplasms surgery, Pancreatic Neoplasms pathology, Pancreatic Neoplasms mortality, Prognosis, Retrospective Studies, Adenocarcinoma genetics, Adenocarcinoma pathology, Adenocarcinoma surgery, Adenocarcinoma mortality, Ampulla of Vater pathology, Common Bile Duct Neoplasms genetics, Common Bile Duct Neoplasms surgery, Common Bile Duct Neoplasms pathology, Common Bile Duct Neoplasms mortality
- Abstract
Importance: Ampullary adenocarcinoma (AA) is characterized by clinical and genomic heterogeneity. A previously developed genomic classifier defined biologically distinct phenotypes with greater accuracy than standard histologic classification. External validation is needed before routine clinical use., Objective: To test external validity of the prognostic value of the hidden genome classifier of AA., Design, Setting, and Participants: This retrospective cohort study took place at 6 international academic institutions. Consecutive patients (n = 192) who underwent curative-intent resection of histologically confirmed AA were included. The data were analyzed from January 2005 through July 2020., Exposures: The multilevel meta-feature regression model previously trained on a prospectively sequenced cohort of 3411 patients (1001 pancreatic adenocarcinoma, 165 distal bile duct adenocarcinoma, and 2245 colorectal adenocarcinoma) was applied to AA sequencing data to quantify the relative proportions of parental cell of origin., Main Outcome and Measures: Genomic classification was correlated with immunohistologic subtype (intestinal [INT] or pancreatobiliary [PB]) and with overall survival (OS), using the log-rank test and Cox proportional hazard models., Results: Among 192 patients with AA (median age, 69.0 [IQR, 60.0-74.0] years and 134 were male [64%]), concordance between immunohistologic and genomic subtypes was 55%. Most INT subtype tumors were categorized into the colorectal genomic subtype (43 of 57 [72.9%]). Of the 114 PB subtype tumors, 29 had a pancreatic genomic profile (25.4%) and 24 had a distal bile duct genomic profile (21.1%). Whereas the standard immunohistologic subtypes were not associated with survival (log rank P = .26), predicted genomic probabilities were correlated with survival probability. Genomic scores with higher colorectal probability were associated with higher survival probability; higher pancreatic and distal bile duct probabilities were associated with lower survival probability., Conclusions and Relevance: The AA genomic classifier is reproducible with available molecular testing in a diverse international cohort of patients and improves stratification of the divergent clinical outcomes beyond standard immunohistologic classification. These data provide a molecular classification that may be incorporated into clinical trials for prospective validation.
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- 2024
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12. Dynamic Assessment of Drain Fluid Amylase Estimates the Risk of CR-POPF Following Pancreatoduodenectomy.
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AlMasri S, Kim VM, Hodges JC, Casciani F, Lee KK, Paniccia A, Vollmer CM Jr, and Zureikat AH
- Abstract
Objective: To evaluate whether drain fluid amylase levels on day-1 (DFA1) and day-3 (DFA3) can reliably estimate the risk of clinically relevant-postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) compared to either value alone or in combination with clinicopathologic variables., Background: CR-POPF is a major source of morbidity and mortality following PD. Current drain management algorithms are variable and are mostly dependent on DFA1, while the DFA3 is seldom utilized to guide clinical decision making., Methods: Between 2015-2020, patients who underwent PD at two high-volume pancreas centers and had intraoperative drain placement with measurement of DFA1 and DFA3 were retrospectively reviewed. Models to predict CR-POPF were constructed using DFA1, DFA3, fistula risk score (FRS) and other patient or treatment-related parameters. The fittest and more parsimonious model was used to construct a CR-POPF risk calculator., Results: Nine-hundred-twenty-three patients were included in the analysis. The FRS was high in 100(10.9%), intermediate in 524(57.3%), low in 211(23.1%) and negligible in 79(8.6%) patients. The overall rate of CR-POPF was 9.2%. Five logistic regression models were constructed using variables known to be implicated in CR-POPF. A model based solely on DFA1 and DFA3 with a cross-validated area under the curve of 0.846 was selected. A calculator using DFA1 and DFA3 was created based on this model to estimate the risk of CR-POPF., Conclusions: Risk of CR-POPF following pancreatoduodenectomy can be accurately estimated based on measurement of DFA1 and DFA3. Our CR-POPF kinetics calculator can facilitate postoperative risk stratification and guide drain management algorithms., Competing Interests: Disclosures: No conflict of interests to declare, financial or otherwise., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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13. Minimally invasive versus open pancreatoduodenectomy in benign, premalignant, and malignant disease.
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Riviere D, van den Boezem PB, Besselink MG, van Laarhoven CJ, Kooby DA, Vollmer CM, Davidson BR, and Gurusamy KS
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- Humans, Systematic Reviews as Topic, Randomized Controlled Trials as Topic, Robotic Surgical Procedures methods, Robotic Surgical Procedures adverse effects, Pancreatic Diseases surgery, Pancreaticoduodenectomy methods, Pancreaticoduodenectomy adverse effects, Laparoscopy methods, Laparoscopy adverse effects, Precancerous Conditions surgery, Pancreatic Neoplasms surgery
- Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of laparoscopic or robot-assisted pancreatoduodenectomy versus open pancreatoduodenectomy for people with benign, premalignant, and malignant disease., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)
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- 2024
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14. Complexity and Experience Grading to Guide Patient Selection for Minimally-invasive Pancreatoduodenectomy: An ISGPS Consensus.
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Barreto SG, Strobel O, Salvia R, Marchegiani G, Wolfgang CL, Werner J, Ferrone CR, Abu Hilal M, Boggi U, Butturini G, Falconi M, Fernandez-Del Castillo C, Friess H, Fusai GK, Halloran CM, Hogg M, Jang JY, Kleeff J, Lillemoe KD, Miao Y, Nagakawa Y, Nakamura M, Probst P, Satoi S, Siriwardena AK, Vollmer CM, Zureikat A, Zyromski NJ, Asbun HJ, Dervenis C, Neoptolemos JP, Büchler MW, Hackert T, Besselink MG, and Shrikhande SV
- Abstract
Objective: The ISGPS aims to develop a universally accepted complexity and experience grading system to guide the safe implementation of robotic and laparoscopic minimally-invasive pancreatoduodenectomy (MIPD)., Background: Despite the perceived advantages of MIPD, its global adoption has been slow due to the inherent complexity of the procedure and challenges to acquiring surgical experience. Its wider adoption must be undertaken with an emphasis towards appropriate patient selection according to adequate surgeon and center experience., Methods: The ISGPS developed a complexity and experience grading system to guide patient selection for MIPD based on an evidence-based review and a series of discussions., Results: The ISGPS complexity and experience grading system for MIPD is subclassified into patient-related risk factors and provider experience-related variables. The patient-related risk factors include anatomical (main pancreatic and common bile duct diameters), tumor-specific (vascular contact), and conditional (obesity and previous complicated upper abdominal surgery/disease) factors, all incorporated in an A-B-C classification, graded as no, a single, and multiple risk factors. The surgeon and center experience-related variables include surgeon total MIPD experience (cut-offs 40 and 80) and center annual MIPD volume (cut-offs 10 and 30), all also incorporated in an A-B-C classification., Conclusion: This ISGPS complexity and experience grading system for robotic and laparoscopic MIPD may enable surgeons to optimally select patients after duly considering specific risk factors known to influence the complexity of the procedure. This grading system will likely allow for a thoughtful and stepwise implementation of MIPD and facilitate a fair comparison of outcome between centers and countries., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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15. Total Neoadjuvant Therapy for Pancreatic Cancer-What Is Totality?
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Cannas S and Vollmer CM Jr
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- Humans, Pancreatectomy, Pancreatic Neoplasms therapy, Neoadjuvant Therapy
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- 2024
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16. Extending Quality Improvement for Pancreatoduodenectomy Within the High-Volume Setting: The Experience Factor.
