Chiara Scandavini - Academia.edu (original) (raw)

Papers by Chiara Scandavini

Ejso, Sep 1, 2013

lymphatic-venous anastomoses are fashioned with tributary veins of the axillary vein, and/or the ... more lymphatic-venous anastomoses are fashioned with tributary veins of the axillary vein, and/or the internal saphena vein, depending on the area involved by the lymphadenectomy. Our Centre in Genoa has a significant case history in both primary and secondary prevention. In the cases treated so far, the application of this prevention protocol has practically cancelled all risks of lymphatic lesions. A prospective randomized case-control study was also designed, to prove the efficacy of our procedure. The clinical outcome of patients treated with lymphadenectomy alone has been compared with those treated with lymphadenectomy plus microsurgical prevention. In any case, a careful preoperative assessment of every lymphadenectomy candidate is key to assess the risk of lymphatic complications.

Annals of pancreatic cancer, Apr 1, 2018

Background: Pancreatectomy plus arterial resection (PAR) for locally advanced pancreatic ductal a... more Background: Pancreatectomy plus arterial resection (PAR) for locally advanced pancreatic ductal adenocarcinoma (PDAC) (LAPC) might potentially offer additional therapeutic option and a better prognosis in patients traditionally addressed to palliation. Being a technically high skill demanding surgery, has been postulated that it could be hampered by higher rates of morbidity and mortality. Anyway few, small studies have specifically investigated its feasibility and data on short and long-term outcomes currently lack. To analyze complications and outcomes of patients underwent PAR. Methods: Retrospective analysis of prospectively collected cohort of operated LAPC patients. Short and long term outcome were analyzed and compared in Group 1 (PAR) and Group 2 (palliative surgery). Results: Seventy-three patients (T4M0) underwent surgical exploration with intent of resection, 46.6% (Group 1), 53.4% (Group 2). No differences were found for neo/ adjuvant chemotherapy. Twenty-three patients (67.7%) in Group 1 received a combined artery-vein resection (AVR). Operation time and blood loss were superior in Group 1 compared to Group 2, respectively (425.7±14.3 vs. 171.4±10.67 minutes, P<0.0001) and (613.2±71.69 vs. 188.3±20.64 mL, P<0.0001) while no differences were found in post-operative mortality (2.9% vs. 2.6%, P=0.9) and post-operative surgical complications (38.2% vs. 25.6%, P=0.2). The 1, 3 and 5 years survival in Group 1 was superior to Group 2 (63.7%, 23.4% and 23.4% vs. 41.7%, 3.2% and 0%, P=0.003). Conclusions: PAR seems to be safe and feasible in well selected patients and associated with an advantage of survival compared to palliations, in patients affected by LAPC.

Pancreatology, Jun 1, 2019

Pancreatology, Nov 1, 2020

Excessive fore-aft vibrations of wind turbine tower are the major reason for tower collapsing, wh... more Excessive fore-aft vibrations of wind turbine tower are the major reason for tower collapsing, which can be evaluated using the equivalent fatigue load (EFL). Wake effects are generated by the former wind turbines on the latter ones, and can greatly increase EFL and reduce lifetime of the latter ones, but they were seldom considered. Consequently, this study calculated EFL countering the wake effects under real wind distributions. The effects of wind turbine spacing on EFL indicate that the wake effects between wind turbines with spacing of approximately 2 times of rotor radius should be considered. Subsequently, tuned mass damper (TMD) was placed in the nacelle to passively control the fore-aft vibrations. An optimization tool for TMDs was developed based on the radial basis function neural network and genetic algorithm, which was compared with the theoretical equations and parametric analysis. GPU acceleration technology was utilized. Numerical results show that, under real wind distributions, the TMDs obtain at least 40.1% EFL reduction, which is 8.9% higher than the theoretically optimized one. Importantly, the GPU-based codes can run 2001 times faster than the CPU-based ones, and the optimization tool can reduce 44.9% computational time further. The codes are made available for other researchers.

Annals of pancreatic cancer, Apr 1, 2018

Pancreatology, Jul 1, 2017

from a focal form. Synchronous occurrence of PDAC and AIP was reported in 11 patients, metachrono... more from a focal form. Synchronous occurrence of PDAC and AIP was reported in 11 patients, metachronous in 22 patients. In the metachronous group, the median time between diagnoses was 66.5 months (2-186). In twothirds of the patients PDAC was diagnosed after the 3rd year of follow-up. In most patients (70%) cancer arose in the part of the pancreas affected by AIP. Survival of patients is known in 11 cases with a median of 15 months (1-51). Conclusion: Numerous cases of PDAC in AIP patients are reported in the literature. PDAC is more frequent in Type 1 patients, more often metachronous and arising in the part of the pancreas affected by AIP.

