Citations 3
Contemporary Adjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasms
Haugk, Beate , White, Steven, Marchegiani, Giovanni, Holmberg, Marcus, Zerbi, Alessandro, Lu, Zipeng , Inoue, Y., Choi, Munseok , Kang, Chang Moo, Visser, B., Corpelijn, Lieke, Andersson, Bodil, Bereza-Carlson, Paulina, Björnsson, Bergthor, Wennerblom, Johanna, Goh, Brian K. P., Hartman, V., Ahmad, Syed, Patel, Sameer, Berrevoet, Frederik, Mortensen, Kim Erlend, Roberts, K., Lynch, Calum, Gupta, Amit, Kleeff, Joerg, Addeo, Pietro, Friess, Helmut, Koea, Jonathan, Gomez, Dhanny , Gordon-Weeks, Alex, Doria, Cataldo, Tzimas, Georgios, Franklin, O., Månsson, C., Cabús, Santiago Sánchez, Bhogal, Ricky H. , Pathak, Samir, Honselmann, Kim Christin, Balakrishnan, Anita, Mann, Kulbir , Gill, Anthony J., Mittal, A, Samra, Jas, Athwal, Tejinderjit, Loveday, Benjamin, Bhardwaj, Neil, Menon, Krishna, Thapa, Prabin, Matsumoto, Ippei, Jamieson, Nigel, Rebours, Vinciane, Descourvières, Clémence, Davidson, BR, Soreide, Kjetil, Pandanaboyana, Sanjay, Collaborative, Adeno-IPMN2, Kumar, Ajit, González, Carol Natalia Clavijo, Lam, Shi, L’Official-German, Ivan, Bergner, Tina, Rosso, Edoardo , Giulianotti, Pier Cristoforo , Morreau, Mathew , Dili, Alexandra, Sotiropoulou, Maria , Kuzman, Matta , Büyükkasap, Ahmet Çağrı, Uludağ, Gökhan, McGuigan, Mari-Claire , Chouari, Tarak , Dogul, Ahmet, Doğu, Doğukan , Rebelo, Artur, Holewik, Franziska Bernadette, Plesa-Furda, Roxana, Revoredo, Fernando, Galanis, Ilias , Maharjan, Dhiresh, Ghorbani, Poya , Lind, Max, Ami, Katsuya , Vijayashanker, Aarathi , Alsaoudi, Tareq , Lundgren, Linda , Ellisa, Katrina, Hong, Paul , Gupta, Archit, MartinXu, Congde, Konstantoudakis, Georgios, Christophides, Thalis, Spurring, Eleanor Margaret, Iwao, Yasuhito, Pirklc, Martin, Vaitha, Ruhi , Tiwari, Navneet, Sheel, Andrea, Kotecha, Krishna , Stavrou, Gregor A., Patel, Rikhilroy, Misca, Mihaela , Hammond, John, Roalso, Marcus Thomas Thor, Soomro, Faiza H, Halimi, Asif , Kendall, Timothy, Patel, Visad, Stankic, Dunja, Dries, Pieter , Hein, Charlotte, Betram, Julia, Jacob, Rosetta, Wilson, Gregory, Redas, Souheil, Poškus, Augustas, Mosert, Paula Lucia, Šilinskaitė, Ugnė , Hirose, Yuki, Liu, Xue, Standaert, Lars, Kay, Tegan J, Nishida, Kenji, Peddakota, Vivek , Gupta, Amit , Kang, Chang Moo , Ven Fong, Zhi, Kang, Chang Moo , Lucocq, James E. , Marchegiani, Giovanni , Zerbi, Alessandro , Pagnanelli, Michele , Visser, B. , Andersson, Bodil , Bereza‐Carlson, Paulina , Björnsson, Bergþór , Wennerblom, Johanna Hansson , Labori, Knut Jørgen , Goh, Brian K P , Hartman, Vera , Berrevoet, Frederik Christiaan , Ausania, Fabio , Bertrand, Claude , Kleeff, Joerg, Addeo, Pietro , Bellotti, Ruben , Fong, Zhi Ven , Friess, Helmut , Koea, Jonathan , Gordon-Weeks, Alex Nicolas , Doria, Cataldo , Franklin, Oskar , Pathak, Samir , Honselmann, Kim C. , Balakrishnan, Anita , Harrison, Ewen M. , Gill, A J, Mittal, Anubhav, Samra, Jas , Athwal, Tejinderjit , Loveday, Benjamin P. T. , Teh, Catherine , Bhardwaj, Neil , Menon, Krishna, Matsumoto, Ippei , Jamieson, Nigel , Rebours, Vinciane , Søreide, Kjetil , Martlı, Hüseyin Fahri , Roeyen, Geert , Antonakis, Pantelis