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Cannas S, Casciani F, and Vollmer CM
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- Humans, Male, Female, Middle Aged, Aged, Pancreatic Fistula epidemiology, Hospitals, High-Volume, Retrospective Studies, Risk Factors, Risk Assessment, Pancreaticoduodenectomy standards, Quality Improvement, Postoperative Complications epidemiology, Clinical Competence
- Abstract
Objective: To analyze the association of a surgeon's experience with postoperative outcomes of pancreatoduodenectomies (PDs) when stratified by Fistula Risk Score (FRS)., Background: Centralization is now well-established for pancreatic surgery. Nevertheless, the benefits of individual surgeon's experience in high-volume settings remain undefined., Methods: Pancreatoduodenectomies performed by 82 surgeons across 18 international specialty institutions (median: 140 PD/year) were analyzed. Surgeon cumulative PD volume was linked with postoperative outcomes through multivariable models, adjusted for patient/operative characteristics and the FRS. Then, surgeon experience was also stratified by the 10, previously defined, most clinically impactful scenarios for clinically relevant pancreatic fistula (CR-POPF) development., Results: Of 8189 PDs, 18.7% suffered severe complications (Accordion≥3), 4.8% were reoperated upon and 2.2% expired. Although the most experienced surgeons (top-quartile; >525 career PDs) more often operated on riskier cases, their experience was significantly associated with declines in CR-POPF ( P <0.001), severe complications ( P =0.008), reoperations ( P <0.001), and length of stay (LOS) ( P <0.001)-accentuated even more in the most impactful FRS scenarios (2830 patients). Risk-adjusted models indicate male sex, increasing age, ASA class, and FRS, but not surgeon experience, as being associated with severe complications, failure-to-rescue, and mortality. Instead, upper-echelon experience demonstrates significant reductions in CR-POPF (OR 0.66), reoperations (OR 0.64), and LOS (OR 0.65) in moderate-to-high fistula risk circumstances (FRS≥3, 68% of cases)., Conclusions: At specialty institutions, major morbidity, mortality, and failure-to-rescue are primarily associated with baseline patient characteristics, while cumulative surgical experience impacts pancreatic fistula occurrence and its attendant effects for most higher-risk pancreatoduodenectomies. These data also suggest an extended proficiency curve exists for this operation., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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17. Standardizing definitions and terminology of left-sided pancreatic resections through an international Delphi consensus.
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van Ramshorst TME, van Hilst J, Boggi U, Dokmak S, Edwin B, Keck T, Khatkov I, Balduzzi A, Pulvirenti A, Ahmad J, Al Saati H, Alseidi A, Ausania F, Azagra JS, Balzano G, Björnsson B, Can FM, Cillo U, D'Hondt M, Efanov M, Erkan M, Espin Alvarez F, Esposito A, Ferrari G, Groot Koerkamp B, Gumbs AA, Hogg ME, Ielpo B, Ivanecz A, Jang JY, Kleive D, Kooby DA, Luyer MDP, Marchegiani G, Menon K, Molenaar IQ, Nagakawa Y, Nakamura M, Palumbo D, Piardi T, Ramia JM, Saint-Marc O, Salti GI, Strobel O, Vollmer CM, Wei AC, White S, Yoon YS, Zerbi A, Bassi C, Berrevoet F, Chan C, Coimbra FJ, Conlon KCP, Dervenis C, Falconi M, Frigerio I, Fusai GK, De Oliveira ML, Pinna AD, Primrose JN, Sauvanet A, Serrablo A, Smadi S, Alfieri S, Berti S, Butturini G, Casadei R, Coppola R, Di Benedetto F, Ettorre GM, Giuliante F, Jovine E, Memeo R, Pietrabissa A, Portolani N, Salvia R, Siriwardena AK, Asbun HJ, Besselink MG, and Abu Hilal M
- Subjects
- Humans, Pancreatectomy standards, Pancreatic Neoplasms surgery, Delphi Technique, Terminology as Topic, Consensus
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- 2024
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18. International survey on opinions and use of robot-assisted and laparoscopic minimally invasive pancreatic surgery: 5-year follow up.
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van Ramshorst TME, van Hilst J, Bannone E, Pulvirenti A, Asbun HJ, Boggi U, Busch OR, Dokmak S, Edwin B, Hogg M, Jang JY, Keck T, Khatkov I, Kohan G, Kokudo N, Kooby DA, Nakamura M, Primrose JN, Siriwardena AK, Toso C, Vollmer CM, Zeh HJ, Besselink MG, and Abu Hilal M
- Subjects
- Humans, Follow-Up Studies, Treatment Outcome, Pancreatectomy adverse effects, Pancreaticoduodenectomy adverse effects, Minimally Invasive Surgical Procedures, Postoperative Complications surgery, Retrospective Studies, Pancreatic Neoplasms surgery, Robotics, Robotic Surgical Procedures adverse effects, Laparoscopy adverse effects
- Abstract
Background: Evidence on the value of minimally invasive pancreatic surgery (MIPS) has been increasing but it is unclear how this has influenced the view of pancreatic surgeons on MIPS., Methods: An anonymous survey was sent to members of eight international Hepato-Pancreato-Biliary Associations. Outcomes were compared with the 2016 international survey., Results: Overall, 315 surgeons from 47 countries participated. The median volume of pancreatic resections per center was 70 (IQR 40-120). Most surgeons considered minimally invasive distal pancreatectomy (MIDP) superior to open (ODP) (94.6%) and open pancreatoduodenectomy (OPD) superior to minimally invasive (MIPD) (67.9%). Since 2016, there has been an increase in the number of surgeons performing both MIDP (79%-85.7%, p = 0.024) and MIPD (29%-45.7%, p < 0.001), and an increase in the use of the robot-assisted approach for both MIDP (16%-45.6%, p < 0.001) and MIPD (23%-47.9%, p < 0.001). The use of laparoscopy remained stable for MIDP (91% vs. 88.1%, p = 0.245) and decreased for MIPD (51%-36.8%, p = 0.024)., Conclusion: This survey showed considerable changes of MIPS since 2016 with most surgeons considering MIDP superior to ODP and an increased use of robot-assisted MIPS. Surgeons prefer OPD and therefore the value of MIPD remains to be determined in randomized trials., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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19. The risk of clinically-relevant pancreatic fistula after pancreaticoduodenectomy is better predicted by a postoperative trend in drain fluid amylase compared to day 1 values in isolation.
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Ahmad SB, Hodges JC, Nassour I, Casciani F, Lee KK, Paniccia A, Vollmer CM Jr, and Zureikat AH
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- Humans, Pancreatectomy, Drainage, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Amylases, Risk Factors, Pancreaticoduodenectomy adverse effects, Pancreatic Fistula diagnosis, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology
- Abstract
Background: Recent studies support early drain removal after pancreaticoduodenectomy in patients with a drain fluid amylase on postoperative day 1 (DFA1) level of ≤5,000. The use of DFA1 to guide drain management is increasingly common among pancreatic surgeons; however, the benefit of checking additional drain fluid amylases beyond DFA1 is less known. We sought to determine whether a change in drain fluid amylase (ΔDFA) is a more reliable predictor of clinically relevant postoperative fistula than DFA1 alone., Methods: Using the American College of Surgeons National Surgical Quality Improvement Plan, pancreaticoduodenectomy patients with intraoperative drain placement, known DFA1, highest recorded drain fluid amylase value on postoperative day 2 to 5 (DFA2nd), day of drain removal, and clinically relevant postoperative fistula status were reviewed. Logistic models compared the predictive performance of DFA1 alone versus DFA1 + ΔDFA., Results: A total of 2,417 patients with an overall clinically relevant postoperative fistula rate of 12.6% were analyzed. On multivariable regression, clinical predictors for clinically relevant postoperative fistula included body mass index, steroid use, operative time, and gland texture. These variables were used to develop model 1 (DFA1 alone) and model 2 (DFA1 + ΔDFA). Model 2 outperformed model 1 in predicting the risk of clinically relevant postoperative fistula. According to model 2 predictions, the risk of clinically relevant postoperative fistula increased with any rise in drain fluid amylase, regardless of whether the DFA1 was above or below 5,000 U/L. The risk of clinically relevant postoperative fistula significantly decreased with any drop in drain fluid amylase, with an odds reduction of approximately 50% corresponding with a 70% decrease in drain fluid amylase (P < .001). A risk calculator was developed using DFA1 and a secondary DFA value in conjunction with other clinical predictors for clinically relevant postoperative fistula., Conclusion: Clinically relevant postoperative fistula after pancreaticoduodenectomy is more accurately predicted by DFA1 and ΔDFA versus DFA1 in isolation. We developed a novel risk calculator to provide an individualized approach to drain management after pancreaticoduodenectomy., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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20. Surveillance for Presumed BD-IPMN of the Pancreas: Stability, Size, and Age Identify Targets for Discontinuation.
