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Article: Tumour Heterogeneity and the Consequent Practical Challenges in the Management of Gastroenteropancreatic Neuroendocrine Neoplasms.

Reccia, Isabella / Pai, Madhava / Kumar, Jayant / Spalding, Duncan / Frilling, Andrea

2023 Volume 15, Issue 6

Abstract: Tumour heterogeneity is a common phenomenon in neuroendocrine neoplasms (NENs) and a significant cause of treatment failure and disease progression. Genetic and epigenetic instability, along with proliferation of cancer stem cells and alterations in the ... ...

Abstract	Tumour heterogeneity is a common phenomenon in neuroendocrine neoplasms (NENs) and a significant cause of treatment failure and disease progression. Genetic and epigenetic instability, along with proliferation of cancer stem cells and alterations in the tumour microenvironment, manifest as intra-tumoural variability in tumour biology in primary tumours and metastases. This may change over time, especially under selective pressure during treatment. The gastroenteropancreatic (GEP) tract is the most common site for NENs, and their diagnosis and treatment depends on the specific characteristics of the disease, in particular proliferation activity, expression of somatostatin receptors and grading. Somatostatin receptor expression has a major role in the diagnosis and treatment of GEP-NENs, while Ki-67 is also a valuable prognostic marker. Intra- and inter-tumour heterogeneity in GEP-NENS, however, may lead to inaccurate assessment of the disease and affect the reliability of the available diagnostic, prognostic and predictive tests. In this review, we summarise the current available evidence of the impact of tumour heterogeneity on tumour diagnosis and treatment of GEP-NENs. Understanding and accurately measuring tumour heterogeneity could better inform clinical decision making in NENs.
Language	English
Publishing date	2023-03-20
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15061861
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Article: The Impact of COVID-19 Global Pandemic on Morbidity and Mortality of Liver Transplant Recipients Children and Adults: A Systematic Review of Case Series.

Gavriilidis, Paschalis / Pai, Madhava

Journal of clinical medicine research

2020 Volume 12, Issue 7, Page(s) 404–408

Abstract: The pandemic of coronavirus disease 2019 (COVID-19) changed the surgical everyday practice overnight. Currently, the first articles reporting outcomes of liver transplant recipients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ...

Abstract	The pandemic of coronavirus disease 2019 (COVID-19) changed the surgical everyday practice overnight. Currently, the first articles reporting outcomes of liver transplant recipients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are published. The aim of the present study was to summarise the existing evidence of impact of COVID-19 global pandemic on liver transplant recipients. Electronic databases were searched in accordance with Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA). Five studies were selected from a pool of 12 studies with a total of 854 liver transplant recipients of whom 700 were children and the rest 154 were adults. The present evidence, based on case reports and series demonstrated lower mortality in liver transplant recipients compared to general population.
Keywords	covid19
Language	English
Publishing date	2020-06-25
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/jocmr4223
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Article: The Impact of COVID-19 Global Pandemic on Morbidity and Mortality of Liver Transplant Recipients Children and Adults: A Systematic Review of Case Series

Gavriilidis, Paschalis / Pai, Madhava

Journal of clinical medicine research

Abstract: The pandemic of coronavirus disease 2019 (COVID-19) changed the surgical everyday practice overnight Currently, the first articles reporting outcomes of liver transplant recipients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ... ...

Abstract	The pandemic of coronavirus disease 2019 (COVID-19) changed the surgical everyday practice overnight Currently, the first articles reporting outcomes of liver transplant recipients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are published The aim of the present study was to summarise the existing evidence of impact of COVID-19 global pandemic on liver transplant recipients Electronic databases were searched in accordance with Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) Five studies were selected from a pool of 12 studies with a total of 854 liver transplant recipients of whom 700 were children and the rest 154 were adults The present evidence, based on case reports and series demonstrated lower mortality in liver transplant recipients compared to general population
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #642997
Database	COVID19

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Article ; Online: HOW TO PERFORM LAPAROSCOPIC DISTAL PANCREATECTOMY USING THE CLOCKWISE TECHNIQUE.

Costa, Adriano Carneiro da / Spalding, Duncan / Cunha-Filho, Geraldo de Almeida / Santana, Matheus Belem / Pai, Madhava / Jiao, Long R / Habib, Nagy

Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery

2022 Volume 35, Page(s) e1683

Abstract: Background: Laparoscopic pancreatectomy is currently a widely used approach for benign and malignant lesions of the pancreas.: Aims: This study aimed to describe how to perform a laparoscopic distal pancreatectomy using The Clockwise Technique.: ... ...

