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Claudio Bassi - One of the best experts on this subject based on the ideXlab platform.
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chyle leak after Pancreatic Surgery validation of the international study group of Pancreatic Surgery classification
Surgery, 2018Co-Authors: Salvatore Paiella, Claudio Bassi, Matteo De Pastena, Fabio Casciani, Teresa Lucia Pan, Selene Bogoni, Stefano Andrianello, Giovanni Marchegiani, Giuseppe Malleo, Roberto SalviaAbstract:Abstract Background Chyle leak is an uncommon complication after Pancreatic Surgery. The chyle leak incidence, definition, diagnosis, and treatment had been reported heterogeneously so far. Recently a consensus definition and grading system was published by the International Study Group for Pancreatic Surgery. This study aims to evaluate the differences in the clinical and economic burden of chyle leak applying the new definition. Methods All data from patients who underwent Pancreatic Surgery for any disease from January 2014 to December 2016 were retrieved from the institutional prospective database. The 2017 International Study Group for Pancreatic Surgery definition and classification were applied. The classification was validated analyzing the differences in major complications, length of stay, and hospitalization costs. Results A total of 945 patients was the final population. A chyle leak was reported in 43 patients (4.5%). Grade A chyle leak occurred in 10 patients (23.3%), Grade B chyle leak in 31 patients (72.1%), and Grade C chyle leak in 2 patients (4.6%). Chyle leak occurred as unique postoperative complication in 29 cases (67.4%). The economic analysis showed that the average costs of the 3 grades were 2,806, 7,150 and 15,684 euros respectively (P Conclusion The present study confirms the validity of the International Study Group for Pancreatic Surgery classification of chyle leak. The 3 grades of chyle leak proposed identify reliably clinical and economical differences among the chyle leak cases.
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modifications in the international study group for Pancreatic Surgery isgps definition of postoperative Pancreatic fistula
Translational Gastroenterology and Hepatology, 2017Co-Authors: Alessandra Pulvirenti, Marco Ramera, Claudio BassiAbstract:Postoperative Pancreatic fistula (POPF) remains the major postoperative cause of morbidity and mortality following Pancreatic Surgery. Since 2005, the International Study Group of Pancreatic Fistula (ISGPF) definition and classification has been adopted worldwide allowing the comparison among different surgical approaches and mitigation strategies. Over the last 11 years, several limitations have emerged from clinical practice and in 2016 the International Study Group for Pancreatic Surgery (ISGPS) updated the POPF definition and grading system. Objectives of this review article were to summarize modifications in the updated ISGPS definition and to illustrate their clinical impact.
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clinical implications of the 2016 international study group on Pancreatic Surgery definition and grading of postoperative Pancreatic fistula on 775 consecutive Pancreatic resections
Annals of Surgery, 2017Co-Authors: Alessandra Pulvirenti, Giovanni Marchegiani, Giuseppe Malleo, Roberto Salvia, Valentina Allegrini, Alessandro Esposito, Luca Casetti, Luca Landoni, Claudio BassiAbstract:Objective:The aim of the present study was to evaluate the clinical implications of the 2016 International Study Group for Pancreatic Surgery (ISGPS) definition and classification of postoperative Pancreatic fistula (POPF) using a single high-volume institutional cohort of patients undergone pancrea
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pan european survey on the implementation of minimally invasive Pancreatic Surgery with emphasis on cancer
Hpb, 2016Co-Authors: Thijs De Rooij, Marc G Besselink, Olivier R Busch, Laureano Fernandezcruz, Awad Shamali, Giovanni Butturini, Bjorn Edwin, Roberto Troisi, Ibrahim Dagher, Claudio BassiAbstract:Background Minimally invasive (MI) Pancreatic Surgery appears to be gaining popularity, but its implementation throughout Europe and the opinions regarding its use in Pancreatic cancer patients are unknown.