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Marchegiani G, Pollini T, Burelli A, Han Y, Jung HS, Kwon W, Rocha Castellanos DM, Crippa S, Belfiori G, Arcidiacono PG, Capurso G, Apadula L, Zaccari P, Noia JL, Gorris M, Busch O, Ponweera A, Mann K, Demir IE, Phillip V, Ahmad N, Hackert T, Heckler M, Lennon AM, Afghani E, Vallicella D, Dall'Olio T, Nepi A, Vollmer CM, Friess H, Ghaneh P, Besselink M, Falconi M, Bassi C, Goh BK, Jang JY, Fernández-Del Castillo C, and Salvia R
- Subjects
- Humans, Retrospective Studies, Pancreas pathology, Pancreatic Ducts pathology, Pancreatic Intraductal Neoplasms pathology, Carcinoma, Pancreatic Ductal pathology, Pancreatic Neoplasms pathology, Cysts pathology
- Abstract
Background & Aims: Currently, most patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMN) are offered indefinite surveillance, resulting in health care costs with questionable benefits regarding cancer prevention. This study sought to identify patients in whom the risk of cancer is equivalent to an age-matched population, thereby justifying discontinuation of surveillance., Methods: International multicenter study involving presumed BD-IPMN without worrisome features (WFs) or high-risk stigmata (HRS) at diagnosis who underwent surveillance. Clusters of individuals at risk for cancer development were defined according to cyst size and stability for at least 5 years, and age-matched controls were used for comparison using standardized incidence ratios (SIRs) for pancreatic cancer., Results: Of 3844 patients with presumed BD-IPMN, 775 (20.2%) developed WFs and 68 (1.8%) HRS after a median surveillance of 53 (interquartile range 53) months. Some 164 patients (4.3%) underwent surgery. Of the overall cohort, 1617 patients (42%) remained stable without developing WFs or HRS for at least 5 years. In patients 75 years or older, the SIR was 1.12 (95% CI, 0.23-3.39), and in patients 65 years or older with stable lesions smaller than 15 mm in diameter after 5 years, the SIR was 0.95 (95% CI, 0.11-3.42). The all-cause mortality for patients who did not develop WFs or HRS for at least 5 years was 4.9% (n = 79), and the disease-specific mortality was 0.3% (n = 5)., Conclusions: The risk of developing pancreatic malignancy in presumed BD-IPMN without WFs or HRS after 5 years of surveillance is comparable to that of the general population depending on cyst size and patient age. Surveillance discontinuation could be justified after 5 years of stability in patients older than 75 years with cysts <30 mm, and in patients 65 years or older who have cysts ≤15 mm., (Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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21. Invited Commentary: Pancreas Surgery Is Hard: Bring the Antiperspirant.
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Cannas S and Vollmer CM
- Subjects
- Humans, Antiperspirants, Pancreas surgery
- Published
- 2023
- Full Text
- View/download PDF
22. Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation.
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De Pastena M, van Bodegraven EA, Mungroop TH, Vissers FL, Jones LR, Marchegiani G, Balduzzi A, Klompmaker S, Paiella S, Tavakoli Rad S, Groot Koerkamp B, van Eijck C, Busch OR, de Hingh I, Luyer M, Barnhill C, Seykora T, Maxwell T T, de Rooij T, Tuveri M, Malleo G, Esposito A, Landoni L, Casetti L, Alseidi A, Salvia R, Steyerberg EW, Abu Hilal M, Vollmer CM, Besselink MG, and Bassi C
- Subjects
- Humans, Risk Assessment methods, Risk Factors, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreatic Fistula prevention & control, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Pancreatectomy adverse effects, Pancreatectomy methods, Pancreaticoduodenectomy methods
- Abstract
Objective: To develop 2 distinct preoperative and intraoperative risk scores to predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) to improve preventive and mitigation strategies, respectively., Background: POPF remains the most common complication after DP. Despite several known risk factors, an adequate risk model has not been developed yet., Methods: Two prediction risk scores were designed using data of patients undergoing DP in 2 Italian centers (2014-2016) utilizing multivariable logistic regression. The preoperative score (calculated before surgery) aims to facilitate preventive strategies and the intraoperative score (calculated at the end of surgery) aims to facilitate mitigation strategies. Internal validation was achieved using bootstrapping. These data were pooled with data from 5 centers from the United States and the Netherlands (2007-2016) to assess discrimination and calibration in an internal-external validation procedure., Results: Overall, 1336 patients after DP were included, of whom 291 (22%) developed POPF. The preoperative distal fistula risk score (preoperative D-FRS) included 2 variables: pancreatic neck thickness [odds ratio: 1.14; 95% confidence interval (CI): 1.11-1.17 per mm increase] and pancreatic duct diameter (OR: 1.46; 95% CI: 1.32-1.65 per mm increase). The model performed well with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.78-0.88) and 0.73 (95% CI: 0.70-0.76) upon internal-external validation. Three risk groups were identified: low risk (<10%), intermediate risk (10%-25%), and high risk (>25%) for POPF with 238 (18%), 684 (51%), and 414 (31%) patients, respectively. The intraoperative risk score (intraoperative D-FRS) added body mass index, pancreatic texture, and operative time as variables with an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.74-0.85)., Conclusions: The preoperative and the intraoperative D-FRS are the first validated risk scores for POPF after DP and are readily available at: http://www.pancreascalculator.com . The 3 distinct risk groups allow for personalized treatment and benchmarking., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2023
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23. Paul Greig, MD - Professor of Surgery, University of Toronto.
- Author
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Dixon E, Cleary S, and Vollmer CM Jr
- Abstract
Summary Dr. Paul Greig is an icon of surgical education, transplantation, hepatobiliary surgery and Canadian surgery. Dr. Greig has trained experts in these fields all over the world and is regarded as one of the most important surgical educators in the past 25 years., Competing Interests: Competing interests: None declared., (© 2023 CMA Impact Inc. or its licensors.)
- Published
- 2023
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24. A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula: A classification of the International Study Group of Pancreatic Surgery.