Pancreatology, Jul 1, 2017

resection for MD-involving IPMN. 10 patients (45.45%) displayed endoscopic characteristics consis... more resection for MD-involving IPMN. 10 patients (45.45%) displayed endoscopic characteristics consistent with the presence of IPMN. 100% of cases were confirmed at definitive histology to have high grade dysplasia-cancer. 12 patients (54.54%) displayed negative endoscopic finding. Among those, definitive histology confirmed the absence of high grade dysplasiacancer in 7 (58.33%). The overall sensitivity was therefore 66.67% (33.38-88.18%), specificity 100% (59.04-100%). PPV was 100% (69.15-100%) and NPV was 58.33 (27.67-84.83%). Pathological vessels were more prevalent in high grade dysplasiaecancer patients (53.33% vs 0% p¼0.02) as well as intraductal esophitic growth (60% vs 14.28% p¼0.07). Conclusion: Intraoperative pancreatos-copy is a promising procedure to guide the extension of the surgical margins and therefore improve radicality during surgery for pancreatic MD-involving IPMN.

Annals of Surgery, Nov 9, 2020

OBJECTIVE To assess outcomes among patients undergoing total pancreatectomy (TP) including predic... more OBJECTIVE To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. BACKGROUND Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. METHODS This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cut-off values for annual volume of pancreatoduodenectomies (<60 vs. ≥60). Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. RESULTS In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared < 60 (4% vs. 10%, p = 0.046). In multivariable analysis, annual volume < 60 pancreatoduodenectomies (OR 3.78, 95%CI 1.18-12.16, p = 0.026), age (OR 1.07, 95%CI 1.01-1.14, p = 0.046), and estimated blood loss ≥2L (OR 11.89, 95%CI 2.64-53.61, p = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95%CI 1.56-5.26, p = 0.001) and estimated blood loss ≥2L (OR 3.52, 95%CI 1.25-9.90, p = 0.017) were associated with major complications. CONCLUSION This pan-European prospective snapshot study found a 5% in-hospital after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.

Journal of Gastrointestinal Surgery, Sep 30, 2015

Pancreatectomy associated with superior mesenteric-portal vein (SMPV) resection is currently cons... more Pancreatectomy associated with superior mesenteric-portal vein (SMPV) resection is currently considered the standard of care for patients with pancreatic tumors involving the major peripancreatic veins. However, a standard approach for resection and reconstruction is not defined yet. The aim of this study is to analyze the feasibility and short-term results of an original Cattell-Braasch artery-first approach (CBAF) for the resection of SMPV during pancreatectomy. Of 144 pancreatectomies with vascular resection undertaken from 2008 to 2013 at Karolinska University Hospital, 45 (31.2 %) were performed combining a Cattell-Braasch maneuver with an artery-first approach (from 2011 to 2013). The mean patient age was 65.2 years. Thirty-seven (82.2 %) patients underwent pancreatoduodenectomy and 8 (17.8 %) total pancreatectomy. Histology showed pancreatic ductal adenocarcinoma in 42 patients (93.3 %). The median length of the resected SMPV segment was 4.6 cm (range 3-7). In all patients, a direct end-to-end anastomosis was performed without graft interposition. In nine cases (20 %), an arterial resection was also performed. There was no mortality in this series, and the morbidity rate was 35.5 %. Combined CBAF for the resection of SMPV during pancreatectomy seems to be safe and effective. The reconstruction of the resected vessels is possible in many cases without graft interposition, even if the resected vein segment is of considerable length.

Pancreatology, Jul 1, 2017

Introduction: Regional lymph node involvement is already a recognized prognostic factor in surgic... more Introduction: Regional lymph node involvement is already a recognized prognostic factor in surgically resected IPMN cancer but few data are available about the significance of non-regional lymph node involvement. Aims: To evaluate the clinical significance of lymph node involvement in surgically resected IPMN cancer and in particular of para-aortic lymph nodes. Patients & methods: Retrospective cohort analysis of a prospectively maintained database of operated patients with IPMN cancer. All the diagnosis were histologically confirmed.. Patient's characteristics, type of operation, pathology report and survival were collected. Survival was analyzed by Kaplan Meier method. Results: 52 patients, 26 males (50%), mean age 70 years (range 48 e 84 years) underwent resection at Karolinska University Hospital. 24 patients (46.1%) underwent pancreaticoduodenectomy, 18 (34.6%) distal pancreatectomy and 10 (19.3%) total pancreatectomy. 14 patients (26.9%) underwent vascular resection. No peri-operative mortality was reported. 18 patients (34.6%) had no lymph node involvement, 28 (53.8%) local but no distant lymph-nodes metastases and 6 (11.6%) had para-aortic lymph node metastases. The 1, 3 and 5 years actuarial rate of survival was significantly decreasing from patients without lymph node involvements, through the ones with loco-regional involvement to the ones with para-aortic lymphnodes involvement (76.4%, 61.2% and 61.2% vs 92.6%, 49.4% and 29.7% vs 33.3%, 16.7% and 16.7% respectively; p¼0.0001). Conclusion: Regional and particularly para-aortic lymph node metastases impact survival. The latter, as for pancreas cancer, might also represent a sign of metastatic disease.