Abstract	Background: Laparoscopic pancreatectomy is currently a widely used approach for benign and malignant lesions of the pancreas. Aims: This study aimed to describe how to perform a laparoscopic distal pancreatectomy using The Clockwise Technique. Methods: An 18-year-old female patient presented with a well-defined tumor in the pancreatic body with 4 cm in diameter that suggested a diagnosis of solid pseudopapillary tumor (Frantz's tumor). The patient was recommended for laparoscopic distal pancreatectomy by using The Clockwise Technique. Results: The clockwise, caudal-to-cephalic approach appears to have other significant technical advantages that facilitate the performance of the procedure. Conclusions: A laparoscopic distal pancreatectomy performed using The Clockwise Technique provides satisfactory outcomes.
MeSH term(s)	Adolescent ; Female ; Humans ; Laparoscopy/methods ; Pancreas/pathology ; Pancreatectomy/methods ; Pancreatic Neoplasms/pathology
Language	English
Publishing date	2022-09-16
Publishing country	Brazil
Document type	Case Reports ; Journal Article
ISSN	2317-6326
ISSN (online)	2317-6326
DOI	10.1590/0102-672020220002e1683
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Article ; Online: Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience.

Das, Bibek / Fehervari, Matyas / Hamrang-Yousefi, Sahar / Jiao, Long R / Pai, Madhava / Jenkins, John T / Spalding, Duncan R C

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2022 Volume 25, Issue 1, Page(s) 16–23

Abstract: Aim: Locally advanced intestinal neoplasms including colon cancer may require radical en bloc pancreaticoduodenectomy and right hemicolectomy (PD-RC) to achieve curative, margin-negative resection, but the safety and benefit of this uncommon procedure ... ...

Abstract	Aim: Locally advanced intestinal neoplasms including colon cancer may require radical en bloc pancreaticoduodenectomy and right hemicolectomy (PD-RC) to achieve curative, margin-negative resection, but the safety and benefit of this uncommon procedure has not been established. The Association of Coloproctology of Great Britain and Ireland IMPACT initiative has also highlighted a lack of awareness about current services available within the UK for patients with advanced colorectal cancer and concerns about low-volume centres managing complex cases. Thus, we aimed to review the feasibility, safety and long-term outcomes of this procedure at a single high-volume hepatopancreaticobiliary surgery unit in the UK. Method: A retrospective cohort study was performed using a database of all consecutive patients with intestinal cancer who had been referred to our regional advanced multidisciplinary team and undergone PD-RC in a 7-year period (2013-2020). Clinico-pathological and outcome data were reviewed. Results: Ten patients (mean age 54 ± 13, 8/10 men) were identified. Final histology revealed the primary tumour sites were colon (n = 7) and duodenum (n = 3). R0 resection was achieved in all cases. The major complication rate (Clavien-Dindo ≥ 3) was 10% (1/10) with no deaths within 90 days of surgery. The Kaplan-Meier estimated 5-year overall survival was 83.3% (95% CI 58.3%-100%). Univariate survival analysis identified perineural invasion and extra-colonic origin as predictors of poor survival (log-rank P < 0.05). Conclusion: En bloc PD-RC for locally advanced intestinal cancer can be performed safely with a high proportion of margin-negative resections and resultant long-term survival in carefully selected patients.
MeSH term(s)	Male ; Humans ; Pancreaticoduodenectomy/methods ; Retrospective Studies ; Colonic Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Colectomy/methods
Language	English
Publishing date	2022-09-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16303
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Zs.A 5799: Show issues

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Article ; Online: Efficacy of local anaesthetic infiltration via wound catheters after open hepatic surgery: a systematic review and meta-analysis.

Sadik, Hatem / Watson, Naomi / Dilaver, Nafi / Reccia, Isabella / Cuell, James / Pai, Madhava / Sutcliffe, Robert P / Baharlo, Behrad

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

2022 Volume 25, Issue 1, Page(s) 1–13

Abstract: Background: This study analysed whether local anaesthetic wound catheter infiltration (LA-WCI) as an adjunct to intravenous patient-controlled analgesia (IV-PCA) provides superior outcomes compared to IV-PCA alone following liver resection.: Methods: ...