- Author
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Schuh F, Mihaljevic AL, Probst P, Trudeau MT, Müller PC, Marchegiani G, Besselink MG, Uzunoglu F, Izbicki JR, Falconi M, Castillo CF, Adham M, Z'graggen K, Friess H, Werner J, Weitz J, Strobel O, Hackert T, Radenkovic D, Kelemen D, Wolfgang C, Miao YI, Shrikhande SV, Lillemoe KD, Dervenis C, Bassi C, Neoptolemos JP, Diener MK, Vollmer CM Jr, and Büchler MW
- Subjects
- Humans, Pancreatic Ducts surgery, Pancreaticoduodenectomy adverse effects, Risk Factors, Postoperative Complications etiology, Pancreatic Fistula etiology, Pancreatic Fistula surgery, Pancreas surgery
- Abstract
Objective: The aim of this study was to develop a classification system for pancreas-associated risk factors in pancreatoduodenectomy (PD)., Summary Background Data: Postoperative pancreatic fistula (POPF) is the most relevant PD-associated complication. A simple standardized surgical reporting system based on pancreas-associated risk factors is lacking., Methods: A systematic literature search was conducted to identify studies investigating clinically relevant (CR) POPF (CR-POPF) and pancreas-associated risk factors after PD. A meta-analysis of CR-POPF rate for texture of the pancreas (soft vs not-soft) and main pancreatic duct (MPD) diameter was performed using the Mantel-Haenszel method. Based on the results, the International Study Group of Pancreatic Surgery (ISGPS) proposes the following classification: A, not-soft (hard) texture and MPD >3 mm; B, not-soft (hard) texture and MPD ≤3 mm; C, soft texture and MPD >3 mm; D, soft texture and MPD ≤3 mm. The classification was evaluated in a multi-institutional, international cohort., Results: Of the 2917 articles identified, 108 studies were included in the analyses. Soft pancreatic texture was significantly associated with the development of CR-POPF [odds ratio (OR) 4.24, 95% confidence interval (CI) 3.67-4.89, P < 0.01) following PD. Similarly, MPD diameter ≤3 mm significantly increased CR-POPF risk compared with >3 mm diameter MPDs (OR 3.66, 95% CI 2.62-5.12, P < 0.01). The proposed 4-stage system was confirmed in an independent cohort of 5533 patients with CR-POPF rates of 3.5%, 6.2%, 16.6%, and 23.2% for type A-D, respectively ( P < 0.001)., Conclusion: For future pancreatic surgical outcomes studies, the ISGPS recommends reporting these risk factors according to the proposed classification system for better comparability of results., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2023
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25. The forecast calls for fistula: Bring your mitigation.
- Author
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Cannas S and Vollmer CM
- Subjects
- Humans, Forecasting, Fistula
- Published
- 2023
- Full Text
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26. The Influence of Intraoperative Blood Loss on Fistula Development Following Pancreatoduodenectomy.
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Trudeau MT, Casciani F, Maggino L, Seykora TF, Asbun HJ, Ball CG, Bassi C, Behrman SW, Berger AC, Bloomston MP, Callery MP, Castillo CF, Christein JD, Dillhoff ME, Dickson EJ, Dixon E, Fisher WE, House MG, Hughes SJ, Kent TS, Malleo G, Salem RR, Wolfgang CL, Zureikat AH, and Vollmer CM
- Subjects
- Humans, Pancreas surgery, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreatic Fistula prevention & control, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications prevention & control, Retrospective Studies, Risk Factors, Blood Loss, Surgical prevention & control, Pancreaticoduodenectomy adverse effects
- Abstract
Objective: To investigate the role of intraoperative estimated blood loss (EBL) on development of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD)., Background: Minimizing EBL has been shown to decrease transfusions and provide better perioperative outcomes in PD. EBL is also felt to be influential on CR-POPF development., Methods: This study consists of 5534 PDs from a 17-institution collaborative (2003-2018). EBL was progressively categorized (≤150mL; 151-400mL; 401-1,000 mL; > 1,000 mL). Impact of additive EBL was assessed using 20 3- factor fistula risk score (FRS) scenarios reflective of endogenous CR-POPF risk., Results: CR-POPF developed in 13.6% of patients (N = 753) and median EBL was 400 mL (interquartile range 250-600 mL). CR-POPF and Grade C POPF were associated with elevated EBL (median 350 vs 400 mL, P = 0.002; 372 vs 500 mL, P < 0.001, respectively). Progressive EBL cohorts displayed incremental CR-POPF rates (8.5%, 13.4%, 15.2%, 16.9%; P < 0.001). EBL >400mL was associated with increased CR-POPF occurrence in 13/20 endogenous risk scenarios. Moreover, 8 of 10 scenarios predicated on a soft gland demonstrated increased CR-POPF incidence. Hypothetical projections demonstrate significant reductions in CR-POPF can be obtained with 1-, 2-, and 3-point decreases in FRS points attributed to EBL risk (12.2%, 17.4%, and 20.0%; P < 0.001). This is especially pronounced in high-risk (FRS7-10) patients, who demonstrate up to a 31% reduction (P < 0.001). Surgeons in the lowest-quartile of median EBL demonstrated CR-POPF rates less than half those in the upper-quartile (7.9% vs 18.8%; P < 0.001)., Conclusion: EBL independently contributes significant biological risk to CR-POPF. Substantial reductions in CR-POPF occurrence are projected and obtainable by minimizing EBL. Decreased individual surgeon EBL is associated with improvements in CR-POPF., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
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27. Fourteen years of pancreatic surgery for malignancy among ACS-NSQIP centers: Trends in major morbidity and mortality.
- Author
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Sharon CE, Thaler AS, Straker RJ 3rd, Kelz RR, Raper SE, Vollmer CM, DeMatteo RP, Miura JT, and Karakousis GC
- Subjects
- Female, Humans, Male, Morbidity, Pancreaticoduodenectomy adverse effects, Postoperative Complications diagnosis, Quality Improvement, Surgical Wound Infection epidemiology, Surgical Wound Infection etiology, Surgical Wound Infection surgery, Pancreatic Neoplasms, Pancreatic Neoplasms complications, Pancreatic Neoplasms surgery, Venous Thromboembolism epidemiology, Venous Thromboembolism etiology
- Abstract
Background: The American College of Surgeons National Surgical Quality Improvement Program was established to help participating hospitals track and report surgical complications with the goal of improving surgical care. We sought to determine whether this has led to improvements in surgical outcomes for pancreatic malignancies., Methods: Patients with pancreatic malignancies who underwent surgical resection were identified from the American College of Surgeons National Surgical Quality Improvement Program database (2006-2019). Thirty-day postoperative major morbidity and mortality were analyzed by year. Major morbidity included organ and deep surgical site infection, venous thromboembolism, cardiac event, pneumonia, acute renal failure, sepsis, and respiratory failure., Results: Of the 28,888 patients identified, 51% were male, the median age was 68, 74.3% underwent a pancreaticoduodenectomy, and 25.7% underwent a distal pancreatectomy. Among patients who underwent a pancreaticoduodenectomy, there was a significant increase in major morbidity (annual percent change 0.77, P = .012) driven by increases in organ space surgical site infection (annual percent change 3.52, P < .001) and venous thromboembolism (annual percent change 4.72, P = .005). However, there was a decrease in postoperative mortality (annual percent change -4.58, P = .001). For distal pancreatectomy patients, there was no change in rates of overall major morbidity (annual percent change -1.35, P = .08) or mortality (annual percent change -3.21, P = .25)., Conclusion: Although major morbidity and mortality have not significantly changed for distal pancreatectomy patients, mortality has steadily decreased for patients undergoing pancreaticoduodenectomy, despite an increase in major morbidity. Whether this trend reflects a change in patient selection, an increase in detection of postoperative morbidities and/or an improvement in mitigation of these morbidities warrants further study., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
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28. Helping Patients Understand Pancreatic Cancer Using Animated Pancreas Patient Education With Visual Formats of Learning.
- Author
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Munigala S, Gardner TB, O'Reilly EM, Fernández-Del Castillo C, Ko AH, Pleskow D, Vollmer CM Jr, Searle NA, Bakelman D, Holt JM, and Gelrud A
- Subjects
- Humans, Pancreas, Patient Education as Topic, Retrospective Studies, United States, Pancreatic Neoplasms therapy, Quality of Life
- Abstract
Objectives: Patient education and resources that address barriers to health literacy to improve understanding in pancreatic cancer are limited. We evaluated the impact and outcomes benefits of Animated Pancreas Patient (APP) cancer educational modules (APP website and YouTube)., Methods: A retrospective study of APP metrics and utilization data from September 2013 to February 2021 was conducted. We evaluated audience reach and calculated top views by media type (animation/expert video/patient video/slideshow) and top retention videos from the modules., Results: During the study period, APP had 4,551,079 views worldwide of which 2,757,064 unique visitors or 60% were from the United States. Of these, 54% were patients, 17% were family members or caregivers, 16% were health care providers, and 13% were other. The most popular topic viewed among the animations was "Understanding Clinical Trials" (n = 182,217), and the most common expert video viewed was "What are the different stages of pancreatic cancer?" (n = 15,357)., Conclusions: Pancreatic cancer patient education using APP's visual formats of learning demonstrated a wide reach and had a significant impact on improved understanding among patients, families, and caregivers. Continued efforts should be made to provide patient resources that address health literacy, better quality of life and improved health outcomes in pancreatic cancer., Competing Interests: The authors declare no conflict of interest. The Animated Pancreas Patient—An Animated Patient's Guide to Pancreatic Diseases is supported by unrestricted education grants from Abbvie Inc, Boston Scientific Corporation, Celgene Corporation, Ethicon US LLC, and Incyte Corporation. Mechanisms in Medicine, the developers of this resource, declare no conflict of interest in the development of the program., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2022
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29. Leptin favors Th17/Treg cell subsets imbalance associated with allergic asthma severity.