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reappraisal of nodal staging and study of lymph node station involvement in Pancreaticoduodenectomy with the standard international study group of Pancreatic Surgery definition of lymphadenectomy for cancer
Journal of The American College of Surgeons, 2015Co-Authors: Giuseppe Malleo, Claudio Bassi, Giovanni Butturini, Laura Maggino, Paola Capelli, Francesco Gulino, Silvia Segattini, Aldo Scarpa, Roberto SalviaAbstract:Background The prognostic role of lymph node (LN) dissection in Pancreatic head ductal adenocarcinoma is still unclear. This study reappraised the value of the number of positive LNs and LN ratio in patients undergoing Pancreaticoduodenectomy with standard lymphadenectomy according to the recent International Study Group of Pancreatic Surgery definition. In addition, the impact of nodal metastases stratified by LN stations was investigated. Study Design After reviewing retrospectively clinical and pathologic data of 758 Pancreaticoduodenectomies for Pancreatic head ductal adenocarcinoma performed from 2002 through 2011, we extracted patients in whom the LN stations included in the International Study Group of Pancreatic Surgery definition had been sampled. Survival analysis was performed using univariate and multivariate models. Results The study population consisted of 255 patients. Mean number of harvested LNs was 30.8. Factors with a significant prognostic impact on multivariate analysis were tumor grade, adjuvant therapy, number of positive LNs, LN metastases along station 14a-b (proximal superior mesenteric artery), and the number of metastatic LN stations. Patients with involvement of station 14a-b exhibited worse pathologic features, indicating more aggressive disease. Conclusions In patients receiving a uniform LN dissection, the number of positive LNs is superior to LN ratio for predicting survival. Lymph node metastases along the proximal superior mesenteric artery have a significant prognostic value, and an increasing number of metastatic stations are associated with a sharp decrease in survival. In future studies, clarification of the pattern of LN metastasis spread could offer valuable insight into the optimal treatment strategies, including selection of patients for neoadjuvant therapies.
Marco J Bruno - One of the best experts on this subject based on the ideXlab platform.
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the daily practice of Pancreatic enzyme replacement therapy after Pancreatic Surgery a northern european survey enzyme replacement after Surgery
Journal of Gastrointestinal Surgery, 2012Co-Authors: Edmee C M Sikkens, Casper H J Van Eijck, Djuna L Cahen, Ernst J Kuipers, Marco J BrunoAbstract:After Pancreatic Surgery, up to 80 % of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of Pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme replacement therapy after Surgery are lacking, and therefore, we conducted this analysis. An anonymous survey was distributed to members of the Dutch and German patient associations for Pancreatic disorders. The target population consisted of patients with chronic pancreatitis or Pancreatic cancer who had undergone Pancreatic Surgery and were using enzymes to treat exocrine insufficiency. Results were compared to a similar group of non-operated patients. Ninety-one cases were analyzed (84 % underwent a resection procedure). The median daily enzyme dose was 6, and 25 % took three or less capsules. Despite treatment, 68 % of patients reported steatorrhea-related symptoms, 48 % adhered to a non-indicated dietary fat restriction, and only 33 % had visited a dietician. The outcome was equally poor for the 91 non-operated patients. Most patients suffering from exocrine insufficiency after Pancreatic Surgery are undertreated. To improve efficacy, physicians should be more focused on treating exocrine insufficiency and educate patients to adjust the dose according to symptoms and their diet.
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the daily practice of Pancreatic enzyme replacement therapy after Pancreatic Surgery a northern european survey enzyme replacement after Surgery
Journal of Gastrointestinal Surgery, 2012Co-Authors: Edmee C M Sikkens, Casper H J Van Eijck, Djuna L Cahen, Ernst J Kuipers, Marco J BrunoAbstract:Introduction After Pancreatic Surgery, up to 80 % of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of Pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme replacement therapy after Surgery are lacking, and therefore, we conducted this analysis.
Roberto Salvia - One of the best experts on this subject based on the ideXlab platform.
