The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Paul J Karanicolas - One of the best experts on this subject based on the ideXlab platform.
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the pylorus take it or leave it systematic review and meta analysis of pylorus preserving versus standard whipple pancreaticoduodenectomy for pancreatic or Periampullary Cancer
Annals of Surgical Oncology, 2007Co-Authors: Paul J Karanicolas, Edward Davies, Regina Kunz, Matthias Briel, Pavan H Koka, Darrin M Payne, Shona E SmithAbstract:Background Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or Periampullary Cancer.
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the pylorus take it or leave it systematic review and meta analysis of pylorus preserving versus standard whipple pancreaticoduodenectomy for pancreatic or Periampullary Cancer
Annals of Surgical Oncology, 2007Co-Authors: Paul J Karanicolas, Edward Davies, Regina Kunz, Matthias Briel, Pavan H Koka, Darrin PayneAbstract:Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or Periampullary Cancer. We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95% confidence interval [95% CI], 53–92), with 284 mL less blood loss (P < .001, 95% CI, 176–391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25–1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.
Casper H J Van Eijck - One of the best experts on this subject based on the ideXlab platform.
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preoperative serum adam12 levels as a stromal marker for overall survival and benefit of adjuvant therapy in patients with resected pancreatic and Periampullary Cancer
Hpb, 2021Co-Authors: Marin Strijker, Casper H J Van Eijck, Olivier R Busch, Bert A Bonsing, Mustafa Suker, Fleur Van Der Sijde, Marja A Boermeester, Marco J Bruno, Michail Doukas, Arja GerritsenAbstract:Abstract Background We evaluated the stroma marker A Disintegrin And Metalloprotease 12 (ADAM12) as a preoperative prognostic and treatment-predictive marker for overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC) and Periampullary Cancers. Methods Materials were derived from the prospective nationwide Dutch Pancreas Biobank (2015–2017). We included patients who underwent resection because of PDAC/Periampullary Cancer or non-invasive IPMN (control group) and had a preoperative serum sample available. ADAM12 levels were dichotomized using a pre-defined cut-off (316 pg/mL). Univariable and multivariable Cox regression analyses (backward selection) were performed. Results Median ADAM12 levels were 161 (IQR 79–352) pg/mL in 215 PDAC and Periampullary adenocarcinomas. High ADAM12 levels (>316 pg/mL) predicted poor OS in the total group of pancreatic and Periampullary adenocarcinomas (P = 0.04), but not after adjustment. In distal cholangiocarcinoma (n = 33), high ADAM12 levels predicted poor OS in univariable analysis (P = 0.02), but not in PDAC (P = 0.63). PDAC patients (n = 135) with high ADAM12 levels benefited from adjuvant treatment (median OS 27 vs 14 months, P = 0.02), whereas those with low levels did not (21 vs 21 months, P = 0.87). Conclusion High circulating ADAM12 levels, as a proxy for activated stroma, predict survival benefit from adjuvant chemotherapy in PDAC, requiring validation in future studies.
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prognostic value of lymph node metastases detected during surgical exploration for pancreatic or Periampullary Cancer a systematic review and meta analysis
Hpb, 2016Co-Authors: Lennart B Van Rijssen, Poorvi Narwade, Nadine C M Van Huijgevoort, Dorine Tseng, Hjalmar C Van Santvoort, Isaac Q Molenaar, Hanneke W M Van Laarhoven, Casper H J Van Eijck, Olivier R Busch, Marc G. BesselinkAbstract:Background Hepatic-artery and para-aortic lymph node metastases (LNM) may be detected during surgical exploration for pancreatic (PDAC) or Periampullary Cancer. Some surgeons will continue the resection while others abort the exploration.