- Author
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Vollmer CM, Dias ASO, Lopes LM, Kasahara TM, Delphim L, Silva JCC, Lourenço LP, Gonçalves HC, Linhares UC, Gupta S, and Bento CAM
- Abstract
Background: Obesity has often been associated with severe allergic asthma (AA). Here, we analyzed the frequency of different circulating CD4
+ T-cell subsets from lean, overweight and obese AA patients., Methods: Mononuclear cells from peripheral blood were obtained from 60 AA patients and the frequency of different CD4+ T-cell subsets and type 1 regulatory B cells (Br1) was determined by cytometry. The effect of obese-related leptin dose on cytokine production and Treg cell function in AA-derived CD4+ T cell cultures was evaluated by ELISA and 3H thymidine uptake, respectively. Leptin levels were quantified in the plasma by ELISA. According to the BMI, patients were stratified as lean, overweight and obese., Results: AA severity, mainly among obese patients, was associated with an expansion of hybrid Th2/Th17 and Th17-like cells rather than classic Th2-like cells. On the other hand, the frequencies of Th1-like, Br1 cells and regulatory CD4+ T-cell subsets were lower in patients with severe AA. While percentages of the hybrid Th2/Th17 phenotype and Th17-like cells positively correlated with leptin levels, the frequencies of regulatory CD4+ T-cell subsets and Br1 cells negatively correlated with this adipokine. Interestingly, the obesity-related leptin dose not only elevated Th2 and Th17 cytokine levels, but also directly reduced the Treg function in CD4+ T cell cultures from lean AA patients., Conclusion: In summary, our results indicated that obesity might increase AA severity by favoring the expansion of Th17-like and Th2/Th17 cells and decreasing regulatory CD4+ T cell subsets, being adverse effects probably mediated by leptin overproduction., Competing Interests: All authors declare that there are no conflicts of interest., (© 2022 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)- Published
- 2022
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30. Automated next-generation profiling of genomic alterations in human cancers.
- Author
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Keefer LA, White JR, Wood DE, Gerding KMR, Valkenburg KC, Riley D, Gault C, Papp E, Vollmer CM, Greer A, Hernandez J, McGregor PM 3rd, Zingone A, Ryan BM, Deak K, McCall SJ, Datto MB, Prescott JL, Thompson JF, Cerqueira GC, Jones S, Simmons JK, McElhinny A, Dickey J, Angiuoli SV, Diaz LA Jr, Velculescu VE, and Sausen M
- Subjects
- Biomarkers, Tumor genetics, Genomics methods, High-Throughput Nucleotide Sequencing methods, Humans, Mutation, Precision Medicine, Neoplasms pathology
- Abstract
The lack of validated, distributed comprehensive genomic profiling assays for patients with cancer inhibits access to precision oncology treatment. To address this, we describe elio tissue complete, which has been FDA-cleared for examination of 505 cancer-related genes. Independent analyses of clinically and biologically relevant sequence changes across 170 clinical tumor samples using MSK-IMPACT, FoundationOne, and PCR-based methods reveals a positive percent agreement of >97%. We observe high concordance with whole-exome sequencing for evaluation of tumor mutational burden for 307 solid tumors (Pearson r = 0.95) and comparison of the elio tissue complete microsatellite instability detection approach with an independent PCR assay for 223 samples displays a positive percent agreement of 99%. Finally, evaluation of amplifications and translocations against DNA- and RNA-based approaches exhibits >98% negative percent agreement and positive percent agreement of 86% and 82%, respectively. These methods provide an approach for pan-solid tumor comprehensive genomic profiling with high analytical performance., (© 2022. The Author(s).)
- Published
- 2022
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31. American Society for Gastrointestinal Endoscopy guideline on screening for pancreatic cancer in individuals with genetic susceptibility: methodology and review of evidence.
- Author
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Calderwood AH, Sawhney MS, Thosani NC, Rebbeck TR, Wani S, Canto MI, Fishman DS, Golan T, Hidalgo M, Kwon RS, Riegert-Johnson DL, Sahani DV, Stoffel EM, Vollmer CM Jr, Al-Haddad MA, Amateau SK, Buxbaum JL, DiMaio CJ, Fujii-Lau LL, Jamil LH, Jue TL, Law JK, Lee JK, Naveed M, Pawa S, Storm AC, and Qumseya BJ
- Subjects
- Early Detection of Cancer, Endoscopy, Gastrointestinal, Humans, United States, Pancreatic Neoplasms, Genetic Predisposition to Disease, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms genetics
- Published
- 2022
- Full Text
- View/download PDF
32. ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: summary and recommendations.
- Author
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Sawhney MS, Calderwood AH, Thosani NC, Rebbeck TR, Wani S, Canto MI, Fishman DS, Golan T, Hidalgo M, Kwon RS, Riegert-Johnson DL, Sahani DV, Stoffel EM, Vollmer CM Jr, and Qumseya BJ
- Subjects
- Early Detection of Cancer, Humans, Mass Screening, Pancreatic Neoplasms, Genetic Predisposition to Disease, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms genetics
- Published
- 2022
- Full Text
- View/download PDF
33. Re: Clinical validation of the risk scoring systems of postoperative pancreatic fistula after laparoscopic pancreatoduodenectomy in Chinese cohorts: A single-center retrospective study.
- Author
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Vollmer CM Jr and Trudeau MT
- Subjects
- China epidemiology, Humans, Pancreaticoduodenectomy adverse effects, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Laparoscopy adverse effects, Pancreatic Fistula diagnosis, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology
- Published
- 2022
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- View/download PDF
34. Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading From the International Study Group for Pancreatic Surgery (ISGPS).
- Author
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Marchegiani G, Barreto SG, Bannone E, Sarr M, Vollmer CM, Connor S, Falconi M, Besselink MG, Salvia R, Wolfgang CL, Zyromski NJ, Yeo CJ, Adham M, Siriwardena AK, Takaori K, Hilal MA, Loos M, Probst P, Hackert T, Strobel O, Busch ORC, Lillemoe KD, Miao Y, Halloran CM, Werner J, Friess H, Izbicki JR, Bockhorn M, Vashist YK, Conlon K, Passas I, Gianotti L, Del Chiaro M, Schulick RD, Montorsi M, Oláh A, Fusai GK, Serrablo A, Zerbi A, Fingerhut A, Andersson R, Padbury R, Dervenis C, Neoptolemos JP, Bassi C, Büchler MW, and Shrikhande SV
- Subjects
- Acute Disease, Humans, Pancreatectomy adverse effects, Pancreatic Fistula etiology, Pancreaticoduodenectomy adverse effects, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Propylamines, Hyperamylasemia diagnosis, Hyperamylasemia etiology, Pancreatitis diagnosis, Pancreatitis etiology
- Abstract
Objective: The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison., Background: PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking., Methods: The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021., Results: We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications., Discussions: The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