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chyle leak after Pancreatic Surgery
2021Co-Authors: Salvatore Paiella, Gabriella Lionetto, Roberto SalviaAbstract:During Pancreatic resection lymph node dissection may be indispensable and chyle leak may occur as a postoperative complication. While uncertainty on its etiopathogenesis still persists, diagnosis and management have been recently standardized. Indeed, in 2017 the International Study Group of Pancreatic Surgery (ISGPS) released a consensus on definition and classification of this uncommon complication, identifying some therapeutic pathways that may help to speed up the healing process. In this book chapter the most relevant literature on the topic is presented.
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chyle leak after Pancreatic Surgery validation of the international study group of Pancreatic Surgery classification
Surgery, 2018Co-Authors: Salvatore Paiella, Claudio Bassi, Matteo De Pastena, Fabio Casciani, Teresa Lucia Pan, Selene Bogoni, Stefano Andrianello, Giovanni Marchegiani, Giuseppe Malleo, Roberto SalviaAbstract:Abstract Background Chyle leak is an uncommon complication after Pancreatic Surgery. The chyle leak incidence, definition, diagnosis, and treatment had been reported heterogeneously so far. Recently a consensus definition and grading system was published by the International Study Group for Pancreatic Surgery. This study aims to evaluate the differences in the clinical and economic burden of chyle leak applying the new definition. Methods All data from patients who underwent Pancreatic Surgery for any disease from January 2014 to December 2016 were retrieved from the institutional prospective database. The 2017 International Study Group for Pancreatic Surgery definition and classification were applied. The classification was validated analyzing the differences in major complications, length of stay, and hospitalization costs. Results A total of 945 patients was the final population. A chyle leak was reported in 43 patients (4.5%). Grade A chyle leak occurred in 10 patients (23.3%), Grade B chyle leak in 31 patients (72.1%), and Grade C chyle leak in 2 patients (4.6%). Chyle leak occurred as unique postoperative complication in 29 cases (67.4%). The economic analysis showed that the average costs of the 3 grades were 2,806, 7,150 and 15,684 euros respectively (P Conclusion The present study confirms the validity of the International Study Group for Pancreatic Surgery classification of chyle leak. The 3 grades of chyle leak proposed identify reliably clinical and economical differences among the chyle leak cases.
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clinical implications of the 2016 international study group on Pancreatic Surgery definition and grading of postoperative Pancreatic fistula on 775 consecutive Pancreatic resections
Annals of Surgery, 2017Co-Authors: Alessandra Pulvirenti, Giovanni Marchegiani, Giuseppe Malleo, Roberto Salvia, Valentina Allegrini, Alessandro Esposito, Luca Casetti, Luca Landoni, Claudio BassiAbstract:Objective:The aim of the present study was to evaluate the clinical implications of the 2016 International Study Group for Pancreatic Surgery (ISGPS) definition and classification of postoperative Pancreatic fistula (POPF) using a single high-volume institutional cohort of patients undergone pancrea
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reappraisal of nodal staging and study of lymph node station involvement in Pancreaticoduodenectomy with the standard international study group of Pancreatic Surgery definition of lymphadenectomy for cancer
Journal of The American College of Surgeons, 2015Co-Authors: Giuseppe Malleo, Claudio Bassi, Giovanni Butturini, Laura Maggino, Paola Capelli, Francesco Gulino, Silvia Segattini, Aldo Scarpa, Roberto SalviaAbstract:Background The prognostic role of lymph node (LN) dissection in Pancreatic head ductal adenocarcinoma is still unclear. This study reappraised the value of the number of positive LNs and LN ratio in patients undergoing Pancreaticoduodenectomy with standard lymphadenectomy according to the recent International Study Group of Pancreatic Surgery definition. In addition, the impact of nodal metastases stratified by LN stations was investigated. Study Design After reviewing retrospectively clinical and pathologic data of 758 Pancreaticoduodenectomies for Pancreatic head ductal adenocarcinoma performed from 2002 through 2011, we extracted patients in whom the LN stations included in the International Study Group of Pancreatic Surgery definition had been sampled. Survival analysis was performed using univariate and multivariate models. Results The study population consisted of 255 patients. Mean number of harvested LNs was 30.8. Factors with a significant prognostic impact on multivariate analysis were tumor grade, adjuvant therapy, number of positive LNs, LN metastases along station 14a-b (proximal superior mesenteric artery), and the number of metastatic LN stations. Patients with involvement of station 14a-b exhibited worse pathologic features, indicating more aggressive disease. Conclusions In patients receiving a uniform LN dissection, the number of positive LNs is superior to LN ratio for predicting survival. Lymph node metastases along the proximal superior mesenteric artery have a significant prognostic value, and an increasing number of metastatic stations are associated with a sharp decrease in survival. In future studies, clarification of the pattern of LN metastasis spread could offer valuable insight into the optimal treatment strategies, including selection of patients for neoadjuvant therapies.