T. , Bramis, Konstantinos , Hall, Lewis A , Valle, Valentina , Connor, Saxon J. , Kapiris, Stylianos A. , Kerem, Mustafa , Rebelo, Artur , Plesa-Furda, R., Filho, Omero Pereira da Costa , Galanis, Ilias, Konstantoudakis, Georgios, Christophides, Thalis, McGuinness, Matthew James , Yaqub, Sheraz , Pellegrini, Riccardo , Perri, Giampaolo , Sheel, Andrea , Sheen, Amy , Evans, Daisy, Ghamarnejad, Omid , Karavias, Dimitrios D. , Roalsø, Marcus T. T. , Stankic, Dunja , Grubor, Nikica , Gulla, Aistė , Furukawa, Takaaki , Hirose, Yuki , Yin, Lingdi
JAMA Network Open | March 27, 2026 | Volume: 9 | Issue: 3 | Pages: e263688
10.1001/jamanetworkopen.2026.3688
Importance Adjuvant chemotherapy regimens may be administered after pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMNs), although the evidence supporting their use is limited. Objective To evaluate the survival benefit associated with contemporary adjuvant chemotherapy regimens after resection in A-IPMNs between 2017 and 2023. Design, Setting, and Participants This retrospective cohort study was an international, multicenter study with 69 participating centers across Europe, North America, South America, and the Asia-Pacific region. Patients undergoing resection for A-IPMNs were included. Data were analyzed from May to August 2025. Intervention Contemporary adjuvant chemotherapy regimens, such as gemcitabine-capecitabine (GemCap); 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX), modified FOLFIRINOX (mFOLFIRINOX), and S-1. Main Outcome and Measure Overall survival (months). Results Among 1321 patients (median [IQR] age 70 [63 to 76] years; 713 males [54.0%] and 608 females [46.0%]), 781 patients (59.1%) received adjuvant chemotherapy, while in 181 patients (13.7%) it was omitted due to poor patient fitness. Of patients who received adjuvant chemotherapy, 568 patients (72.6%) received contemporary regimens, including GemCap (232 patients [29.7%]), FOLFIRINOX (176 patients [22.5%]), mFOLFIRINOX (71 patients [9.1%]), and S-1 (70 patients [9.0%]). The median (IQR) follow-up for the cohort was 64.2 (40.4 to 85.0) months, and the median overall survival was 73.8 months (95% CI, 66.4 to 81.9 months). After 90-day landmark analysis and exclusion of patients ineligible for chemotherapy, adjuvant chemotherapy vs no adjuvant chemotherapy (propensity score–matched populations, 243:243 patients) was not associated with improved overall survival (median, 82.3 months; 95% CI, 78.2 months to not applicable [NA] vs not reached; 95% CI, 75.3 months to NA; P = .58). Contemporary regimens vs no adjuvant chemotherapy (propensity score–matched populations, 309:309 patients) was not associated with longer survival, and a mean survival benefit greater than 4.2 months over 5 years was excluded (difference in restricted mean survival, 1.26 months; 95%, −1.72 to 4.24 months). Treatment outcomes did not vary by chemotherapy regimen or disease characteristic (eg, N stage or carbohydrate antigen 19-9 level). Conclusions and Relevance In this study, contemporary adjuvant chemotherapy was not associated with improved overall survival in A-IPMNs, and a randomized clinical trial is indicated.
