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  1. Article: State of the Art, Current Perspectives, and Controversies of Budd-Chiari Syndrome: A Review.

    Gavriilidis, Paschalis / Marangoni, Gabriele / Ahmad, Jawad / Azoulay, Daniel

    Journal of clinical medicine research

    2022  Volume 14, Issue 4, Page(s) 147–157

    Abstract: Background: Budd-Chiari syndrome (BCS) is an eponym that includes a group of conditions characterized by partial or complete hepatic venous tract outflow obstruction, and the site of obstruction may involve one or more hepatic veins, inferior vena cava, ...

    Abstract Background: Budd-Chiari syndrome (BCS) is an eponym that includes a group of conditions characterized by partial or complete hepatic venous tract outflow obstruction, and the site of obstruction may involve one or more hepatic veins, inferior vena cava, or the right atrium. The classification of BCS is based on etiology, site of obstruction, and duration. Its etiology is very heterogeneous; in particular, hepatic vein thrombosis is the most common type of obstruction and myeloproliferative disorder, the most common thrombophilic disorder, in the West. In Asian countries, the type of obstruction, thrombophilic disorders, clinical features, and treatment strategies vary widely from region to region. Although the cause can be identified in 90% of patients with the help of gene mutation testing, BCS remains under-recognized in many countries. A higher prevalence of acute cases has been reported in the West than in the East. This global and regional heterogeneity raises several challenges regarding the evaluation, management strategy, and individualized approach of BCS. This study aimed to conduct a systematic review of BCS to elucidate treatment strategy options.
    Methods: PubMed, Embase, Cochrane Library, and Google Scholar databases were searched systematically.
    Results: Sixty-nine pertinent articles were retrieved and included in the present study.
    Conclusions: Further research on the following three topics would help define individualized treatment strategies. The first is a better understanding of the molecular pathways underlying the thrombophilic conditions implicated in the pathogenesis of BCS. The second is the role of the genotype and gene mutations in the determination of coagulation status of patients with BCS. The third is the definition of clear criteria and development of a common prognostic index to risk stratify the patients at presentation and consequently detect candidates for invasive therapies.
    Language English
    Publishing date 2022-04-30
    Publishing country Canada
    Document type Journal Article ; Review
    ZDB-ID 2548987-2
    ISSN 1918-3011 ; 1918-3003
    ISSN (online) 1918-3011
    ISSN 1918-3003
    DOI 10.14740/jocmr4724
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Simultaneous portal and hepatic vein embolization is better than portal embolization or ALPPS for hypertrophy of future liver remnant before major hepatectomy: A systematic review and network meta-analysis.

    Gavriilidis, Paschalis / Marangoni, Gabriele / Ahmad, Jawad / Azoulay, Daniel

    Hepatobiliary & pancreatic diseases international : HBPD INT

    2022  Volume 22, Issue 3, Page(s) 221–227

    Abstract: Background: Post-hepatectomy liver failure (PHLF) is the Achilles' heel of hepatic resection for colorectal liver metastases. The most commonly used procedure to generate hypertrophy of the functional liver remnant (FLR) is portal vein embolization (PVE) ...

    Abstract Background: Post-hepatectomy liver failure (PHLF) is the Achilles' heel of hepatic resection for colorectal liver metastases. The most commonly used procedure to generate hypertrophy of the functional liver remnant (FLR) is portal vein embolization (PVE), which does not always lead to successful hypertrophy. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed to overcome the limitations of PVE. Liver venous deprivation (LVD), a technique that includes simultaneous portal and hepatic vein embolization, has also been proposed as an alternative to ALPPS. The present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy, effectiveness, and safety of the three regenerative techniques.
    Data sources: A systematic search for literature was conducted using the electronic databases Embase, PubMed (MEDLINE), Google Scholar and Cochrane.
    Results: The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days, respectively. Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts. There was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort, but non-significant differences were observed when compared to the LVD cohort. Notably, the LVD cohort demonstrated a significantly better FLR/body weight (BW) ratio compared to both the ALPPS and PVE cohorts. Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort. The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.
    Conclusions: LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy. Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.
    MeSH term(s) Humans ; Hepatectomy/methods ; Hepatic Veins/pathology ; Network Meta-Analysis ; Treatment Outcome ; Liver/pathology ; Portal Vein/surgery ; Portal Vein/pathology ; Liver Neoplasms/pathology ; Hepatomegaly/etiology ; Hypertrophy/pathology ; Hypertrophy/surgery ; Embolization, Therapeutic/adverse effects ; Embolization, Therapeutic/methods ; Ligation
    Language English
    Publishing date 2022-09-07
    Publishing country Singapore
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 2241386-8
    ISSN 1499-3872
    ISSN 1499-3872
    DOI 10.1016/j.hbpd.2022.08.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Meta-analysis and trial sequential analysis of pancreatic stump closure using a hand-sewn or stapler technique in distal pancreatectomy.