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delayed gastric emptying after pylorus preserving Pancreaticoduodenectomy validation of international study group of Pancreatic Surgery classification and analysis of risk factors
Hpb, 2010Co-Authors: Giuseppe Malleo, Roberto Salvia, Paolo Pederzoli, Giovanni Butturini, Stefano Crippa, Stefano Partelli, Roberto Rossini, Matilde Bacchion, Claudio BassiAbstract:Objectives This study evaluates the incidence and clinical features and associated risk factors of delayed gastric emptying (DGE) after Pancreaticoduodenectomy, employing the International Study Group of Pancreatic Surgery (ISGPS) consensus definition.
M W Buchler - One of the best experts on this subject based on the ideXlab platform.
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incidence risk factors and clinical implications of chyle leak after Pancreatic Surgery
British Journal of Surgery, 2016Co-Authors: Oliver Strobel, S Brangs, Ulf Hinz, Thomas Pausch, Felix J Huttner, Markus K Diener, Lutz Schneider, T Hackert, M W BuchlerAbstract:Background Chyle leak is a well known but poorly characterized complication after Pancreatic Surgery. Available data on incidence, risk factors and clinical significance of chyle leak are highly heterogeneous. Methods For this cohort study all patients who underwent Pancreatic Surgery between January 2008 and December 2012 were identified from a prospective database. Chyle leak was defined as any drainage output with triglyceride content of 110 mg/dl or more. Risk factors for chyle leak were assessed by univariable and multivariable analyses. The clinical relevance of chyle leak was evaluated using hospital stay and resolution by 14 days for short-term outcome and overall survival for long-term outcome. Results Chyle leak developed in 346 (10·4 per cent) of 3324 patients. Pre-existing diabetes, resection for malignancy, distal pancreatectomy, duration of Surgery 180 min or longer, and concomitant Pancreatic fistula or abscess were independent risk factors for chyle leak. Both isolated chyle leak and coincidental chyle leak (with other intra-abdominal complications) were associated with prolonged hospital stay. Some 178 (87·7 per cent) of 203 isolated chyle leaks and 90 (70·3 per cent) of 128 coincidental chyle leaks resolved with conservative management within 14 days. Initial and maximum drainage volumes were associated with duration of hospital stay and success of therapy by 14 days. Impact on survival was restricted to chyle leaks that persisted at 14 days in patients with cancer undergoing palliative Surgery. Conclusion Chyle leak is a relevant complication, with an incidence of more than 10 per cent after Pancreatic Surgery, and has a major impact on hospital stay. Drainage volume is associated with hospital stay and success of therapy.