35. A risk-adjusted analysis of drain use in pancreaticoduodenectomy: Some is good, but more may not be better.
- Author
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Brubaker LS, Casciani F, Fisher WE, Wood AL, Cagigas MN, Trudeau MT, Parikh VJ, Baugh KA, Asbun HJ, Ball CG, Behrman SW, Berger AC, Bloomston MP, Callery MP, Christein JD, Fernandez-Del Castillo C, Dillhoff ME, Dixon E, House MG, Hughes SJ, Kent TS, Kunstman JW, Wolfgang CL, Zureikat AH, Vollmer CM Jr, and Van Buren G 2nd
- Subjects
- Anastomosis, Surgical adverse effects, Drainage adverse effects, Humans, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications prevention & control, Retrospective Studies, Risk Assessment, Risk Factors, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreatic Fistula prevention & control, Pancreaticoduodenectomy adverse effects
- Abstract
Background: Intraperitoneal drain placement decreases morbidity and mortality in patients who develop a clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD). It is unknown whether multiple drains mitigate CR-POPF better than a single drain. We hypothesized that multiple drains decrease the complication burden more than a single drain in cases at greater risk for CR-POPF., Methods: The Fistula Risk Score (FRS), mitigation strategies (including number of drains placed), and clinical outcomes were obtained from a multi-institutional database of PDs performed from 2003 to 2020. Outcomes were compared between cases utilizing 0, 1, or 2 intraperitoneal drains. Multivariable regression analysis was used to evaluate the optimal drainage approach., Results: A total of 4,292 PDs used 0 (7.3%), 1 (45.2%), or 2 (47.5%) drains with an observed CR-POPF rate of 9.6%, which was higher in intermediate/high FRS zone cases compared with negligible/low FRS zone cases (13% vs 2.4%, P < .001). The number of drains placed also correlated with FRS zone (median of 2 in intermediate/high vs 1 in negligible/low risk cases). In intermediate/high risk cases, the use of 2 drains instead of 1 was not associated with a reduced rate of CR-POPF, average complication burden attributed to a CR-POPF, reoperations, or mortality. Obviation of drains was associated with significant increases in complication burden and mortality - regardless of the FRS zone., Conclusion: In intermediate/high risk zone cases, placement of a single drain or multiple drains appears to mitigate the complication burden while use of no drains is associated with inferior outcomes., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2022
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36. The Fistula Risk Score Catalog: Toward Precision Medicine for Pancreatic Fistula After Pancreatoduodenectomy.
- Author
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Trudeau MT, Casciani F, Ecker BL, Maggino L, Seykora TF, Puri P, McMillan MT, Miller B, Pratt WB, Asbun HJ, Ball CG, Bassi C, Behrman SW, Berger AC, Bloomston MP, Callery MP, Castillo CF, Christein JD, Dillhoff ME, Dickson EJ, Dixon E, Fisher WE, House MG, Hughes SJ, Kent TS, Malleo G, Salem RR, Wolfgang CL, Zureikat AH, and Vollmer CM
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Pancreatic Fistula epidemiology, Pancreaticoduodenectomy, Postoperative Complications epidemiology, Precision Medicine
- Abstract
Objective: This study aims to present a full spectrum of individual patient presentations of pancreatic fistula risk, and to define the utility of mitigation strategies amongst some of the most prevalent, and vulnerable scenarios surgeons encounter., Background: The FRS has been utilized to identify technical strategies associated with reduced CR-POPF incidence across various risk strata. However, risk-stratification using the FRS has never been investigated with greater granularity. By deriving all possible combinations of FRS elements, individualized risk assessment could be utilized for precision medicine purposes., Methods: FRS profiles and outcomes of 5533 PDs were accrued from 17 international institutions (2003-2019). The FRS was used to derive 80 unique combinations of patient "scenarios." Risk-matched analyses were conducted using a Bonferroni adjustment to identify scenarios with increased vulnerability for CR-POPF occurrence. Subsequently, these scenarios were analyzed using multivariable regression to explore optimal mitigation approaches., Results: The overall CR-POPF rate was 13.6%. All 80 possible scenarios were encountered, with the most frequent being scenario #1 (8.1%) - the only negligible-risk scenario (CR-POPF rate = 0.7%). The moderate-risk zone had the most scenarios (50), patients (N = 3246), CR-POPFs (65.2%), and greatest non-zero discrepancy in CR-POPF rates between scenarios (18-fold). In the risk-matched analysis, 2 scenarios (#59 and 60) displayed increased vulnerability for CR-POPF relative to the moderate-risk zone (both P < 0.001). Multivariable analysis revealed factors associated with CR-POPF in these scenarios: pancreaticogastrostomy reconstruction [odds ratio (OR) 4.67], omission of drain placement (OR 5.51), and prophylactic octreotide (OR 3.09). When comparing the utilization of best practice strategies to patients who did not have these conjointly utilized, there was a significant decrease in CR-POPF (10.7% vs 35.5%, P < 0.001; OR 0.20, 95% confidence interval 0.12-0.33)., Conclusion: Through this data, a comprehensive fistula risk catalog has been created and the most clinically-impactful scenarios have been discerned. Focusing on individual scenarios provides a practical way to approach precision medicine, allowing for more directed and efficient management of CR-POPF., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
37. Open drainage for intra-abdominal collections after pancreatectomy: What is the rest of the story?
- Author
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Casciani F and Vollmer CM
- Subjects
- Humans, Pancreatic Fistula surgery, Drainage, Pancreatectomy
- Published
- 2022
- Full Text
- View/download PDF
38. SSAT GI Surgery Debate: Hepatobiliary and Pancreas: Is Post-Pancreatectomy Acute Pancreatitis a Relevant Clinical Entity?
- Author
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Maggino L, Marchegiani G, Zyromski NJ, and Vollmer CM Jr
- Subjects
- Abdomen, Acute Disease, Humans, Pancreas diagnostic imaging, Pancreas surgery, Pancreatectomy, Pancreatitis etiology, Pancreatitis surgery
- Published
- 2022
- Full Text
- View/download PDF
39. Moving toward prediction with purpose.
- Author
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Vollmer CM Jr
- Published
- 2021
- Full Text
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40. The effect of high intraoperative blood loss on pancreatic fistula development after pancreatoduodenectomy: An international, multi-institutional propensity score matched analysis.
- Author
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Casciani F, Trudeau MT, Asbun HJ, Ball CG, Bassi C, Behrman SW, Berger AC, Bloomston MP, Callery MP, Christein JD, Falconi M, Fernandez-Del Castillo C, Dillhoff ME, Dickson EJ, Dixon E, Fisher WE, House MG, Hughes SJ, Kent TS, Kunstman JW, Malleo G, Partelli S, Wolfgang CL, Zureikat AH, and Vollmer CM
- Subjects
- Aged, Female, Follow-Up Studies, Global Health, Humans, Incidence, Male, Middle Aged, Pancreatic Fistula diagnosis, Pancreatic Fistula epidemiology, Retrospective Studies, Risk Factors, Blood Loss, Surgical statistics & numerical data, Pancreatic Fistula etiology, Pancreaticoduodenectomy adverse effects, Propensity Score, Risk Assessment methods
- Abstract
Background: The association between intraoperative estimated blood loss and outcomes after pancreatoduodenectomy has, thus far, been rarely explored., Methods: In total, 7,706 pancreatoduodenectomies performed at 18 international institutions composing the Pancreas Fistula Study Group were examined (2003-2020). High estimated blood loss (>700 mL) was defined as twice the median. Propensity score matching (1:1 exact-match) was employed to adjust for variables associated with high estimated blood loss and clinically relevant pancreatic fistula occurrence. The study was powered to detect a 33% clinically relevant pancreatic fistula increase in the high estimated blood loss group, with α = 0.05 and β = 0.2., Results: The propensity score model included 966 patients with high estimated blood loss and 966 patients with lower estimated blood loss; all covariate imbalantces were solved. Patients with high estimated blood loss patients experienced higher clinically relevant pancreatic fistula rates (19.4 vs 12.6%, odds ratio 1.66; P < .001), as well as higher severe complication rates (27.8 vs 15.6%), transfusions (50.1 vs 14.3%), reoperations (9.2 vs 4.0%), intensive care unit transfers (9.9 vs 4.8%) and 90-day mortality (4.7 vs 2.0%, all P < .001). High estimated blood loss was an independent predictor for clinically relevant pancreatic fistula (odds ratio 1.78, 95% confidence interval 1.37-2.32), as were prophylactic Octreotide administration (odds ratio 1.95, 95% confidence interval 1.46-2.61) and soft pancreatic texture (odds ratio 5.32, 95% confidence interval 3.74-5.57; all P < .001). Moreover, a second model including 1,126 pancreatoduodenectomies was derived including vascular resections as additional confounder (14.0% vascular resections performed in each group). On multivariable regression, high estimated blood loss was confirmed an independent predictor for clinically relevant pancreatic fistula reduction (odds ratio 1.80, 95% confidence interval 1.32-2.44; P < .001), whereas vascular resection was not (odds ratio 0.64, 95% confidence interval 0.34-1.88; P = .156)., Conclusion: This study better establishes the relationship between estimated blood loss and outcomes after pancreatoduodenectomy. Despite inherent contributions to blood loss, its minimization is an actionable opportunity for clinically relevant pancreatic fistula reduction and performance optimization in pancreatoduodenectomy. Accordingly, practical insights are offered to achieve this goal., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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41. Decision points in pancreatoduodenectomy: Insights from the contemporary experts on prevention, mitigation, and management of postoperative pancreatic fistula.