    Hajibandeh, Shahin / Hajibandeh, Shahab / Hablus, Mohammed Abdallah / Bari, Hassaan / Pathanki, Adithya Malolan / Ali, Majid / Ahmad, Jawad / Marangoni, Gabriele / Khan, Saboor / Lam, For Tai

    Annals of hepato-biliary-pancreatic surgery

    2024  

    Abstract: This study aimed to compare outcomes of hand-sewn and stapler closure techniques of pancreatic stump in patients undergoing distal pancreatectomy (DP). Impact of stapler closure reinforcement using mesh on outcomes was also evaluated. Literature search ... ...

    Abstract This study aimed to compare outcomes of hand-sewn and stapler closure techniques of pancreatic stump in patients undergoing distal pancreatectomy (DP). Impact of stapler closure reinforcement using mesh on outcomes was also evaluated. Literature search was carried out using multiple data sources to identify studies that compared hand-sewn and stapler closure techniques in management of pancreatic stump following DP. Odds ratio (OR) was determined for clinically relevant postoperative pancreatic fistula (POPF) via random-effects modelling. Subsequently, trial sequential analysis was performed. Thirty-two studies with a total of 4,022 patients undergoing DP with hand-sewn (n = 1,184) or stapler (n = 2,838) closure technique of pancreatic stump were analyzed. Hand-sewn closure significantly increased the risk of clinically relevant POPF compared to stapler closure (OR: 1.56,
    Language English
    Publishing date 2024-03-25
    Publishing country Korea (South)
    Document type Journal Article ; Review
    ZDB-ID 3012179-6
    ISSN 2508-5859 ; 2508-5778
    ISSN (online) 2508-5859
    ISSN 2508-5778
    DOI 10.14701/ahbps.24-015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Multivisceral robotic resection: a glimpse into the future of minimally invasive abdominal surgery.

    Bhat, Anantha Shreepad / Farrugia, Alexia / Marangoni, Gabriele / Ahmad, Jawad

    BMJ case reports

    2020  Volume 13, Issue 8

    Abstract: A 62-year-old man was referred to the Hepato-Pancreato-Biliary (HPB) surgeons with left upper quadrant discomfort. The initial investigations and CT scans revealed a tumour in the pancreatic tail with liver metastases, confirmed on MRI. It was initially ... ...

    Abstract A 62-year-old man was referred to the Hepato-Pancreato-Biliary (HPB) surgeons with left upper quadrant discomfort. The initial investigations and CT scans revealed a tumour in the pancreatic tail with liver metastases, confirmed on MRI. It was initially thought to be an adenocarcinoma; however, further investigations found that it was a grade 1 neuroendocrine tumour with Ki 67 at 1% and it was agreed that he would undergo a total robotic surgery involving resection of the locally advanced tumour of the tail of pancreas, with the involvement of the stomach, and splenic flexure of the colon with liver metastases. The resulting procedure was a total robotic distal pancreatectomy, splenectomy, sleeve resection of stomach, cholecystectomy, atypical resection of two liver lesions and microwave ablation of multiple liver lesions. Four days post-operatively, he was discharged from hospital and commenced adjuvant chemotherapy. He currently enjoys a good quality of life.
    MeSH term(s) Digestive System/diagnostic imaging ; Digestive System Neoplasms/diagnostic imaging ; Digestive System Neoplasms/surgery ; Digestive System Surgical Procedures/methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/methods ; Neuroendocrine Tumors/surgery ; Robotic Surgical Procedures/methods ; Tomography, X-Ray Computed
    Keywords covid19
    Language English
    Publishing date 2020-08-24
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2020-234887
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Surgical treatment of megaduodenum in familial visceral myopathy - report of a case and review of the literature.