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borderline resectable Pancreatic cancer a consensus statement by the international study group of Pancreatic Surgery isgps
Surgery, 2014Co-Authors: M Bockhorn, Claudio Bassi, M W Buchler, Mustapha Adham, Faik G Uzunoglu, C W Imrie, Miroslav Milicevic, Aken A Sandberg, Horacio J Asbun, R M CharnleyAbstract:Background This position statement was developed to expedite a consensus on definition and treatment for borderline resectable Pancreatic ductal adenocarcinoma (BRPC) that would have worldwide acceptability. Methods An international panel of Pancreatic surgeons from well-established, high-volume centers collaborated on a literature review and development of consensus on issues related to borderline resectable Pancreatic cancer. Results The International Study Group of Pancreatic Surgery (ISGPS) supports the National Comprehensive Cancer Network criteria for the definition of BRPC. Current evidence supports operative exploration and resection in the case of involvement of the mesentericoportal venous axis; in addition, a new classification of extrahepatic mesentericoportal venous resections is proposed by the ISGPS. Suspicion of arterial involvement should lead to exploration to confirm the imaging-based findings. Formal arterial resections are not recommended; however, in exceptional circumstances, individual therapeutic approaches may be evaluated under experimental protocols. The ISGPS endorses the recommendations for specimen examination and the definition of an R1 resection (tumor within 1 mm from the margin) used by the British Royal College of Pathologists. Standard preoperative diagnostics for BRPC may include: (1) serum levels of CA19-9, because CA19-9 levels predict survival in large retrospective series; and also (2) the modified Glasgow Prognostic Score and the neutrophil/lymphocyte ratio because of the prognostic relevance of the systemic inflammatory response. Various regimens of neoadjuvant therapy are recommended only in the setting of prospective trials at high-volume centers. Conclusion Current evidence justifies portomesenteric venous resection in patients with BRPC. Basic definitions were identified, that are currently lacking but that are needed to obtain further evidence and improvement for this important patient subgroup. A consensus for each topic is given.
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use and results of consensus definitions in Pancreatic Surgery a systematic review
Surgery, 2014Co-Authors: Markus K Diener, M W Buchler, Alexis Ulrich, Julian C Harnoss, Thilo WelschAbstract:Background Because of the lack of standardized definitions of complications in gastrointestinal operations, consensus definitions have been developed in recent years. The aim of the current study was to systematically review the available consensus definitions and to report their use, acceptance, and results. Methods A systematic search of the literature was conducted of the Medline, Cochrane, and ISI Web of Science databases. All articles published until August 2011 and that applied the identified consensus definitions were considered. Inclusion criteria for quantitative analysis were studies with correct usage of the definition and 100 or more patients who were treated after the year 2000. Results Seven consensus definitions were identified: postoperative Pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, posthepatectomy liver failure, bile leakage after hepatobiliary and Pancreatic Surgery, posthepatectomy hemorrhage, and anastomotic leakage after anterior resection of the rectum. Of 1,637 articles retrieved from the literature search, 59 articles that correctly applied the definitions met the inclusion criteria. Subanalyses were feasible for definitions after Pancreatic Surgery. According to the consensus definitions, the median complication rates of retrospective studies were 21.9% (postoperative Pancreatic fistula, n = 11,244 patients), 5.9% (postpancreatectomy hemorrhage, n = 3,311 patients), and 22.8% (delayed gastric emptying, n = 4,553 patients) after Pancreatic resections. The incidences were not substantially different in prospective trials. Validation was performed for all three definitions, demonstrating that the severity grades significantly correlated with the clinical course of the patients. Conclusion The available consensus definitions were increasingly cited and facilitate scientific comparability and transparency if appropriately applied. The present data update the incidences of major Pancreatic complications.
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critical appraisal of the international study group of Pancreatic Surgery isgps consensus definition of postoperative hemorrhage after pancreatoduodenectomy
Langenbeck's Archives of Surgery, 2011Co-Authors: T Welsch, Ulf Hinz, M W Buchler, Hanna Eisele, Stefanie Zschabitz, Moritz N WenteAbstract:Purpose Postpancreatectomy hemorrhage (PPH) is one of the most serious complications after pancreatoduodenectomy (PD). This study analyzed and validated the International Study Group of Pancreatic Surgery (ISGPS) definition of PPH and aimed to identify risk factors for early (<24 h) and late PPH.