Abstract	Background: This study analysed whether local anaesthetic wound catheter infiltration (LA-WCI) as an adjunct to intravenous patient-controlled analgesia (IV-PCA) provides superior outcomes compared to IV-PCA alone following liver resection. Methods: A systematic review and meta-analysis was conducted for randomised control trials (RCTs) comparing LA-WCI with IV-PCA(LA-WCI group) versus IV-PCA alone (IV-PCA group). PubMed and the Cochrane Library were searched for relevant articles. Results: Six RCTs with a total of 440 patients were included. Opioid use in the initial 48 h was less in the LA-WCI group [MD -21.27 mg (-39.39,-3.15), p = 0.02]. Pain scores were lower in the LA-WCI group at rest at POD0 (post-operative day 0)6-8 h (p = 0.0009), POD1AM(p = 0.01), POD1PM(p = 0.02) and POD2 (p = 0.0006), and exertion at POD0 0-2 h (p = 0.05), POD1AM(p = 0.03), POD1PM(p = 0.03), POD2 (p = 0.03) and POD3 (p = 0.01). LA-WCI group had reduced length of hospital stay [MD -1.32 days (-2.23,-0.40),p = 0.005], time to ambulation [MD -5.94 h (-8.47,-3.42),p = 0.00001] and incidence of nausea and vomiting (PONV) [OR 0.17 (0.07,0.43),p = 0.0002]. No differences were observed in length of intensive care unit (ICU) stay or incidence of surgical site infections. Discussion: LA-WCI as an adjunct to opiate IV-PCA post-hepatectomy reduces opioid use, pain scores at multiple time points at rest and exertion, length of hospital stay, time to ambulation and PONV. However, LA-WCI use does not alter length of ICU stay or incidence of wound infection.
MeSH term(s)	Humans ; Anesthetics, Local/adverse effects ; Analgesics, Opioid/therapeutic use ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Postoperative Nausea and Vomiting/complications ; Catheters/adverse effects ; Liver/surgery
Chemical Substances	Anesthetics, Local ; Analgesics, Opioid
Language	English
Publishing date	2022-10-17
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2022.10.006
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Article ; Online: A systematic review into patient reported outcomes following pancreaticoduodenectomy for malignancy.

Patel, Bhavik Y / White, Laura / Gavriilidis, Paschalis / Satyadas, Thomas / Frampton, Adam E / Pai, Madhava

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

2020 Volume 47, Issue 5, Page(s) 970–978

Abstract: Background: Pancreaticoduodenectomy is associated with high rates of morbidity. This combined with the psychological burden of cancer, may impact on a patient's quality of life (QoL), which can be measured by using patient-reported outcomes (PRO).: ... ...

Abstract	Background: Pancreaticoduodenectomy is associated with high rates of morbidity. This combined with the psychological burden of cancer, may impact on a patient's quality of life (QoL), which can be measured by using patient-reported outcomes (PRO). Objective: To perform a systematic review to evaluate the measurement of PRO after pancreaticoduodenectomy for cancer. Methods: 7 different databases were searched using 2 groups of search terms, one relating to pancreaticoduodenectomy, and one to PRO. Three authors screened the search results independently in a systematic manner based on predefined inclusion and exclusion criteria. Results: 27 studies, with 2173 eligible patients were included in the final analysis. Most of the included studies used validated instruments. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire was most popular and used in 12 studies. The methodology of all included studies was also scrutinised. 12 studies were deemed to have high quality methodology according to pre-defined criteria. Conclusion: The instruments and methods used to measure PRO are variable. The quality of PRO within the available literature has improved over time, as has the number of studies measuring PRO. PRO should be measured with uniformity in future trials so that patients can be provided with more comprehensive information regarding post-operative recovery and QoL during the shared decision-making process preoperatively.
MeSH term(s)	Humans ; Pancreatic Neoplasms/psychology ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Patient Reported Outcome Measures ; Quality of Life
Language	English
Publishing date	2020-12-08
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2020.11.146
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 549: Show issues

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Article ; Online: Integrating the evidence for single-incision laparoscopic cholecystectomy: is it "looking" good?