    Papis, Davide / Marangoni, Gabriele

    Acta chirurgica Belgica

    2016  Volume 116, Issue 5, Page(s) 305–308

    Abstract: Introduction: Familial visceral myopathy (VM) is a rare genetic disease that affects intestinal motility and results in pseudo-obstruction. Medical treatments can provide supportive measures but no curative treatment.: Case report: A 20-year-old male ...

    Abstract Introduction: Familial visceral myopathy (VM) is a rare genetic disease that affects intestinal motility and results in pseudo-obstruction. Medical treatments can provide supportive measures but no curative treatment.
    Case report: A 20-year-old male with known diagnosis of VM was referred to our Unit in May 2013 with recurrent episodes of vomiting and hospital admissions not responding to medical treatment. Pre-operative imaging showed megaduodenum with marked delayed transit and normal small and large bowel transit. He underwent an elective Roux-en-Y duodeno-jejunostomy. The post-operative course was uneventful with complete resolution of the symptoms with a 2 years follow-up.
    Discussion: Due to the early age of presentation, VM affects patient both psychologically and physically. Surgical treatment of megaduodenum in visceral myopathy in the absence of motility disorder of the small bowel seems to achieve satisfactory symptomatic relief and could be considered in this rare cohort of patients.
    MeSH term(s) Anastomosis, Roux-en-Y ; Duodenum/abnormalities ; Duodenum/surgery ; Fetal Diseases/diagnosis ; Fetal Diseases/surgery ; Follow-Up Studies ; Humans ; Intestinal Pseudo-Obstruction/complications ; Intestinal Pseudo-Obstruction/diagnosis ; Intestinal Pseudo-Obstruction/surgery ; Jejunostomy/methods ; Male ; Rare Diseases ; Risk Assessment ; Severity of Illness Index ; Treatment Outcome ; Urinary Bladder/abnormalities ; Urinary Bladder/surgery ; Young Adult
    Language English
    Publishing date 2016-10
    Publishing country England
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 210274-2
    ISSN 0001-5458
    ISSN 0001-5458
    DOI 10.1080/00015458.2016.1147263
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Proposed training pathway with initial experience to set up robotic hepatobiliary and pancreatic service.

    Farrugia, Alexia / Muhammad, Qazi Rahim / Ravichandran, Niranjan T / Ali, Majid / Marangoni, Gabriele / Ahmad, Jawad

    Journal of robotic surgery

    2021  Volume 16, Issue 1, Page(s) 65–71

    Abstract: Although robot-assisted hepatobiliary and pancreatic (HPB) surgery has gained momentum over the last 2 decades, only a handful of units in the world perform major robotic resections. Adaptation of robotic surgery in the UK lags behind its European ... ...

    Abstract Although robot-assisted hepatobiliary and pancreatic (HPB) surgery has gained momentum over the last 2 decades, only a handful of units in the world perform major robotic resections. Adaptation of robotic surgery in the UK lags behind its European counterparts and this is mainly because of cost implications in a publicly funded National Health Service (NHS). We describe our experience of setting up a robotic HPB programme with clinical outcomes and propose a training pathway that would help prospective centres in setting up their own robotic HPB service with robust clinical governance oversight. After gaining colleagues' and departmental support, approval from the hospital clinical governance, finance department and new intervention procedure committee was sought. A team of two consultant surgeons, three assistants and three theatre staff went through a structured training programme sponsored mainly by the industry. Surgeon training consisted of online modules, simulation, wet lab, cadaveric training, case observations, proctored procedures followed by independent practice. All major cases were recorded and videos reviewed to improve performance. A total of 111 procedures were successfully completed with robotic assistance between April 2018 and March 2020. The programme started with robot-assisted cholecystectomy as index procedure and progressed on to more complex liver and pancreatic resections including major hepatectomy and Whipple's procedure. The training pathway followed by our team has been effective in setting up a safe robotic HPB programme and could be considered as a roadmap to start new Robotic HPB services.
    MeSH term(s) Humans ; Pancreas/surgery ; Prospective Studies ; Robotic Surgical Procedures/methods ; Robotics ; State Medicine
    Language English
    Publishing date 2021-02-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-021-01207-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Initial Experience of Consecutive Robotic Pancreatoduodenectomies With Patient Reported Outcomes From a Single Center in the UK.