Scandinavian Journal of Surgery, Mar 1, 2020

DeFInITIOn AnD epIDemIOlOgy Chronic pancreatitis is a long-standing, inflammatory condition of th... more DeFInITIOn AnD epIDemIOlOgy Chronic pancreatitis is a long-standing, inflammatory condition of the pancreas triggered by different endogenous or exogenous factors, that leads to the progressive damage of pancreatic parenchyma, to the loss of acinar and islet components, to the development of scar tissue, and eventually to endocrine and/or exocrine pancreatic insufficiency. Once the process is triggered it cannot be reversed, although clinical and endoscopic management can modulate its evolution over time (1). The disease itself often encompasses systemic involvement and might be accompanied by the Conservative treatment of ChroniC PanCreatitis: a PraCtiCal aPProaCh r. valente 1,2 , a. Waldthaler 3 , C. m. scandavini 1 , m. vujasinovic 2,3 , m. Del Chiaro 4 , U. arnelo 2 , J.-m. löhr 1,2

Anz Journal of Surgery, Aug 27, 2018

Background: The increasing age of the population and prolonged life expectancy result in a wideni... more Background: The increasing age of the population and prolonged life expectancy result in a widening of age limit criteria for a variety of surgical procedures. Oesophagectomy and total gastrectomy are complex operations associated with significant risks of post-operative complications. Methods: This is a single-centre cohort study of patients operated with curative intent due to oesophageal or gastric cancer. Results: From 2007 to 2017, 548 patients underwent surgery with curative intent, with 122 patients (22.3%) classified as elderly (≥75 years). There was no difference in total complication rates between the groups. The adjusted odds ratio for 90-day mortality after oesophageal resection in the elderly group was 3.65 (95% confidence interval (CI): 1.33-10.03) and after gastrectomy was 1.62 (95% CI: 0.55-4.79). The adjusted hazard ratio for 1-year mortality after oesophagectomy was 2.29 (95% CI: 1.25-4.19), and after gastrectomy the adjusted hazard ratio was 1.48 (95% CI: 0.75-2.92). In the event of a complication with Clavien-Dindo score IIIb or higher, there was a statistically significant increase of 90-day mortality to over 50% among elderly patients both after oesophagectomy and gastrectomy (50.0% versus 19.8%; P = 0.005 and 57.1% versus 17.4%; P = 0.012, respectively). Conclusion: There is a statistically significant increase in 90-day mortality after oesophageal and gastric cancer surgery in elderly compared with younger patients. Post-operative complications with high Clavien-Dindo score in patients undergoing oesophagectomy or gastrectomy, with age ≥75 years, are a dramatic risk factor for post-operative death.

Journal of Pediatric Surgery, Sep 1, 2017

Children Esophageal replacement Long-term follow up Quality of life Dysphagia Reflux Background: ... more Children Esophageal replacement Long-term follow up Quality of life Dysphagia Reflux Background: The indications of esophageal replacement (ER) in pediatric patients include long gap esophageal atresia (LGEA), intractable post-corrosive esophageal strictures (PCES), and some rare esophageal diseases. Various conduits and procedures are currently used worldwide with a lack of consensus regarding the ideal substitute to replace the esophagus replacement. The short-term outcomes of these advanced procedures are well known; there are few data available describing long-term functional outcomes of these patients with long life expectancy. Objectives: The objective of this study is to investigate the long-term functional outcomes of the most widely used techniques for ER in pediatric patients based on a comprehensive literature search covering the last 10 years. Methods: Eligible were all clinical studies reporting outcomes after esophagectomy in pediatric patients, which contained information on at least 3 years of follow-up after the operation. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic web-based search using MEDLINE, the Cochrane Library and EMBASE databases was performed, reviewing all medical literature published between January 2006 and December 2015. Results: The scientific quality of the data was generally poor, converging toward only 14 full-text articles for the final analysis. The stomach was the preferred organ for esophageal replacement, where the tubulization of the stomach resulted in significant gastroesophageal reflux. Dysphagia symptoms were more seldom reported, but several authors presented growing figures with the length of follow-up. Dumping syndrome and delayed gastric emptying were only scarcely reported upon. Following colonic graft, chronic gastrocolic reflux affects these patients, in the range of 35-70.8%, while 4 studies reported any dysphagia from 2.7% to 50% of the children. Only one study reported the outcome of the use of a long jejunal segment, where presence of symptoms of functional obstruction was mentioned in 46% of cases. Very few if any data were available on a structured assessment of postprandial dumping and disturbed bowel functions. Conclusions: Available data in pediatric patients, on the long-term functional outcomes after esophageal replacement with a gastric tube, colonic graft or a long jejunal segment, are of poor scientific quality. Although symptoms are frequently reported currently no conclusions can be drawn regarding potential advantages of one graft over another.