Pai, Madhava / Frampton, Adam E / Jiao, Long R

Annals of surgery

2015 Volume 261, Issue 3, Page(s) e85–7

MeSH term(s)	Bile Ducts/injuries ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/methods ; Female ; Humans ; Intraoperative Complications/epidemiology ; Male
Language	English
Publishing date	2015-03
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000000210
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Article: Effectiveness of Terlipressin on Modulation of Portal Vein Pressure after Hepatic Resections in Non-Cirrhotic Patients. A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Gavriilidis, Paschalis / Roberts, Keith J / Angelis, Nicola de / Memeo, Riccardo / Pai, Madhava / Saverio, Salomone Di / Askari, Alan / Sutcliffe, Robert P

Chirurgia (Bucharest, Romania : 1990)

2020 Volume 115, Issue 6, Page(s) 707–714

Abstract: Background-Objectives: It has been reported, that high posthepatectomy portal vein pressure (PVP) has deleterious effect on the liver parenchyma and causes posthepatectomy liver failure (PHLF) and increased 90-day mortality. Terlipressin, is widely used ... ...

Abstract	Background-Objectives: It has been reported, that high posthepatectomy portal vein pressure (PVP) has deleterious effect on the liver parenchyma and causes posthepatectomy liver failure (PHLF) and increased 90-day mortality. Terlipressin, is widely used to mitigate the effects of portal hyper-tension. Randomised clinical trials (RCTs) demonstrated encouraging results of use of terlipressin for modulation of increased posthepatectomy PVP. The aim of the present study was to evaluate the effectiveness of the pharmacological modulation of the increased posthepatectomy PVP after major hepatectomy.
MeSH term(s)	Cardiovascular Agents/pharmacology ; Hepatectomy/adverse effects ; Humans ; Liver Cirrhosis/surgery ; Liver Diseases/surgery ; Portal Pressure/drug effects ; Portal Vein/drug effects ; Portal Vein/surgery ; Randomized Controlled Trials as Topic ; Terlipressin/pharmacology ; Treatment Outcome
Chemical Substances	Cardiovascular Agents ; Terlipressin (7Z5X49W53P)
Language	English
Publishing date	2020-12-30
Publishing country	Romania
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	419244-8
ISSN	1842-368X ; 1221-9118 ; 0009-4730 ; 0377-5003
ISSN (online)	1842-368X
ISSN	1221-9118 ; 0009-4730 ; 0377-5003
DOI	10.21614/chirurgia.115.6.707
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Zs.B 1352: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 620: Show issues

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Article: No difference in mortality among ALPPS, two-staged hepatectomy, and portal vein embolization/ligation: A systematic review by updated traditional and network meta-analyses.

Gavriilidis, Paschalis / Sutcliffe, Robert P / Roberts, Keith J / Pai, Madhava / Spalding, Duncan / Habib, Nagy / Jiao, Long R / Sodergren, Mikael H

Hepatobiliary & pancreatic diseases international : HBPD INT

2020 Volume 19, Issue 5, Page(s) 411–419

Abstract: Background: There is an ongoing debate on the feasibility, safety, and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique. The aim of this study was to compare ALPPS, two-staged ... ...

Abstract	Background: There is an ongoing debate on the feasibility, safety, and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique. The aim of this study was to compare ALPPS, two-staged hepatectomy (TSH), and portal vein embolization (PVE)/ligation (PVL) using updated traditional meta-analysis and network meta-analysis (NMA). Data sources: Electronic databases were used in a systematic literature search. Updated traditional meta-analysis and NMA were performed and compared. Mortality and major morbidity were selected as primary outcomes. Results: Nineteen studies including 1200 patients were selected from the pool of 436 studies. Of these patients, 315 (31%) and 702 (69%) underwent ALPPS and portal vein occlusion (PVO), respectively. Ninety-day mortality based on updated traditional meta-analysis, subgroup analysis of the randomized controlled trials (RCTs), and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE, PVL, and TSH cohorts. Moreover, analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO cohorts. The ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters, time to operation, definitive hepatectomy, and R0 margins rates compared with the PVO cohort. In contrast, 1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS cohort. Conclusions: This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy approaches. Furthermore, two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Bayes Theorem ; Cell Proliferation ; Embolization, Therapeutic/adverse effects ; Embolization, Therapeutic/mortality ; Female ; Hepatectomy/adverse effects ; Hepatectomy/mortality ; Humans ; Ligation ; Liver/pathology ; Liver/physiopathology ; Liver/surgery ; Liver Regeneration ; Male ; Middle Aged ; Network Meta-Analysis ; Organ Size ; Portal Vein/surgery ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2020-07-25
Publishing country	Singapore
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2241386-8
ISSN	1499-3872
ISSN	1499-3872
DOI	10.1016/j.hbpd.2020.07.005
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