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pancreatic exocrine insufficiency in patients with pancreatic or Periampullary Cancer a systematic review
Pancreas, 2016Co-Authors: Dorine S J Tseng, Marc G. Besselink, Casper H J Van Eijck, Quintus I Molenaar, Inne Borel H M Rinkes, Hjalmar C Van SantvoortAbstract:ObjectivesThe aim of this study was to determine the prevalence of pancreatic exocrine insufficiency in patients with pancreatic or Periampullary Cancer, both before and after resection.MethodsSystematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIS
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liver contrast enhanced ultrasound improves detection of liver metastases in patients with pancreatic or Periampullary Cancer
Ultrasound in Medicine and Biology, 2015Co-Authors: Pavel Taimr, Vivian L Jongerius, Chulja J Pek, Nanda C Krak, Bettina E Hansen, Harry L A Janssen, Herold J Metselaar, Casper H J Van EijckAbstract:The aim of this study is to provide a diagnostic performance evaluation of contrast-enhanced ultrasonography (CEUS) in detecting liver metastases in patients with suspected of pancreatic or Periampullary Cancer. Computed tomography (CT) is often insufficient for detection of liver metastases, but their presence plays a crucial role in the choice of therapy. Eighty-nine patients with suspected pancreatic or Periampullary Cancer were included in this prospective study with retrospective analysis. Patients underwent an abdominal CT and CEUS. Fifteen patients had liver metastases. The CT sensitivity was 73.3% (11/15), the specificity 93.2% (69/74), the positive predictive value (PPV) 68.8% (11/16) and the negative predictive value (NPV) 94.6% (69/73). Based on CEUS, the sensitivity was 80% (12/15), specificity 98.6% (73/74), PPV 92.3% (12/13) and NPV 96.1% (73/76). CEUS improved characterization of liver lesions in patients with suspected pancreatic or Periampullary Cancer compared with CT. CEUS can better detect benign liver lesions and distinguish false-positive or indeterminate CT results.
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bcl 2 associated anthanogen 1 bag 1 expression and prognostic value in pancreatic head and Periampullary Cancer
European Journal of Cancer, 2013Co-Authors: Jill A Van Der Zee, Timo Ten L M Hagen, Wim C J Hop, Herman Van Dekken, Bilyana M Dicheva, Ann L B Seynhaeve, Gerben A Koning, Alexander M M Eggermont, Casper H J Van EijckAbstract:The expression of anti-apoptosis gene Bcl-2 associated anthanogen-1 (Bag-1), has been associated with outcome in several Cancer types, however its prognostic role in pancreatic Cancer is unknown. Aim was therefore to evaluate expression of Bag-1 in two anatomically closely related however prognostically different tumours, pancreatic head- and Periampullary Cancer and correlate expression with outcome. Bag-1 protein expression was studied by immunohistochemistry on original paraffin embedded tissue from 217 patients with microscopic radical resection (R0) of adenocarcinoma of the pancreatic head or Periampullary region. Expression was assessed for associations with recurrence free- (RFS), Cancer specific- (CSS), overall survival (OS) and conventional prognostic factors. Nuclear Bag-1 was present in 80% of tumours. In 40% Bag-1 resided in the cytosol, which was almost exclusively associated with nuclear expression. Nuclear Bag-1 protein was identified as an independent factor predicting a favourable outcome following radical resection of pancreatic head Cancer. Eighteen percent of patients with nuclear Bag-1 were recurrence free and alive 5 years following surgery compared to none of the patients lacking expression. In Periampullary Cancer Bag-1 was not associated with outcome. In conclusion, Bag-1 was present in the majority of both pancreatic head- and Periampullary Cancers. However it was only identified as a discriminator of outcome in pancreatic head Cancer.
Brian R. Davidson - One of the best experts on this subject based on the ideXlab platform.