Pancreatology, Jun 1, 2023

Annals of pancreatic cancer, Apr 1, 2018

Pancreatology, Jul 1, 2017

Introduction: The absence of univocal definition of main pancreatic duct (MPD) involvement implie... more Introduction: The absence of univocal definition of main pancreatic duct (MPD) involvement implies different cutoff in different guidelines. The role of preoperative Ca19.9 measurement still has to be fully clarified. Aim: To correlate preoperative MPD-dilation and elevated Ca19.9 with the presence of advanced finding on the final histological report. Method: Retrospective cohort analysis of histologically confirmed IPMN-patients. Subclass analysis, according to degree of MPD-dilation and Ca19.9 elevation(>37u/ml), was performed in relation with the presence of HGD/cancer. Results: From 2008 to 2015 152 patients were operated for IPMN. Patients with MPD-diameter 6-9.9mm and above 10mm had a major prevalence of HGD/cancer compared to MPD-diameter <6mm (respectively 40.00% vs 19.44% p¼0.006 and 27.50% vs 12.50% p¼0.02). At univariate analysis, both MPD 6-9.9mm and >10mm were consistent with an increased risk of HGD/cancer (respectively OR 2.92, CI 1.38-6.20, p¼0.005 and OR 2.65, CI 1.12-6.25 P¼0.02). Patients with higher Ca19.9 also displayed a statistically significant higher prevalence of HGD/cancer compared to LGD/MGD (47.94% vs 17.64%, p¼0.0001). At univariable analysis, Ca19.9 was consistent with higher risk of HGD/cancer (OR 4.15 CI 1.90-9.05 p¼0.0003). At sex and age adjusted multivariable logistic regression analysis, both MPD 6-9.9 mm and MPD >10 mm (respectively OR 2.47

Pancreatology, Jun 1, 2015

This year, we plan to address the direction of future studies based on the results of the critica... more This year, we plan to address the direction of future studies based on the results of the critical reviews. Materials & methods: Clinical questions (CGs) of interest were proposed by the panel. The recommendations for the CQs in representative seven guidelines were compared. The presence or absence of evidence on which these recommendations were based was evaluated. Results: Among 37 CQs, there were only five CQs where agreement based on sufficient evidence was achieved: the use of CT and MRI for diagnosis, the definition of resectable pancreatic cancer, first line chemotherapy for metastatic disease, the role of celiac neurolysis and the reporting of lymph node metastases. There was agreement in other four CQs despite the lack of sufficient evidence: optimal combination of imaging studies for staging, the role of EUS and FNA, the use of radiotherapy to imrpove quality of life and the role of pre-operative biliary drainage. In 25 CQs, there was disagreement. Conclusion: The lack of sufficient evidence is one of the resons for the disagreement among the existing guidelines. In order to create strong evidence, especially in areas where there is disagreement among the guidelines, and to create a global evidence-based consensus in future studies.

Pancreatology, Jun 1, 2015

s / Pancreatology 15 (2015) S1eS141 S94 Aims: The purpose of this study was to examine the preope... more s / Pancreatology 15 (2015) S1eS141 S94 Aims: The purpose of this study was to examine the preoperative patient and radiographic factors that are associated increased POPF rate after DP. Patientsm Ethiconâ“z) were investigated. Clinicopathologic data including POPF were prospectively collected. Pancreatic thickness and cross-sectional area of the pancreas stump were checked with 64 channel multi-detector CT and calculated using Rapidia 2.0 and Autocad 2014. Preoperative fatty infiltration of pancreas on MR was measured by a specialized radiologist. Results: Twenty patients (33.3%) had laparoscopic surgery. Clinicallyrelevant POPF by International Study Group of Pancreatic Fistula criteria occurred in 12 patients (20.0 %). Multivariate analysis revealed that the pancreatic thickness over than 17.6mm (odds ratio [OR] 6.69; P 1⁄4 0.029) and the extent of cross-sectional area over than 377 mm2 (OR 12.68; P 1⁄4 0.022) of pancreas stump were independent risk factors for clinicallyrelevant POPF. Pathologic diagnosis, the diameter of the pancreatic duct, pancreatic texture, and the degree of fatty infiltration on MR did not influence the incidence of POPF. Conclusion: Pancreatic thickness and cross-sectional area of pancreas transection surface are the significant independent risk factors for POPF development after DP. The appropriate modalities to reduce POPF are recommended in cases with thick pancreas.

Minerva gastroenterology, Feb 1, 2022

BACKGROUND Few studies compared lumen-apposing metal stents (LAMS) and standard double pigtail pl... more BACKGROUND Few studies compared lumen-apposing metal stents (LAMS) and standard double pigtail plastic stents (PS) for the endoscopic drainage of pancreatic walled-off necrosis (WON). Albeit sometimes large, previously described cohorts display considerable heterogeneity and often pooled together data from several centers, involving multiple operators and techniques. Moreover, they often lack a control group for the comparison of outcomes. AIM to compare clinical efficacy and safety of PS versus LAMS for the endoscopic drainage of infected WON. METHODS Single-centre, 1:1 case-control study. We compared patients undergoing endoscopic drainages of infected WON through LAMS (cases) or PS (controls). The primary endpoint was the clinical efficacy (resolution of the WON/sepsis), the secondary endpoint was safety (procedure-related complications). RESULTS Thirty patients were enrolled between 2011 and 2017. Cases and controls were homogeneous in terms of etiology and clinical characteristics. 93% of cases and 86.7% of controls were clinically successfully treated, with no significant differences in rates of post-operative infections, bleedings and stent migrations (respectively 13.3% vs 21.4%; p=0.65; 13.3% vs 0%; p=0.48; 13.3% vs 7.1%; p=1.00). No difference was shown regarding the need for additional percutaneous or surgical treatments (33.3% vs 13.3%; p=0.39). Cases, however, displayed a significantly prolonged mean hospital stay (90.2 days vs 18.5 days; p<0.01) and a higher mean number of endoscopic procedures per patient (4.8 vs 1.5; p<0.01). CONCLUSIONS PS might be not inferior to LAMS for the treatment WONs. Further prospective RCT is needed to compare clinical efficacy and safety in the two groups.

