Citations 2
REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer
Boggi, Ugo , Kauffmann, Emanuele F. , Barreto, Savio George , Fusai, Giuseppe , Hackert, Thilo , Hilal, Mohammad Abu , Shrikhande, Shailesh, Truty, Mark J. , Werner, Jens , Wolfgang, Christopher L. , Capretti, Giovanni , Cattelani, Alice , Sio, Davide De , Dato, Armando Di, Meo, Giovanna Di , Gianfaldoni, Cesare , Salinas, C , Montorsi, Roberto Maria , Pagnanelli, Michele , Poli, Andrea , Sucameli, Francesco , Viti, Virginia, Addeo, Pietro , Bachellier, Philippe , Barbarello, Linda, Busquets, Juli , Butturini, Giovanni , Caniglia, Fabio, Chunhua, Xi, Colangelo, Ettore, Coratti, Andrea , Costa, Francesca, Crafa, Francesco , Valle, Raffaele Dalla , Carlis, Luciano De , Chiaro, Marco Del , Domak, Safi, Ercolani, Giorgio , Filauro, Marco, Gruttaduaria, Salvatore, Izbicki, Jakob R. , Jovine, Elio , Kiguchi, Gozo , Kooby, David A. , Lang, Hauke , Lombardo, Carlo , Massani, Marco , Miao, Yi , Mishima, Kohei , Molino, Carlo , Nardo, Bruno , Panaro, Fabrizio , Pasquali, Claudio , Perrone, Vittorio, Rangelova, Elena , Liu, Rong, Romito, Raffaele, Rosso, Edoardo , Schulick, Richard D. , Spampinato, Marcello , Troisi, Roberto , Uzunoglo, Faik G, Veneroni, Luigi , Zerbi, Alessandro , Vicente, Emilio, Vistoli, Fabio , Wakabayashi, Go , Zanus, Giacomo , Zureikat, Amer H., Zyromski, Nicholas J. , Davide, José , Dervenis, Christos, Konlon, Kevin C., Michelassi, Fabrizio, Nealon, William H. , Portolani, Nazario , Silva, Donzília Sousa , Ferrari, Viviana Nicoleta, Cameron, John L., Clavien, Pierre‐Alain , Asbun, Horacio J. , Board, The REDISCOVER Multidisciplinary Advisory, Truty, Mark, Napoli, Niccolò , Besselink, Marc G , Marchegiani, Giovanni , Salvia, Roberto , Bannone, Elisa , Coppola, Alessandro , Cucchetti, Alessandro , Fiorillo, Claudio , Ginesini, Michael , Lai, Quirino , Miccoli, Mario , Ricci, Claudio , Tamburrino, Domenico , Alfieri, Sergio , Baiocchi, Gian Luca , Balzano, Gianpaolo , Brolese, Alberto , Caputo, Damiano D. , Casadei, Riccardo , Wilde, Roeland F. de , Benedetto, Fabrizio Di , Sebastiano, Pierluigi Di , Hogg, Melissa E. , Egorov, V. , Ettorre, Giuseppe M , Falconi, Massimo , Ferrari, Giovanni , Ferrero, Alessandro , Giardino, Alessandro , Grazi, Gian Luca , Gruttadauria, Salvatore , Katz, Matthew H. G. , Keck, Tobias , Khatkov, Igor , Malleo, Giuseppe , Mazzaferro, Vincenzo , Memeo, Riccardo , Nagakawa, Yuichi , Nakamura, Masafumi , Liu, Rong, Romagnoli, Renato , Siriwardena, Ajith K. , Strobel, Oliver , Testini, Mario , Valente, Umberto , Vivarelli, Marco , Coppola, Roberto , D’Andrea, Vito , Frigerio, Isabella M. , Montorsi, Marco , Bozzi, Giuseppe, Ferrari, Viviana, Trivella, Maria Giovanna , Board, The REDISCOVER Multidisciplinary Advisory
Annals of Surgery | February 26, 2024 | Volume: 280 | Issue: 1 | Pages: 56-65
Objective: The REDISCOVER consensus conference aimed at developing and validating guidelines on the perioperative care of patients with borderline-resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Background: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports the resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. Methods: The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach a consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to nonsurgical guidelines. Results: Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis, and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive means to promptly advance our understanding in this field is to establish an international registry addressing this patient population (https://rediscover.unipi.it/). Conclusions: The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR-PDAC and LA-PDAC, and serve as the basis of a new international registry for this patient population.
Preoperative carbohydrate antigen 19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: a further plea for biological resectability criteria
Farolfi, Tommaso , Asbun, Horacio J. , Boggi, Ugo, Conlon, Kevin C. , Ferrone, Cristina R. , Jonas, Eduard , Kokudo, Norihiro , Satoi, Sohei , Sparrelid, Ernesto , Zerbi, Alessandro , Takemura, Nobuyuki , Lai, Quirino , Almerey, Tariq , Cammarata, Roberto , Djoumi, Yasmine, Gallagher, Tom , Ghorbani, Poya , Ginesini, Michael , Kauffmann, Emanuele F. , Kleive, Dyre , Lluís, Núria , Nappo, Gennaro , Nebbia, Martina , Ricchitelli, S, Sahakyan, Mushegh А. , Lai, Quirino , Jonas, Eduard , Coppola, Alessandro , Vaccara, Vincenzo La , Edwin, Bjørn , Martín‐Pérez, Elena , Stauffer, John , Bernon, Marc M. , Cammarata, Roberto , Hashimoto, Daisuke , González, Rocio Maqueda, Napoli, Niccolò , Yamamoto, Tomohisa , Coppola, Roberto , Caputo, Damiano D.
International Journal of Surgery | September 22, 2023 | Volume: 110 | Issue: 10 | Pages: 6092-6099
Introduction: Lymph-nodal involvement (N+) represents an adverse prognostic factor after pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC). Preoperative diagnostic and staging modalities lack sensitivity for identifying N+. This study aimed to investigate preoperative carbohydrate antigen 19.9 (CA 19.9) in predicting the N+ stage in resectable-PDAC (R-PDAC). Methods: Patients included in a multi-institutional retrospective database of PDs performed for R-PDAC from January 2000 to June 2021 were analysed. A preoperative laboratory value of CA 19.9 greater than 37 U/l was used in univariate and multivariate logistic regression analysis to determine a possible association with N+. Additionally, different cut-offs of CA 19.9 related to the preoperative clinical T (cT) stage was assessed to evaluate the risk of N+. Results: A total of 2034 PDs from thirteen centres were included in the study. CA 19.9 greater than 37 U/l was significantly associated with higher N+ at univariate and multivariate analysis ( P <0.001). CA 19.9 levels greater than 37 U/l were associated with N+ in 75.9%, 81.3%, and 85.7% of patients, respectively, in cT1, cT2, and cT3 tumours and with higher cut-off values for all cT stages. Conclusion: Lymph-nodal involvement is strongly related to preoperative CA 19.9 levels. Specially in patients staged as cT3 the CA 19.9 could represent a valid and easy tool to suspect nodal involvement. Due to these findings, R-PDAC patients with elevated CA 19.9 values should be considered in a more biologically advanced stage.