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enucleation in Pancreatic Surgery indications technique and outcome compared to standard Pancreatic resections
Langenbeck's Archives of Surgery, 2011Co-Authors: Thilo Hackert, Oliver Strobel, Ulf Hinz, Lutz Schneider, M W Buchler, Werner Hartwig, Stefan Fritz, Jens WernerAbstract:Pancreatic Surgery is a technically challenging intervention with high demands for preoperative diagnostics and perioperative management. A perioperative mortality rate below 5% is achieved in high-volume centers due to the high level of standardization in surgical procedures and perioperative care. Besides standard resections, certain indications may require individualized surgical concepts such as tumor enucleations. The aim of the study was to evaluate the indications, technique, and outcome of this limited local approach compared to major resections. Data from patients undergoing Pancreatic Surgery were prospectively recorded. All patients with tumor enucleations were compared with classical resections (Pancreaticoduodenectomy or left resection) in a matched-pair analysis (1:2). Tumor type, localization, operative parameters, complications, and outcome were evaluated. Fifty-three patients underwent Pancreatic tumor enucleation between October 2001 and December 2009. Indications included cystic lesions, IPMNs, and neuroendocrine Pancreatic tumors. Enucleations were associated with shorter operation time, less blood loss as well as shorter ICU and hospital stay compared to Pancreaticoduodenectomy and left resections. The overall surgical morbidity of enucleations was 28.3% without major complications. Leading clinical problems were ISGPF type A fistulas (20.8%) requiring prolonged primary drainage. No surgical revisions were necessary, and no deaths occurred. Pancreatic tumor enucleations can be carried out with good results and no mortality. Decisions regarding enucleations are highly individual compared to standard resections, underlining the importance of treatment in experienced high-volume institutions. Enucleations should be carried out whenever possible and oncologically feasible to prevent the typical complications of major Pancreatic resection.
Edmee C M Sikkens - One of the best experts on this subject based on the ideXlab platform.
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the daily practice of Pancreatic enzyme replacement therapy after Pancreatic Surgery a northern european survey enzyme replacement after Surgery
Journal of Gastrointestinal Surgery, 2012Co-Authors: Edmee C M Sikkens, Casper H J Van Eijck, Djuna L Cahen, Ernst J Kuipers, Marco J BrunoAbstract:After Pancreatic Surgery, up to 80 % of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of Pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme replacement therapy after Surgery are lacking, and therefore, we conducted this analysis. An anonymous survey was distributed to members of the Dutch and German patient associations for Pancreatic disorders. The target population consisted of patients with chronic pancreatitis or Pancreatic cancer who had undergone Pancreatic Surgery and were using enzymes to treat exocrine insufficiency. Results were compared to a similar group of non-operated patients. Ninety-one cases were analyzed (84 % underwent a resection procedure). The median daily enzyme dose was 6, and 25 % took three or less capsules. Despite treatment, 68 % of patients reported steatorrhea-related symptoms, 48 % adhered to a non-indicated dietary fat restriction, and only 33 % had visited a dietician. The outcome was equally poor for the 91 non-operated patients. Most patients suffering from exocrine insufficiency after Pancreatic Surgery are undertreated. To improve efficacy, physicians should be more focused on treating exocrine insufficiency and educate patients to adjust the dose according to symptoms and their diet.
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the daily practice of Pancreatic enzyme replacement therapy after Pancreatic Surgery a northern european survey enzyme replacement after Surgery
Journal of Gastrointestinal Surgery, 2012Co-Authors: Edmee C M Sikkens, Casper H J Van Eijck, Djuna L Cahen, Ernst J Kuipers, Marco J BrunoAbstract:Introduction After Pancreatic Surgery, up to 80 % of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of Pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme replacement therapy after Surgery are lacking, and therefore, we conducted this analysis.