Ejso, Sep 1, 2013

lymphatic-venous anastomoses are fashioned with tributary veins of the axillary vein, and/or the ... more lymphatic-venous anastomoses are fashioned with tributary veins of the axillary vein, and/or the internal saphena vein, depending on the area involved by the lymphadenectomy. Our Centre in Genoa has a significant case history in both primary and secondary prevention. In the cases treated so far, the application of this prevention protocol has practically cancelled all risks of lymphatic lesions. A prospective randomized case-control study was also designed, to prove the efficacy of our procedure. The clinical outcome of patients treated with lymphadenectomy alone has been compared with those treated with lymphadenectomy plus microsurgical prevention. In any case, a careful preoperative assessment of every lymphadenectomy candidate is key to assess the risk of lymphatic complications.

Annals of pancreatic cancer, Apr 1, 2018

Background: Pancreatectomy plus arterial resection (PAR) for locally advanced pancreatic ductal a... more Background: Pancreatectomy plus arterial resection (PAR) for locally advanced pancreatic ductal adenocarcinoma (PDAC) (LAPC) might potentially offer additional therapeutic option and a better prognosis in patients traditionally addressed to palliation. Being a technically high skill demanding surgery, has been postulated that it could be hampered by higher rates of morbidity and mortality. Anyway few, small studies have specifically investigated its feasibility and data on short and long-term outcomes currently lack. To analyze complications and outcomes of patients underwent PAR. Methods: Retrospective analysis of prospectively collected cohort of operated LAPC patients. Short and long term outcome were analyzed and compared in Group 1 (PAR) and Group 2 (palliative surgery). Results: Seventy-three patients (T4M0) underwent surgical exploration with intent of resection, 46.6% (Group 1), 53.4% (Group 2). No differences were found for neo/ adjuvant chemotherapy. Twenty-three patients (67.7%) in Group 1 received a combined artery-vein resection (AVR). Operation time and blood loss were superior in Group 1 compared to Group 2, respectively (425.7±14.3 vs. 171.4±10.67 minutes, P<0.0001) and (613.2±71.69 vs. 188.3±20.64 mL, P<0.0001) while no differences were found in post-operative mortality (2.9% vs. 2.6%, P=0.9) and post-operative surgical complications (38.2% vs. 25.6%, P=0.2). The 1, 3 and 5 years survival in Group 1 was superior to Group 2 (63.7%, 23.4% and 23.4% vs. 41.7%, 3.2% and 0%, P=0.003). Conclusions: PAR seems to be safe and feasible in well selected patients and associated with an advantage of survival compared to palliations, in patients affected by LAPC.

Pancreatology, Jun 1, 2019

Pancreatology, Nov 1, 2020

Excessive fore-aft vibrations of wind turbine tower are the major reason for tower collapsing, wh... more Excessive fore-aft vibrations of wind turbine tower are the major reason for tower collapsing, which can be evaluated using the equivalent fatigue load (EFL). Wake effects are generated by the former wind turbines on the latter ones, and can greatly increase EFL and reduce lifetime of the latter ones, but they were seldom considered. Consequently, this study calculated EFL countering the wake effects under real wind distributions. The effects of wind turbine spacing on EFL indicate that the wake effects between wind turbines with spacing of approximately 2 times of rotor radius should be considered. Subsequently, tuned mass damper (TMD) was placed in the nacelle to passively control the fore-aft vibrations. An optimization tool for TMDs was developed based on the radial basis function neural network and genetic algorithm, which was compared with the theoretical equations and parametric analysis. GPU acceleration technology was utilized. Numerical results show that, under real wind distributions, the TMDs obtain at least 40.1% EFL reduction, which is 8.9% higher than the theoretically optimized one. Importantly, the GPU-based codes can run 2001 times faster than the CPU-based ones, and the optimization tool can reduce 44.9% computational time further. The codes are made available for other researchers.

Annals of pancreatic cancer, Apr 1, 2018

Pancreatology, Jul 1, 2017

from a focal form. Synchronous occurrence of PDAC and AIP was reported in 11 patients, metachrono... more from a focal form. Synchronous occurrence of PDAC and AIP was reported in 11 patients, metachronous in 22 patients. In the metachronous group, the median time between diagnoses was 66.5 months (2-186). In twothirds of the patients PDAC was diagnosed after the 3rd year of follow-up. In most patients (70%) cancer arose in the part of the pancreas affected by AIP. Survival of patients is known in 11 cases with a median of 15 months (1-51). Conclusion: Numerous cases of PDAC in AIP patients are reported in the literature. PDAC is more frequent in Type 1 patients, more often metachronous and arising in the part of the pancreas affected by AIP.