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diagnostic accuracy of laparoscopy following computed tomography ct scanning for assessing the resectability with curative intent in pancreatic and Periampullary Cancer
Cochrane Database of Systematic Reviews, 2016Co-Authors: Victoria B Allen, Kurinchi Selvan Gurusamy, Yemisi Takwoingi, Amun Kalia, Brian R. DavidsonAbstract:Background Surgical resection is the only potentially curative treatment for pancreatic and Periampullary Cancer. A considerable proportion of patients undergo unnecessary laparotomy because of underestimation of the extent of the Cancer on computed tomography (CT) scanning. Laparoscopy can detect metastases not visualised on CT scanning, enabling better assessment of the spread of Cancer (staging of Cancer). This is an update to a previous Cochrane Review published in 2013 evaluating the role of diagnostic laparoscopy in assessing the resectability with curative intent in people with pancreatic and Periampullary Cancer. Objectives To determine the diagnostic accuracy of diagnostic laparoscopy performed as an add-on test to CT scanning in the assessment of curative resectability in pancreatic and Periampullary Cancer. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, EMBASE via OvidSP (from inception to 15 May 2016), and Science Citation Index Expanded (from 1980 to 15 May 2016). Selection criteria We included diagnostic accuracy studies of diagnostic laparoscopy in people with potentially resectable pancreatic and Periampullary Cancer on CT scan, where confirmation of liver or peritoneal involvement was by histopathological examination of suspicious (liver or peritoneal) lesions obtained at diagnostic laparoscopy or laparotomy. We accepted any criteria of resectability used in the studies. We included studies irrespective of language, publication status, or study design (prospective or retrospective). We excluded case-control studies. Data collection and analysis Two review authors independently performed data extraction and quality assessment using the QUADAS-2 tool. The specificity of diagnostic laparoscopy in all studies was 1 because there were no false positives since laparoscopy and the reference standard are one and the same if histological examination after diagnostic laparoscopy is positive. The sensitivities were therefore meta-analysed using a univariate random-effects logistic regression model. The probability of unresectability in people who had a negative laparoscopy (post-test probability for people with a negative test result) was calculated using the median probability of unresectability (pre-test probability) from the included studies, and the negative likelihood ratio derived from the model (specificity of 1 assumed). The difference between the pre-test and post-test probabilities gave the overall added value of diagnostic laparoscopy compared to the standard practice of CT scan staging alone. Main results We included 16 studies with a total of 1146 participants in the meta-analysis. Only one study including 52 participants had a low risk of bias and low applicability concern in the patient selection domain. The median pre-test probability of unresectable disease after CT scanning across studies was 41.4% (that is 41 out of 100 participants who had resectable Cancer after CT scan were found to have unresectable disease on laparotomy). The summary sensitivity of diagnostic laparoscopy was 64.4% (95% confidence interval (CI) 50.1% to 76.6%). Assuming a pre-test probability of 41.4%, the post-test probability of unresectable disease for participants with a negative test result was 0.20 (95% CI 0.15 to 0.27). This indicates that if a person is said to have resectable disease after diagnostic laparoscopy and CT scan, there is a 20% probability that their Cancer will be unresectable compared to a 41% probability for those receiving CT alone. A subgroup analysis of people with pancreatic Cancer gave a summary sensitivity of 67.9% (95% CI 41.1% to 86.5%). The post-test probability of unresectable disease after being considered resectable on both CT and diagnostic laparoscopy was 18% compared to 40.0% for those receiving CT alone. Authors' conclusions Diagnostic laparoscopy may decrease the rate of unnecessary laparotomy in people with pancreatic and Periampullary Cancer found to have resectable disease on CT scan. On average, using diagnostic laparoscopy with biopsy and histopathological confirmation of suspicious lesions prior to laparotomy would avoid 21 unnecessary laparotomies in 100 people in whom resection of Cancer with curative intent is planned.
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cost effectiveness of diagnostic laparoscopy for assessing resectability in pancreatic and Periampullary Cancer
BMC Gastroenterology, 2015Co-Authors: Stephen Morris, Kurinchi Selvan Gurusamy, Jessica Sheringham, Brian R. DavidsonAbstract:Surgical resection is the only curative treatment for pancreatic and Periampullary Cancer, but many patients undergo unnecessary laparotomy because tumours can be understaged by computerised tomography (CT). A recent Cochrane review found diagnostic laparoscopy can decrease unnecessary laparotomy. We compared the cost-effectiveness of diagnostic laparoscopy prior to laparotomy versus direct laparotomy in patients with pancreatic and Periampullary Cancer with resectable disease based on CT scanning.
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cost effectiveness of preoperative biliary drainage for obstructive jaundice in pancreatic and Periampullary Cancer
Journal of Surgical Research, 2015Co-Authors: Stephen Morris, Kurinchi Selvan Gurusamy, Jessica Sheringham, Brian R. DavidsonAbstract:Background A recent Cochrane Review found that preoperative biliary drainage (PBD) in patients with resectable pancreatic and Periampullary Cancer undergoing surgery for obstructive jaundice is associated with similar mortality but increased serious morbidity compared with no PBD. Despite this clinical evidence of its lack of effectiveness, PBD is still in use. We considered the economic implications of PBD versus direct surgery for obstructive jaundice in patients with pancreatic and Periampullary Cancer.