    Jalil, Omar / Muhammad, Qazi Rahim / Farrugia, Alexia / Ali, Majid / Gavriilidis, Paschalis / Marangoni, Gabriele / Ahmad, Jawad

    Journal of clinical medicine research

    2021  Volume 13, Issue 8, Page(s) 435–437

    Language English
    Publishing date 2021-08-30
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2548987-2
    ISSN 1918-3011 ; 1918-3003
    ISSN (online) 1918-3011
    ISSN 1918-3003
    DOI 10.14740/jocmr4574
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Oncological outcomes after pancreatoduodenectomy for pancreatic ductal adenocarcinoma in octogenarians: case-control study.

    Pande, Rupaly / Attard, Joseph A / Al-Sarireh, Bilal / Bhogal, Ricky Harminder / Farrugia, Alexia / Fusai, Giuseppe / Harper, Simon / Hidalgo-Salinas, Camila / Jah, Asif / Marangoni, Gabriele / Mortimer, Matthew / Pizanias, Michail / Prachialias, Andreas / Roberts, Keith J / Hee, Chloe Sew / Soggiu, Fiammetta / Srinivasan, Parthi / Chatzizacharias, Nikolaos A

    BJS open

    2023  Volume 7, Issue 4

    Abstract: Background: By the end of this decade, 70 per cent of all diagnosed pancreatic ductal adenocarcinomas will be in the elderly. Surgical resection is the only curative option. In the elderly perioperative mortality is higher, while controversy still ... ...

    Abstract Background: By the end of this decade, 70 per cent of all diagnosed pancreatic ductal adenocarcinomas will be in the elderly. Surgical resection is the only curative option. In the elderly perioperative mortality is higher, while controversy still exists as to whether aggressive treatment offers any survival benefit. This study aimed to assess the oncological benefit of pancreatoduodenectomy in octogenarians with pancreatic ductal adenocarcinoma.
    Method: Retrospective multicentre case-control study of octogenarians and younger controls who underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma between 2008 and 2017. The primary endpoint was overall survival and the secondary endpoint was disease-free survival.
    Results: Overall, 220 patients were included. Although the Charlson co-morbidity index was higher in octogenerians, Eastern Cooperative Oncology Group performance status, ASA and pathological parameters were comparable. Adjuvant therapy was more frequently delivered in the younger group (n = 80, 73 per cent versus n = 58, 53 per cent, P = 0.006). There was no significant difference between octogenarians and controls in overall survival (20 versus 29 months, P = 0.095) or disease-free survival (19 versus 22 months, P = 0.742). On multivariable analysis, age was not an independent predictor of either oncological outcome measured.
    Conclusion: Octogenarians with pancreatic ductal adenocarcinoma of the head and uncinate process may benefit from comparable oncological outcomes to younger patients with surgical treatment. Due to the age- and disease-related frailty and co-morbidities, careful preoperative assessment and patient selection is of paramount importance.
    MeSH term(s) Aged ; Aged, 80 and over ; Humans ; Case-Control Studies ; Pancreaticoduodenectomy ; Octogenarians ; Pancreatic Neoplasms/surgery ; Carcinoma, Pancreatic Ductal/surgery ; Pancreatic Neoplasms
    Language English
    Publishing date 2023-07-11
    Publishing country England
    Document type Multicenter Study ; Journal Article
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrad053
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Patterns, timing and predictors of recurrence following pancreaticoduodenectomy for distal cholangiocarcinoma: An international multicentre retrospective cohort study.

    Labib, Peter Lz / Russell, Thomas B / Denson, Jemimah L / Puckett, Mark A / Ausania, Fabio / Pando, Elizabeth / Roberts, Keith J / Kausar, Ambareen / Mavroeidis, Vasileios K / Bhogal, Ricky H / Marangoni, Gabriele / Thomasset, Sarah C / Frampton, Adam E / Spalding, Duncan R / Lykoudis, Pavlos / Bellotti, Ruben / Alhaboob, Nassir / Srinivasan, Parthi / Bari, Hassaan /
    Smith, Andrew / Dominguez-Rosado, Ismael / Croagh, Daniel / Thakkar, Rohan G / Gomez, Dhanny / Silva, Michael A / Lapolla, Pierfrancesco / Mingoli, Andrea / Davidson, Brian R / Porcu, Alberto / Shah, Nehal S / Hamady, Zaed Z / Al-Sarireh, Bilal A / Serrablo, Alejandro / Aroori, Somaiah

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2024  Volume 50, Issue 6, Page(s) 108353

    Abstract: Introduction: Patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma (dCCA) often develop cancer recurrence. Establishing timing, patterns and risk factors for recurrence may help inform surveillance protocol strategies or select ... ...