Pancreatology, Jul 1, 2017

resection for MD-involving IPMN. 10 patients (45.45%) displayed endoscopic characteristics consis... more resection for MD-involving IPMN. 10 patients (45.45%) displayed endoscopic characteristics consistent with the presence of IPMN. 100% of cases were confirmed at definitive histology to have high grade dysplasia-cancer. 12 patients (54.54%) displayed negative endoscopic finding. Among those, definitive histology confirmed the absence of high grade dysplasiacancer in 7 (58.33%). The overall sensitivity was therefore 66.67% (33.38-88.18%), specificity 100% (59.04-100%). PPV was 100% (69.15-100%) and NPV was 58.33 (27.67-84.83%). Pathological vessels were more prevalent in high grade dysplasiaecancer patients (53.33% vs 0% p¼0.02) as well as intraductal esophitic growth (60% vs 14.28% p¼0.07). Conclusion: Intraoperative pancreatos-copy is a promising procedure to guide the extension of the surgical margins and therefore improve radicality during surgery for pancreatic MD-involving IPMN.

Annals of Surgery, Nov 9, 2020

OBJECTIVE To assess outcomes among patients undergoing total pancreatectomy (TP) including predic... more OBJECTIVE To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. BACKGROUND Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. METHODS This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cut-off values for annual volume of pancreatoduodenectomies (<60 vs. ≥60). Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. RESULTS In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared < 60 (4% vs. 10%, p = 0.046). In multivariable analysis, annual volume < 60 pancreatoduodenectomies (OR 3.78, 95%CI 1.18-12.16, p = 0.026), age (OR 1.07, 95%CI 1.01-1.14, p = 0.046), and estimated blood loss ≥2L (OR 11.89, 95%CI 2.64-53.61, p = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95%CI 1.56-5.26, p = 0.001) and estimated blood loss ≥2L (OR 3.52, 95%CI 1.25-9.90, p = 0.017) were associated with major complications. CONCLUSION This pan-European prospective snapshot study found a 5% in-hospital after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.

Journal of Gastrointestinal Surgery, Sep 30, 2015

Pancreatectomy associated with superior mesenteric-portal vein (SMPV) resection is currently cons... more Pancreatectomy associated with superior mesenteric-portal vein (SMPV) resection is currently considered the standard of care for patients with pancreatic tumors involving the major peripancreatic veins. However, a standard approach for resection and reconstruction is not defined yet. The aim of this study is to analyze the feasibility and short-term results of an original Cattell-Braasch artery-first approach (CBAF) for the resection of SMPV during pancreatectomy. Of 144 pancreatectomies with vascular resection undertaken from 2008 to 2013 at Karolinska University Hospital, 45 (31.2 %) were performed combining a Cattell-Braasch maneuver with an artery-first approach (from 2011 to 2013). The mean patient age was 65.2 years. Thirty-seven (82.2 %) patients underwent pancreatoduodenectomy and 8 (17.8 %) total pancreatectomy. Histology showed pancreatic ductal adenocarcinoma in 42 patients (93.3 %). The median length of the resected SMPV segment was 4.6 cm (range 3-7). In all patients, a direct end-to-end anastomosis was performed without graft interposition. In nine cases (20 %), an arterial resection was also performed. There was no mortality in this series, and the morbidity rate was 35.5 %. Combined CBAF for the resection of SMPV during pancreatectomy seems to be safe and effective. The reconstruction of the resected vessels is possible in many cases without graft interposition, even if the resected vein segment is of considerable length.

Pancreatology, Jul 1, 2017

Introduction: Regional lymph node involvement is already a recognized prognostic factor in surgic... more Introduction: Regional lymph node involvement is already a recognized prognostic factor in surgically resected IPMN cancer but few data are available about the significance of non-regional lymph node involvement. Aims: To evaluate the clinical significance of lymph node involvement in surgically resected IPMN cancer and in particular of para-aortic lymph nodes. Patients & methods: Retrospective cohort analysis of a prospectively maintained database of operated patients with IPMN cancer. All the diagnosis were histologically confirmed.. Patient's characteristics, type of operation, pathology report and survival were collected. Survival was analyzed by Kaplan Meier method. Results: 52 patients, 26 males (50%), mean age 70 years (range 48 e 84 years) underwent resection at Karolinska University Hospital. 24 patients (46.1%) underwent pancreaticoduodenectomy, 18 (34.6%) distal pancreatectomy and 10 (19.3%) total pancreatectomy. 14 patients (26.9%) underwent vascular resection. No peri-operative mortality was reported. 18 patients (34.6%) had no lymph node involvement, 28 (53.8%) local but no distant lymph-nodes metastases and 6 (11.6%) had para-aortic lymph node metastases. The 1, 3 and 5 years actuarial rate of survival was significantly decreasing from patients without lymph node involvements, through the ones with loco-regional involvement to the ones with para-aortic lymphnodes involvement (76.4%, 61.2% and 61.2% vs 92.6%, 49.4% and 29.7% vs 33.3%, 16.7% and 16.7% respectively; p¼0.0001). Conclusion: Regional and particularly para-aortic lymph node metastases impact survival. The latter, as for pancreas cancer, might also represent a sign of metastatic disease.

