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  1. Article ; Online: Early Recurrence after Upfront Surgery for Pancreatic Ductal Adenocarcinoma.

    Nappo, Gennaro / Donisi, Greta / Capretti, Giovanni / Ridolfi, Cristina / Pagnanelli, Michele / Nebbia, Martina / Bozzarelli, Silvia / Petitti, Tommasangelo / Gavazzi, Francesca / Zerbi, Alessandro

    Current oncology (Toronto, Ont.)

    2023  Volume 30, Issue 4, Page(s) 3708–3720

    Abstract: Background: Survival after surgery for pancreatic ductal adenocarcinoma (PDAC) remains poor, due to early recurrence (ER) of the disease. A global definition of ER is lacking and different cut-off values (6, 8, and 12 months) have been adopted. The aims ...

    Abstract Background: Survival after surgery for pancreatic ductal adenocarcinoma (PDAC) remains poor, due to early recurrence (ER) of the disease. A global definition of ER is lacking and different cut-off values (6, 8, and 12 months) have been adopted. The aims of this study were to define the optimal cut-off for the definition of ER and predictive factors for ER.
    Methods: Recurrence was recorded for all consecutive patients undergoing upfront surgery for PDAC at our institute between 2010 and 2017. Receiver operating characteristic (ROC) curves were utilized, to estimate the optimal cut-off for the definition of ER as a predictive factor for poor post-progression survival (PPS). To identify predictive factors of ER, univariable and multivariable logistic regression models were used.
    Results: Three hundred and fifty one cases were retrospectively evaluated. The recurrence rate was 76.9%. ER rates were 29.0%, 37.6%, and 47.6%, when adopting 6, 8, and 12 months as cut-offs, respectively. A significant difference in median PPS was only shown between ER and late recurrence using 12 months as cut-off (
    Conclusions: A twelve-months cut-off should be adopted for the definition of ER. Almost 50% of upfront-resected patients presented ER, and it significantly affected the prognosis. A high preoperative value of CA 19-9 and the omission of adjuvant treatment were the only predictive factors for ER.
    MeSH term(s) Humans ; Retrospective Studies ; Pancreatic Neoplasms ; Carcinoma, Pancreatic Ductal/surgery ; Prognosis ; Pancreatic Neoplasms
    Language English
    Publishing date 2023-03-27
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 1236972-x
    ISSN 1718-7729 ; 1198-0052
    ISSN (online) 1718-7729
    ISSN 1198-0052
    DOI 10.3390/curroncol30040282
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  2. Article ; Online: Clinical usefulness of routinely performed drain fluid cultures after pancreaticoduodenectomy. A new ally to predict patients' outcomes?

    Ciprani, Debora / Capretti, Giovanni / Sorrentino, Martina / Gramellini, Marco / Famularo, Simone / Casari, Erminia / Gavazzi, Francesca / Nappo, Gennaro / Ridolfi, Cristina / Zerbi, Alessandro

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

    2023  Volume 24, Issue 1, Page(s) 178–183

    Abstract: Background: Previous studies showed that bacterial contamination of surgical drains was associated with higher morbidity and mortality following pancreaticoduodenectomy (PD). However, there is still no agreement on the routine use of fluid drainage ... ...