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prophylactic gastrojejunostomy for unresectable Periampullary carcinoma
Cochrane Database of Systematic Reviews, 2013Co-Authors: Kurinchi Selvan Gurusamy, Senthil Kumar, Brian R. DavidsonAbstract:Background The role of prophylactic gastrojejunostomy in patients with unresectable Periampullary Cancer is controversial. Objectives To determine whether prophylactic gastrojejunostomy should be performed routinely in patients with unresectable Periampullary Cancer. Search methods For the initial version of this review, we searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, issue 3), MEDLINE, EMBASE and Science Citation Index Expanded until April 2010. Literature searches were re-run in August 2012. Selection criteria We included randomised controlled trials comparing prophylactic gastrojejunostomy versus no gastrojejunostomy in patients with unresectable Periampullary Cancer (irrespective of language or publication status). Data collection and analysis Two review authors independently assessed trials for inclusion and independently extracted data. We analysed data with both the fixed-effect and the random-effects models using Review Manager (RevMan). We calculated the hazard ratio (HR), risk ratio (RR), and mean difference (MD) with 95% confidence intervals (CI) based on an intention-to-treat or available case analysis. Main results We identified two trials (of high risk of bias) involving 152 patients randomised to gastrojejunostomy (80 patients) and no gastrojejunostomy (72 patients). In both trials, patients were found to be unresectable during exploratory laparotomy. Most of the patients also underwent biliary-enteric drainage. There was no evidence of difference in the overall survival (HR 1.02; 95% CI 0.84 to 1.25), peri-operative mortality or morbidity, quality of life, or hospital stay (MD 0.97 days; 95%CI -0.18 to 2.12) between the two groups. The proportion of patients who developed long-term gastric outlet obstruction was significantly lower in the prophylactic gastrojejunostomy group (2/80; 2.5%) compared with no gastrojejunostomy group (20/72; 27.8%) (RR 0.10; 95%CI 0.03 to 0.37). The operating time was significantly longer in the gastrojejunostomy group compared with no gastrojejunostomy group (MD 45.00 minutes; 95%CI 21.39 to 68.61). Authors' conclusions Routine prophylactic gastrojejunostomy is indicated in patients with unresectable Periampullary Cancer undergoing exploratory laparotomy (with or without hepaticojejunostomy).
Pavan H Koka - One of the best experts on this subject based on the ideXlab platform.
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the pylorus take it or leave it systematic review and meta analysis of pylorus preserving versus standard whipple pancreaticoduodenectomy for pancreatic or Periampullary Cancer
Annals of Surgical Oncology, 2007Co-Authors: Paul J Karanicolas, Edward Davies, Regina Kunz, Matthias Briel, Pavan H Koka, Darrin M Payne, Shona E SmithAbstract:Background Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or Periampullary Cancer.
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the pylorus take it or leave it systematic review and meta analysis of pylorus preserving versus standard whipple pancreaticoduodenectomy for pancreatic or Periampullary Cancer
Annals of Surgical Oncology, 2007Co-Authors: Paul J Karanicolas, Edward Davies, Regina Kunz, Matthias Briel, Pavan H Koka, Darrin PayneAbstract:Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or Periampullary Cancer. We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95% confidence interval [95% CI], 53–92), with 284 mL less blood loss (P < .001, 95% CI, 176–391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25–1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.
Darrin Payne - One of the best experts on this subject based on the ideXlab platform.
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the pylorus take it or leave it systematic review and meta analysis of pylorus preserving versus standard whipple pancreaticoduodenectomy for pancreatic or Periampullary Cancer
Annals of Surgical Oncology, 2007Co-Authors: Paul J Karanicolas, Edward Davies, Regina Kunz, Matthias Briel, Pavan H Koka, Darrin PayneAbstract:Our objective was to determine the relative effects of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard Whipple pancreaticoduodenectomy (SWPD) in patients with pancreatic or Periampullary Cancer. We searched seven bibliographic databases, conference proceedings, and reference lists of articles and textbooks, and we contacted experts in the field of hepatobiliary surgery. We included published and unpublished randomized controlled trials. We evaluated the methodological quality of trials and, in duplicate, extracted data regarding operative, perioperative, and long-term outcomes. We contacted all authors and asked them to provide additional information regarding the trials. We pooled results from the studies by using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity. Six trials that included a total of 574 patients met eligibility criteria. In the pooled analysis, PPPD was 72 minutes faster (P < .001, 95% confidence interval [95% CI], 53–92), with 284 mL less blood loss (P < .001, 95% CI, 176–391) and .66 fewer units of blood transfused (P = .002, 95% CI, .25–1.16). Other perioperative and long-term outcomes did not statistically differ, although the confidence intervals include important differences. Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD. Large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.