Scandinavian Journal of Surgery, Mar 1, 2020

DeFInITIOn AnD epIDemIOlOgy Chronic pancreatitis is a long-standing, inflammatory condition of th... more DeFInITIOn AnD epIDemIOlOgy Chronic pancreatitis is a long-standing, inflammatory condition of the pancreas triggered by different endogenous or exogenous factors, that leads to the progressive damage of pancreatic parenchyma, to the loss of acinar and islet components, to the development of scar tissue, and eventually to endocrine and/or exocrine pancreatic insufficiency. Once the process is triggered it cannot be reversed, although clinical and endoscopic management can modulate its evolution over time (1). The disease itself often encompasses systemic involvement and might be accompanied by the Conservative treatment of ChroniC PanCreatitis: a PraCtiCal aPProaCh r. valente 1,2 , a. Waldthaler 3 , C. m. scandavini 1 , m. vujasinovic 2,3 , m. Del Chiaro 4 , U. arnelo 2 , J.-m. löhr 1,2

Anz Journal of Surgery, Aug 27, 2018

Background: The increasing age of the population and prolonged life expectancy result in a wideni... more Background: The increasing age of the population and prolonged life expectancy result in a widening of age limit criteria for a variety of surgical procedures. Oesophagectomy and total gastrectomy are complex operations associated with significant risks of post-operative complications. Methods: This is a single-centre cohort study of patients operated with curative intent due to oesophageal or gastric cancer. Results: From 2007 to 2017, 548 patients underwent surgery with curative intent, with 122 patients (22.3%) classified as elderly (≥75 years). There was no difference in total complication rates between the groups. The adjusted odds ratio for 90-day mortality after oesophageal resection in the elderly group was 3.65 (95% confidence interval (CI): 1.33-10.03) and after gastrectomy was 1.62 (95% CI: 0.55-4.79). The adjusted hazard ratio for 1-year mortality after oesophagectomy was 2.29 (95% CI: 1.25-4.19), and after gastrectomy the adjusted hazard ratio was 1.48 (95% CI: 0.75-2.92). In the event of a complication with Clavien-Dindo score IIIb or higher, there was a statistically significant increase of 90-day mortality to over 50% among elderly patients both after oesophagectomy and gastrectomy (50.0% versus 19.8%; P = 0.005 and 57.1% versus 17.4%; P = 0.012, respectively). Conclusion: There is a statistically significant increase in 90-day mortality after oesophageal and gastric cancer surgery in elderly compared with younger patients. Post-operative complications with high Clavien-Dindo score in patients undergoing oesophagectomy or gastrectomy, with age ≥75 years, are a dramatic risk factor for post-operative death.

Journal of Pediatric Surgery, Sep 1, 2017

Children Esophageal replacement Long-term follow up Quality of life Dysphagia Reflux Background: ... more Children Esophageal replacement Long-term follow up Quality of life Dysphagia Reflux Background: The indications of esophageal replacement (ER) in pediatric patients include long gap esophageal atresia (LGEA), intractable post-corrosive esophageal strictures (PCES), and some rare esophageal diseases. Various conduits and procedures are currently used worldwide with a lack of consensus regarding the ideal substitute to replace the esophagus replacement. The short-term outcomes of these advanced procedures are well known; there are few data available describing long-term functional outcomes of these patients with long life expectancy. Objectives: The objective of this study is to investigate the long-term functional outcomes of the most widely used techniques for ER in pediatric patients based on a comprehensive literature search covering the last 10 years. Methods: Eligible were all clinical studies reporting outcomes after esophagectomy in pediatric patients, which contained information on at least 3 years of follow-up after the operation. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic web-based search using MEDLINE, the Cochrane Library and EMBASE databases was performed, reviewing all medical literature published between January 2006 and December 2015. Results: The scientific quality of the data was generally poor, converging toward only 14 full-text articles for the final analysis. The stomach was the preferred organ for esophageal replacement, where the tubulization of the stomach resulted in significant gastroesophageal reflux. Dysphagia symptoms were more seldom reported, but several authors presented growing figures with the length of follow-up. Dumping syndrome and delayed gastric emptying were only scarcely reported upon. Following colonic graft, chronic gastrocolic reflux affects these patients, in the range of 35-70.8%, while 4 studies reported any dysphagia from 2.7% to 50% of the children. Only one study reported the outcome of the use of a long jejunal segment, where presence of symptoms of functional obstruction was mentioned in 46% of cases. Very few if any data were available on a structured assessment of postprandial dumping and disturbed bowel functions. Conclusions: Available data in pediatric patients, on the long-term functional outcomes after esophageal replacement with a gastric tube, colonic graft or a long jejunal segment, are of poor scientific quality. Although symptoms are frequently reported currently no conclusions can be drawn regarding potential advantages of one graft over another.

Pancreatology, Jun 1, 2023

Annals of pancreatic cancer, Apr 1, 2018

Pancreatology, Jul 1, 2017

Introduction: The absence of univocal definition of main pancreatic duct (MPD) involvement implie... more Introduction: The absence of univocal definition of main pancreatic duct (MPD) involvement implies different cutoff in different guidelines. The role of preoperative Ca19.9 measurement still has to be fully clarified. Aim: To correlate preoperative MPD-dilation and elevated Ca19.9 with the presence of advanced finding on the final histological report. Method: Retrospective cohort analysis of histologically confirmed IPMN-patients. Subclass analysis, according to degree of MPD-dilation and Ca19.9 elevation(>37u/ml), was performed in relation with the presence of HGD/cancer. Results: From 2008 to 2015 152 patients were operated for IPMN. Patients with MPD-diameter 6-9.9mm and above 10mm had a major prevalence of HGD/cancer compared to MPD-diameter <6mm (respectively 40.00% vs 19.44% p¼0.006 and 27.50% vs 12.50% p¼0.02). At univariate analysis, both MPD 6-9.9mm and >10mm were consistent with an increased risk of HGD/cancer (respectively OR 2.92, CI 1.38-6.20, p¼0.005 and OR 2.65, CI 1.12-6.25 P¼0.02). Patients with higher Ca19.9 also displayed a statistically significant higher prevalence of HGD/cancer compared to LGD/MGD (47.94% vs 17.64%, p¼0.0001). At univariable analysis, Ca19.9 was consistent with higher risk of HGD/cancer (OR 4.15 CI 1.90-9.05 p¼0.0003). At sex and age adjusted multivariable logistic regression analysis, both MPD 6-9.9 mm and MPD >10 mm (respectively OR 2.47