The E-AHPBA—ESSO—Innsbruck consensus recommendations on peri- and postoperative management following liver resection
Maier, Eva , Stättner, Stefan, Carrión-Álvarez, Lucía , Martino, Marcello Di, Primavesi, Florian, Sochorová, Dana , Laarhoven, Stijn van , Balakrishnan, Anita, Buis, Carlijn I. , Cipriani, Federica, Erdmann, Joris, Frampton, A., Fuks, David, Melloul, Emmanuel, Oberkofler, Christian E. , Petritsch, Stefan, Raab, Helmut, Rahbari, Nuh N. , Rappold, Daniela , Ruzzenente, Andrea, Schäfer, Benedikt , Serrablo, Alejandro, Soreide, Kjetil, Ernesto, Sparrelid, Starlinger, Patrick P, Tinguely, Pascale, Dasari, Bobby V M, Donadon, Matteo, Dopazo, Cristina, Gruenberger, T., Jonas, E G, Malik, Hassan, Siriwardena, Ajith K, Braunwarth, Eva , Di Martino, Marcello , Olthof, Pim , van Laarhoven, Stijn , Cipriani, Federica , Erdmann, Joris I , Lancellotti, Francesco , Oberkofler, Christian , Sallinen, Ville , Søreide, Kjetil , Starlinger, Patrick , Aldrighetti, Luca , Donadon, Matteo , Dopazo, Cristina , Gruenberger, Thomas , Viganó, Luca , Maglione, Manuel , Stättner, Stefan , Primavesi, Florian , Breitkopf, Robert , Fuks, David , Gilg, Stefan , Gulla, Aistė , Margreiter, Christian , Reiberger, Thomas , Ruzzenente, Andrea , Schaefer, Benedikt, Schnitzbauer, Andreas A. , Søreide, Kjetil , Sparrelid, Ernesto , Starlinger, Patrick , Stavrou, Gregor Alexander , Aldrighetti, Luca , Dasari, B. , Gruenberger, Thomas , Jonas, Eduard , Malik, Hassan , Siriwardena, Ajith K. , Maglione, Manuel
British Journal of Surgery | December 30, 2025 | Volume: 113 | Issue: 1 | Pages: No page available
Abstract Background Liver surgery carries a high risk of complications due to the complex interplay of patient-related factors, disease characteristics, and liver function. Expertise is essential for healthcare professionals managing hepatobiliary patients. This European consensus provides evidence-based guidance on selected aspects of peri- and postoperative care. Methods A modified Delphi process was used to achieve consensus, with a 70% agreement threshold. The expert panel comprised hepatobiliary surgeons, anaesthetists, hepatologists, a specialist nurse, and a physiotherapist. A systematic literature search was conducted in PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases. Six topics were addressed: thromboprophylaxis; perioperative antibiotics; prehabilitation/nutrition/mobilization; bile leak including bilioenteric anastomosis leaks; post-hepatectomy haemorrhage; and post-hepatectomy liver failure (PHLF). Evidence appraisal and statement development followed Scottish Intercollegiate Guidelines Network methodology. A patient representative reviewed the guideline. Results Searching the literature yielded 204 included publications from an initial 6514. Thirty-two statements were formulated with a median evidence level of 2. Evidence strength varied by topic with noticeably lower evidence levels in complex surgery settings and less prevalent conditions. In some topics, study heterogeneity and specific inclusion criteria resulted in conditional recommendations, despite high-level evidence. Notably, the weakest evidence was found for perioperative thromboprophylaxis and PHLF management. Strong recommendations were formulated for prehabilitation, early postoperative mobilization, and avoidance of routine drain use. Several evidence gaps warranting multicentre studies were identified. Conclusion Optimizing peri- and postoperative care after liver resection remains challenging. Standardizing key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.
Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected
Machicado, Jorge D. , Gougol, Amir , Tan, Xiaoqing , Gao, Xiaotian , Pothoulakis, Ioannis , Talukdar, Rupjyoti , Gulla, Aistė , Stevens, Tyler , Barbu, Sorin T. , Nawaz, Haq , Gutierrez, Silvia C., Zarnescu, Narcis , Capurso, Gabriele , Easler, Jeffrey J. , Τriantafyllou, Κonstantinos , Thakkar, Shyam , Ocampo, Carlos , de‐Madaria, Enrique , Coté, Gregory A. , Conwell, Darwin L. , Hart, Phil A. , Tang, Gong , Pothoulakis, Ioannis , de-Madaria, Enrique , Paragomi, Pedram , Kochhar, Rakesh K. , Goenka, Mahesh Kumar , González, José Alberto , Singh, Vikesh K. , Ferreira, Miguel Godinho , Peláez‐Luna, Mario , Wu, Bechien U. , Papachristou, Georgios I.
United European Gastroenterology Journal | April 19, 2021 | Volume: 9 | Issue: 2 | Pages: 139-149
Abstract Background Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF. Objective We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF. Methods We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders. Results 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF ( p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3–34.9) and three (48%, OR = 20.2, 5.9–68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ ( p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality ( p < 0.05). Onset and duration of POF had no impact mortality. Conclusion In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.