- Author
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Casciani F, Bassi C, and Vollmer CM Jr
- Subjects
- Adult, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Female, Humans, Male, Middle Aged, Pancreas surgery, Pancreatic Fistula etiology, Pancreatic Fistula therapy, Pancreaticoduodenectomy methods, Risk Assessment, Surveys and Questionnaires, Clinical Decision-Making methods, Pancreatic Fistula prevention & control, Pancreaticoduodenectomy adverse effects, Surgeons statistics & numerical data
- Abstract
Background: Despite abundant, high-level scientific evidence, there is no consensus regarding the prevention, mitigation, and management of clinically relevant pancreatic fistula after pancreatoduodenectomy. The aim of the present investigation is three-fold: (1) to analyze the multiple decision-making points for pancreatico-enteric anastomotic creation and fistula mitigation and management after pancreatoduodenectomy, (2) to reveal the practice of contemporary experts, and (3) to indicate avenues for future research to reduce the burden of clinically relevant pancreatic fistula., Methods: A 109-item questionnaire was sent to a panel of international pancreatic surgery experts, recognized for their clinical and scientific authority. Their practice habits and thought processes regarding clinically relevant pancreatic fistula risk assessment, anastomotic construction, application of technical adjuncts, and mitigation strategies, as well as postoperative management, was explored. Sixteen clinical vignettes were presented to reveal their certain approaches to unique situations-both common and uncommon., Results: Sixty experts, with a cumulative 48,860 pancreatoduodenectomies, completed the questionnaire. Their median pancreatectomy/pancreatoduodenectomy case volume was 1,200 and 705 procedures, respectively, with a median career duration of 22 years and 200 indexed publications. Although pancreatico-jejunostomy reconstruction with transperitoneal drainage is the standard operative approach for most authorities, uncertainty emerges regarding the employment of objective risk stratification and adaptation of practice to risk. Concrete suggestions are offered to inform decision-making in intimidating circumstances. Early drain removal is frequently embraced, while a step-up approach is unanimously invoked to treat severe clinically relevant pancreatic fistula., Conclusion: A comprehensive conceptual framework of 4 sequential phases of decision-making is proposed-risk assessment, anastomotic technique, mitigation strategy employment, and postoperative management. Basic science studies and outcome analyses are proposed for improvement., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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42. Kinetics of postoperative drain fluid amylase values after pancreatoduodenectomy: New insights to dynamic, data-driven drain management.
- Author
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Zureikat AH, Casciani F, Ahmad S, Bassi C, and Vollmer CM Jr
- Subjects
- Humans, Pancreatic Fistula etiology, Pancreatic Fistula metabolism, Postoperative Complications etiology, Postoperative Complications metabolism, Predictive Value of Tests, Amylases metabolism, Drainage, Pancreatic Fistula diagnosis, Pancreaticoduodenectomy adverse effects, Postoperative Complications diagnosis
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- 2021
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43. Objectifying Pancreatic Fistula Risk: On the Right Track, but More yet to Do.
- Author
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Vollmer CM, Trudeau M, and Casciani F
- Subjects
- Humans, Postoperative Complications, Pancreatectomy, Pancreatic Fistula etiology
- Published
- 2021
- Full Text
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44. Reappraisal of a 2-Cm Cut-off Size for the Management of Cystic Pancreatic Neuroendocrine Neoplasms: A Multicenter International Study.
- Author
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Maggino L, Schmidt A, Käding A, Westermark S, Ceppa EP, Falconi M, Javed AA, Landoni L, Pergolini I, Perinel J, Vollmer CM Jr, Sund M, and Gaujoux S
- Subjects
- Aged, Endosonography, Female, Humans, Male, Neuroendocrine Tumors diagnosis, Pancreatic Neoplasms diagnosis, Retrospective Studies, Neuroendocrine Tumors surgery, Pancreatectomy methods, Pancreatic Neoplasms surgery
- Abstract
Objective: The aim of this study was to characterize an international cohort of resected cystic pancreatic neuroendocrine neoplasms (cPanNENs) and identify preoperative predictors of aggressive behavior., Background: The characteristics of cPanNENs are unknown and their clinical management remains unclear. An observational strategy for asymptomatic cPanNENs ≤2 cm has been proposed by recent guidelines, but evidence is scarce and limited to single-institutional series., Methods: Resected cPanNENs (1995-2017) from 16 institutions worldwide were included. Solid lesions (>50% solid component), functional tumors, and MEN-1 patients were excluded. Aggressiveness was defined as lymph node (LN) involvement, G3 grading, distant metastases, and/or recurrence., Results: Overall, 263 resected cPanNENs were included, among which 177 (63.5%) were >2 cm preoperatively. A preoperative diagnosis of cPanNEN was established in 162 cases (61.6%) and was more frequent when patients underwent endoscopic ultrasound [EUS, odds ratio (OR) 2.69, 95% confidence interval (CI) 1.52-4.77] and somatostatin-receptor imaging (OR 3.681, 95% CI 1.809-7.490), and for those managed in specialized institutions (OR 3.12, 95% CI 1.57-6.21). Forty-one cPanNENs (15.6%) were considered aggressive. In the whole cohort, LN involvement on imaging, age >65 years, preoperative size >2 cm, and pancreatic duct dilation were independently associated with aggressive behavior. In asymptomatic patients, older age and a preoperative size >2 cm remained independently associated with aggressiveness. Only 1 of 61 asymptomatic cPanNENs ≤2 cm displayed an aggressive behavior., Conclusions: The diagnostic accuracy of cPanNENs is increased by the use of EUS and somatostatin-receptor imaging and is higher in specialized institutions. Preoperative size >2 cm is independently associated with aggressive behavior. Consequently, a watch-and-wait policy for sporadic asymptomatic cPanNENs ≤2 cm seems justified and safe for most patients., Competing Interests: This work was performed and written as part of a project of the 8th Pancreas 2000 program funded and organized by the European Pancreatic Club (EPC). None of the authors have any financial or any other kind of personal conflicts of interest in relation to this study The authors report no conflicts of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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45. Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review.