    Abstract Background: Previous studies showed that bacterial contamination of surgical drains was associated with higher morbidity and mortality following pancreaticoduodenectomy (PD). However, there is still no agreement on the routine use of fluid drainage cultures in the management of patients underwent PD. Therefore, we aimed to clarify the role of surgical drain bacterial contamination in predicting patients' postoperative course.
    Method: Single-centre study including patients underwent PD at Humanitas Research Hospital (2010-2021). Preoperative, intraoperative and postoperative data were collected. Routinely performed fluid drain cultures on postoperative day (POD) 5 were analyzed and compared among patients throughout the cohort.
    Results: A total of 825 patients were analyzed. Bacterial contamination of surgical drains was observed in 420 (50.9 %) patients and it was found to be associated with a higher rate of B/C grade pancreatic fistula (POPF) (P < 0.001), Clavien-Dindo≥3 (P < 0.001), 30-day mortality (P = 0.011), wound infection (P < 0.001), relaparotomies (P = 0.003) and greater length of hospital stay (LOS) (P < 0.001). Also, E. coli surgical drain contamination was demonstrated to double the risk of B/C grade POPF development (OR = 1.628, 95 % IC = 1.009-2.625, P = 0.046). Finally, preoperative biliary drainage (OR = 2.474, 95 % IC = 1.855-3.298, P < 0.001), age ≥75 years old (OR = 1.492, 95 % IC = 1.077-2.067, P = 0.016) and isolated Roux-en-Y pancreaticojejunostomy (OR = 1.639, 95 % IC = 1.229-2.188, P < 0.001) were identified as risk factors for surgical drains bacterial contamination.
    Conclusion: Bacterial contamination of surgical drains predicts the development of B/C grade POPF and other major complications after PD. Therefore, we suggest the routine use of fluid drain cultures following PD.
    MeSH term(s) Humans ; Aged ; Pancreaticoduodenectomy/adverse effects ; Escherichia coli ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Drainage/adverse effects ; Pancreatic Fistula/etiology ; Pancreatic Fistula/complications ; Risk Factors ; Retrospective Studies
    Language English
    Publishing date 2023-12-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2056680-3
    ISSN 1424-3911 ; 1424-3903
    ISSN (online) 1424-3911
    ISSN 1424-3903
    DOI 10.1016/j.pan.2023.12.013
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  3. Article ; Online: Pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous tumor: Different prognostic factors for different overall survival.

    Gavazzi, Francesca / Capretti, Giovanni / Giordano, Laura / Ridolfi, Cristina / Spaggiari, Paola / Sollai, Mauro / Carrara, Silvia / Nappo, Gennaro / Bozzarelli, Silvia / Zerbi, Alessandro

    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

    2021  Volume 54, Issue 6, Page(s) 826–833

    Abstract: Background: It is unclear whether invasive intraductal papillary mucinous neoplasm (IPMN) has different clinical and prognostic characteristics, beyond histological factors, when compared to pancreatic ductal adenocarcinoma (PDAC).: Aims: compare ... ...

    Abstract Background: It is unclear whether invasive intraductal papillary mucinous neoplasm (IPMN) has different clinical and prognostic characteristics, beyond histological factors, when compared to pancreatic ductal adenocarcinoma (PDAC).
    Aims: compare prognostic features of resected PDAC and invasive IPMN METHODS: A retrospective study of patients resected for PDAC or invasive IPMN realized at Humanitas Cancer Center's Pancreatic Surgery Unit, Milan, Italy, between 2010 and 2016. Data recorded included patient demographics, onset symptoms, preoperative health status, tumor features, histology and surgical characteristics. Overall survival was estimated using Kaplan-Meier and prognostic factors for survival were assessed by multivariate Cox regression.
    Results: A total of 332 patients were included (PDAC, n = 289; invasive IPMN, n = 43). Patients with invasive IPMN had better overall survival than PDAC patients (median: 76.6 versus 25.6 months; 5-year OS rate: 65.4% vs. 14.2%; p < 0.001). PDAC histology was associated with a significantly higher risk of death than IPMN (hazard ratio 1.815, 95% CI: 1.02, 3.24; p = 0.044). Survival was also worse with PDAC in early-stage disease (IA-IB-IIA, N0). In multivariate analysis, independent predictors of worse survival included perineural invasion, preoperative ASA physical status ≥3 and pain at diagnosis.
    Conclusions: Patients with IPMN had a better prognosis than PDAC patients, regardless of disease stage.
    MeSH term(s) Adenocarcinoma, Mucinous/pathology ; Adenocarcinoma, Mucinous/surgery ; Carcinoma, Pancreatic Ductal ; Humans ; Pancreatic Intraductal Neoplasms/surgery ; Pancreatic Neoplasms/pathology ; Prognosis ; Retrospective Studies ; Pancreatic Neoplasms
    Language English
    Publishing date 2021-07-01
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1459373-7
    ISSN 1878-3562 ; 1125-8055
    ISSN (online) 1878-3562
    ISSN 1125-8055
    DOI 10.1016/j.dld.2021.06.006
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  4. Article ; Online: Invasive IPMN relapse later and more often in lungs in comparison to pancreatic ductal adenocarcinoma.