Pancreatology, Jun 1, 2015

This year, we plan to address the direction of future studies based on the results of the critica... more This year, we plan to address the direction of future studies based on the results of the critical reviews. Materials & methods: Clinical questions (CGs) of interest were proposed by the panel. The recommendations for the CQs in representative seven guidelines were compared. The presence or absence of evidence on which these recommendations were based was evaluated. Results: Among 37 CQs, there were only five CQs where agreement based on sufficient evidence was achieved: the use of CT and MRI for diagnosis, the definition of resectable pancreatic cancer, first line chemotherapy for metastatic disease, the role of celiac neurolysis and the reporting of lymph node metastases. There was agreement in other four CQs despite the lack of sufficient evidence: optimal combination of imaging studies for staging, the role of EUS and FNA, the use of radiotherapy to imrpove quality of life and the role of pre-operative biliary drainage. In 25 CQs, there was disagreement. Conclusion: The lack of sufficient evidence is one of the resons for the disagreement among the existing guidelines. In order to create strong evidence, especially in areas where there is disagreement among the guidelines, and to create a global evidence-based consensus in future studies.

Pancreatology, Jun 1, 2015

s / Pancreatology 15 (2015) S1eS141 S94 Aims: The purpose of this study was to examine the preope... more s / Pancreatology 15 (2015) S1eS141 S94 Aims: The purpose of this study was to examine the preoperative patient and radiographic factors that are associated increased POPF rate after DP. Patientsm Ethiconâ“z) were investigated. Clinicopathologic data including POPF were prospectively collected. Pancreatic thickness and cross-sectional area of the pancreas stump were checked with 64 channel multi-detector CT and calculated using Rapidia 2.0 and Autocad 2014. Preoperative fatty infiltration of pancreas on MR was measured by a specialized radiologist. Results: Twenty patients (33.3%) had laparoscopic surgery. Clinicallyrelevant POPF by International Study Group of Pancreatic Fistula criteria occurred in 12 patients (20.0 %). Multivariate analysis revealed that the pancreatic thickness over than 17.6mm (odds ratio [OR] 6.69; P 1⁄4 0.029) and the extent of cross-sectional area over than 377 mm2 (OR 12.68; P 1⁄4 0.022) of pancreas stump were independent risk factors for clinicallyrelevant POPF. Pathologic diagnosis, the diameter of the pancreatic duct, pancreatic texture, and the degree of fatty infiltration on MR did not influence the incidence of POPF. Conclusion: Pancreatic thickness and cross-sectional area of pancreas transection surface are the significant independent risk factors for POPF development after DP. The appropriate modalities to reduce POPF are recommended in cases with thick pancreas.

Minerva gastroenterology, Feb 1, 2022

BACKGROUND Few studies compared lumen-apposing metal stents (LAMS) and standard double pigtail pl... more BACKGROUND Few studies compared lumen-apposing metal stents (LAMS) and standard double pigtail plastic stents (PS) for the endoscopic drainage of pancreatic walled-off necrosis (WON). Albeit sometimes large, previously described cohorts display considerable heterogeneity and often pooled together data from several centers, involving multiple operators and techniques. Moreover, they often lack a control group for the comparison of outcomes. AIM to compare clinical efficacy and safety of PS versus LAMS for the endoscopic drainage of infected WON. METHODS Single-centre, 1:1 case-control study. We compared patients undergoing endoscopic drainages of infected WON through LAMS (cases) or PS (controls). The primary endpoint was the clinical efficacy (resolution of the WON/sepsis), the secondary endpoint was safety (procedure-related complications). RESULTS Thirty patients were enrolled between 2011 and 2017. Cases and controls were homogeneous in terms of etiology and clinical characteristics. 93% of cases and 86.7% of controls were clinically successfully treated, with no significant differences in rates of post-operative infections, bleedings and stent migrations (respectively 13.3% vs 21.4%; p=0.65; 13.3% vs 0%; p=0.48; 13.3% vs 7.1%; p=1.00). No difference was shown regarding the need for additional percutaneous or surgical treatments (33.3% vs 13.3%; p=0.39). Cases, however, displayed a significantly prolonged mean hospital stay (90.2 days vs 18.5 days; p<0.01) and a higher mean number of endoscopic procedures per patient (4.8 vs 1.5; p<0.01). CONCLUSIONS PS might be not inferior to LAMS for the treatment WONs. Further prospective RCT is needed to compare clinical efficacy and safety in the two groups.