- Author
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Balduzzi A, van der Heijde N, Alseidi A, Dokmak S, Kendrick ML, Polanco PM, Sandford DE, Shrikhande SV, Vollmer CM, Wang SE, Zeh HJ, Hilal MA, Asbun HJ, and Besselink MG
- Subjects
- Humans, Pancreatectomy, Risk Factors, Treatment Outcome, Laparoscopy, Pancreatic Neoplasms surgery, Robotic Surgical Procedures
- Abstract
Purpose: The reported conversion rates for minimally invasive distal pancreatectomy (MIDP) range widely from 2 to 38%. The identification of risk factors for conversion may help surgeons during preoperative planning and patient counseling. Moreover, the impact of conversion on outcomes of MIDP is unknown., Methods: A systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). The PubMed, Cochrane, and Embase databases were searched for studies concerning conversion to open surgery in MIDP., Results: Of the 828 studies screened, eight met the eligibility criteria, resulting in a combined dataset including 2592 patients after MIDP. The overall conversion rate was 17.1% (range 13.0-32.7%) with heterogeneity between studies associated with the definition of conversion adopted. Only one study divided conversion into elective and emergency conversion. The main indications for conversion were vascular involvement (23.7%), concern for oncological radicality (21.9%), and bleeding (18.9%). The reported risk factors for conversion included a malignancy as an indication for surgery, the proximity of the tumor to vascular structures in preoperative imaging, higher BMI or visceral fat, and multi-organ resection or extended resection. Contrasting results were seen in terms of blood loss and length of stay in comparing converted MIDP and completed MIDP patients., Conclusion: The identified risk factors for conversion from this study can be used for patient selection and counseling. Surgeon experience should be considered when contemplating MIDP for a complex patient. Future studies should divide conversion into elective and emergency conversion.
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- 2021
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46. Surgeon experience contributes to improved outcomes in pancreatoduodenectomies at high risk for fistula development.
- Author
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Casciani F, Trudeau MT, Asbun HJ, Ball CG, Bassi C, Behrman SW, Berger AC, Bloomston MP, Callery MP, Christein JD, Falconi M, Fernandez-Del Castillo C, Dillhoff ME, Dickson EJ, Dixon E, Fisher WE, House MG, Hughes SJ, Kent TS, Malleo G, Partelli S, Salem RR, Stauffer JA, Wolfgang CL, Zureikat AH, and Vollmer CM Jr
- Subjects
- Aged, Clinical Competence, Female, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Pancreatic Fistula diagnosis, Pancreaticoduodenectomy methods, Postoperative Complications epidemiology, Postoperative Complications etiology, Risk Assessment, Risk Factors, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreaticoduodenectomy adverse effects, Quality Improvement, Quality of Health Care statistics & numerical data, Surgeons
- Abstract
Background: Pancreatoduodenectomies at high risk for clinically relevant pancreatic fistula are uncommon, yet intimidating, situations. In such scenarios, the impact of individual surgeon experience on outcomes is poorly understood., Methods: The fistula risk score was applied to identify high-risk patients (fistula risk score 7-10) from 7,706 pancreatoduodenectomies performed at 18 international institutions (2003-2020). For each case, surgeon pancreatoduodenectomy career volume and years of practice were linked to intraoperative fistula mitigation strategy adoption and outcomes. Consequently, best operative approaches for clinically relevant pancreatic fistula prevention and best performer profiles were identified through multivariable analysis models., Results: Eight hundred and thirty high-risk pancreatoduodenectomies, performed by 64 surgeons, displayed an overall clinically relevant pancreatic fistula rate of 33.7%. Clinically relevant pancreatic fistula rates decreased with escalating surgeon career pancreatoduodenectomy (-49.7%) and career length (-41.2%; both P < .001), as did transfusion and reoperation rates, postoperative morbidity index, and duration of stay. Great experience (≥400 pancreatoduodenectomies performed or ≥21-year-long career) was a significant predictor of clinically relevant pancreatic fistula prevention (odds ratio 0.52, 95% confidence interval 0.35-0.76) and was more often associated with pancreatojejunostomy reconstruction and prophylactic octreotide omission, which were both independently associated with clinically relevant pancreatic fistula reduction. A risk-adjusted performance analysis also correlated with experience. Moreover, minimizing blood loss (≤400 mL) significantly contributed to clinically relevant pancreatic fistula prevention (odds ratio 0.40, 95% confidence interval 0.22-0.74)., Conclusion: Surgeon experience is a key contributor to achieve better outcomes after high-risk pancreatoduodenectomy. Surgeons can improve their performance in these challenging situations by employing pancreatojejunostomy reconstruction, omitting prophylactic octreotide, and minimizing blood loss., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
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47. Of Fistula and Football.
- Author
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Casciani F, Trudeau MT, and Vollmer CM Jr
- Subjects
- Humans, Pancreatic Fistula etiology, Risk Factors, Football, Pancreatectomy adverse effects, Pancreatic Fistula surgery
- Abstract
Competing Interests: The authors have no conflicts of interests to disclose.
- Published
- 2021
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48. Response to: Re: Management of the pancreatic transection plane after left (distal) pancreatectomy: Expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS).
- Author
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Miao Y, Lu Z, Vollmer CM Jr, Castillo CF, Dervenis C, Bassi C, Hackert T, Neoptolemos JP, and Büchler MW
- Subjects
- Humans, Pancreas diagnostic imaging, Pancreas surgery, Pancreatic Fistula etiology, Pancreatic Fistula surgery, Digestive System Surgical Procedures, Pancreatectomy
- Published
- 2021
- Full Text
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49. The Landmark Series: Mitigation of the Postoperative Pancreatic Fistula.
- Author
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Van Buren G 2nd and Vollmer CM Jr
- Subjects
- Humans, Postoperative Complications prevention & control, Prospective Studies, Retrospective Studies, Pancreas, Pancreatic Fistula etiology, Pancreatic Fistula prevention & control
- Abstract
Pancreatic fistula has been the defining complication and challenge of pancreatic surgery. Better awareness and mitigation of postoperative pancreatic fistulas has led to significant improvements in morbidity and mortality of pancreatic surgery. The definition and management of pancreatic fistulas has sequentially progressed over the last three decades; the literature ranges from retrospective, observational studies to prospective multicenter randomized controlled trials. The landmark literature contributions driving the perioperative management of pancreatic fistulas are detailed in this article.
- Published
- 2021
- Full Text
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50. Forecasting surgical costs: Towards informed financial consent and financial risk reduction.
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Barreto SG, Bulamu N, Chaudhary A, Chen G, Kawakami K, Maggino L, Malleo G, Pendharkar S, Trudeau MT, Salvia R, Vollmer CM Jr, and Windsor JA
- Subjects
- Adult, Aged, Blood Loss, Surgical, Cost-Benefit Analysis, Costs and Cost Analysis, Female, Forecasting, Humans, India, Informed Consent, Italy, Length of Stay economics, Male, Middle Aged, Models, Economic, Operating Rooms economics, Pancreatic Neoplasms economics, Pancreatic Neoplasms surgery, Postoperative Complications economics, Risk Reduction Behavior, United States, Pancreaticoduodenectomy economics
- Abstract
Background: Health care expenditure is increasing around the world and surgery is a major cause of financial hardship to patients and their families. Using pancreatoduodenectomy (PD), one of the most complex, morbid and costly operation as an example, this study aimed to identify the cost drivers of surgery, estimate relative contribution of these drivers, and derive and validate a cohort-specific cost forecasting tool., Methods: Data on the costs of 1406 patients undergoing PD in three tertiary hospitals in India, Italy and the United States were analysed. Cost drivers were identified and cost models developed using a 4-stage process., Results: There was a significant difference in overall cost of PD between the 3 cohorts. The cost drivers common to the 3 cohorts included duration of hospital stay and the outcome of death (Clavien-Dindo 5). Significant cohort-specific cost drivers included co-morbidities, operating theatre utilisation times and operative blood loss, development of pancreatectomy-specific complications (POPF, DGE, PPH), and need for interventional radiology to manage complications. Based on this, a cost forecasting tool was developed., Conclusions: Drivers of costs for a surgical procedure (e.g. PD) are different between hospitals. Developing cost models/nomograms to predict the expected cost of surgery and perioperative care will not be applicable between hospitals. However, the approach could be used to develop context-specific data that will provide patients (at the time of the informed financial consent) and funding agencies with a more realistic cost estimate for a given operation. The developed cost forecasting tool warrants future validation., (Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
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