    Abstract Introduction: Patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma (dCCA) often develop cancer recurrence. Establishing timing, patterns and risk factors for recurrence may help inform surveillance protocol strategies or select patients who could benefit from additional systemic or locoregional therapies. This multicentre retrospective cohort study aimed to determine timing, patterns, and predictive factors of recurrence following pancreaticoduodenectomy for dCCA.
    Materials and methods: Patients who underwent pancreaticoduodenectomy for dCCA between June 2012 and May 2015 with five years of follow-up were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on comorbidities, investigations, operation details, complications, histology, adjuvant and palliative therapies, recurrence-free and overall survival. Univariable tests and regression analyses investigated factors associated with recurrence.
    Results: In the cohort of 198 patients, 129 (65%) developed recurrence: 30 (15%) developed local-only recurrence, 44 (22%) developed distant-only recurrence and 55 (28%) developed mixed pattern recurrence. The most common recurrence sites were local (49%), liver (24%) and lung (11%). 94% of patients who developed recurrence did so within three years of surgery. Predictors of recurrence on univariable analysis were cancer stage, R1 resection, lymph node metastases, perineural invasion, microvascular invasion and lymphatic invasion. Predictors of recurrence on multivariable analysis were female sex, venous resection, advancing histological stage and lymphatic invasion.
    Conclusion: Two thirds of patients have cancer recurrence following pancreaticoduodenectomy for dCCA, and most recur within three years of surgery. The commonest sites of recurrence are the pancreatic bed, liver and lung. Multiple histological features are associated with recurrence.
    Language English
    Publishing date 2024-04-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2024.108353
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Five-year recurrence/survival after pancreatoduodenectomy for pancreatic adenocarcinoma: does pre-existing diabetes matter? Results from the Recurrence After Whipple's (RAW) study.

    Rajagopalan, Ashray / Aroori, Somaiah / Russell, Thomas B / Labib, Peter L / Ausania, Fabio / Pando, Elizabeth / Roberts, Keith J / Kausar, Ambareen / Mavroeidis, Vasileios K / Marangoni, Gabriele / Thomasset, Sarah C / Frampton, Adam E / Lykoudis, Pavlos / Maglione, Manuel / Alhaboob, Nassir / Bari, Hassaan / Smith, Andrew M / Spalding, Duncan / Srinivasan, Parthi /
    Davidson, Brian R / Bhogal, Ricky H / Dominguez, Ismael / Thakkar, Rohan / Gomez, Dhanny / Silva, Michael A / Lapolla, Pierfrancesco / Mingoli, Andrea / Porcu, Alberto / Shah, Nehal S / Hamady, Zaed Z R / Al-Sarrieh, Bilal / Serrablo, Alejandro / Croagh, Daniel

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2024  

    Abstract: Background: Diabetes mellitus (DM) has a complex relationship with pancreatic cancer. This study examines the impact of preoperative DM, both recent-onset and pre-existing, on long-term outcomes following pancreatoduodenectomy (PD) for pancreatic ductal ...

    Abstract Background: Diabetes mellitus (DM) has a complex relationship with pancreatic cancer. This study examines the impact of preoperative DM, both recent-onset and pre-existing, on long-term outcomes following pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).
    Methods: Data were extracted from the Recurrence After Whipple's (RAW) study, a multi-centre cohort of PD for pancreatic head malignancy (2012-2015). Recurrence and five-year survival rates of patients with DM were compared to those without, and subgroup analysis performed to compare patients with recent-onset DM (less than one year) to patients with established DM.
    Results: Out of 758 patients included, 187 (24.7%) had DM, of whom, 47 of the 187 (25.1%) had recent-onset DM. There was no difference in the rate of postoperative pancreatic fistula (DM: 5.9% vs no DM 9.8%; p = 0.11), five-year survival (DM: 24.1% vs no DM: 22.9%; p = 0.77) or five-year recurrence (DM: 71.7% vs no DM: 67.4%; p = 0.32). There was also no difference between patients with recent-onset DM and patients with established DM in postoperative outcomes, recurrence, or survival.
    Conclusion: We found no difference in five-year recurrence and survival between diabetic patients and those without diabetes. Patients with pre-existing DM should be evaluated for PD on a comparable basis to non-diabetic patients.
    Language English
    Publishing date 2024-04-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2024.04.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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