    Capretti, Giovanni / Nebbia, Martina / Gavazzi, Francesca / Nappo, Gennaro / Ridolfi, Cristina / Sollai, Mauro / Spaggiari, Paola / Bozzarelli, Silvia / Carrara, Silvia / Luberto, Antonio / Zerbi, Alessandro

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

    2022  Volume 22, Issue 6, Page(s) 782–788

    Abstract: Background: The different oncological outcomes of invasive intraductal papillary mucinous neoplasm (I-IPMN) and pancreatic ductal adenocarcinoma (PDAC) are debated. This study aimed to compare disease recurrence patterns and histopathological ... ...

    Abstract Background: The different oncological outcomes of invasive intraductal papillary mucinous neoplasm (I-IPMN) and pancreatic ductal adenocarcinoma (PDAC) are debated. This study aimed to compare disease recurrence patterns and histopathological characteristics in patients with resected I-IPMN and PDAC.
    Methods: Consecutive patients undergoing surgical resection for stage I-III I-IPMN or PDAC between 2010 and 2016 were retrospectively analyzed. Patients treated with neoadjuvant therapy or resected for Tis neoplasia were excluded. All surgical specimens were re-staged according to AJCC-8th-edition.
    Results: A total of 330 patients were included, of whom 43 had I-IPMN and 287 had PDAC. Median follow-up time was 26.7 (1.3-92.3) months and estimated median disease-free survival (DFS) was 60.3 months (47.2-73.4) for I-IPMN and 23.8 (19.3-28.2) months for PDAC (p < 0.001). During follow-up, 32.6% of I-IPMN and 67.9% of PDAC patients experienced recurrence (p < 0.001). The sites of first recurrence were the lungs (38.5% vs 13.1%, p = 0.027), liver (28.6% vs 45.0%, p = 0.180) and local (15.4% vs 36.6%, p = 0.101) for I-IPMN and PDAC, respectively. At multivariate analysis, I-IPMN histology remained an independent predictive factor for longer DFS (OR 0.528, CI 95% 0.278-1.000, p = 0.050), regardless of stage or adjuvant chemotherapy. I-IPMN and PDAC differed in rates of neuroinvasion (51.2% vs 97.2%) and positive lymph node status (N+) (46.5% vs 82.7%), especially in patients with lower T status.
    Conclusion: I-IPMN showed a different recurrence pattern compared to PDAC, with a higher lung tropism, and longer DFS. This different biological behavior is associated with lower rates of neuroinvasion and nodal involvement, especially in early-stage disease.
    MeSH term(s) Adenocarcinoma, Mucinous/pathology ; Adenocarcinoma, Mucinous/surgery ; Carcinoma, Pancreatic Ductal/pathology ; Humans ; Lung ; Neoplasm Recurrence, Local/epidemiology ; Pancreatic Intraductal Neoplasms ; Pancreatic Neoplasms/surgery ; Retrospective Studies ; Pancreatic Neoplasms
    Language English
    Publishing date 2022-06-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2056680-3
    ISSN 1424-3911 ; 1424-3903
    ISSN (online) 1424-3911
    ISSN 1424-3903
    DOI 10.1016/j.pan.2022.05.006
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  5. Article ; Online: Enhanced Recovery After Pancreatic Surgery Does One Size Really Fit All? A Clinical Score to Predict the Failure of an Enhanced Recovery Protocol After Pancreaticoduodenectomy.

    Capretti, Giovanni / Cereda, Marco / Gavazzi, Francesca / Uccelli, Fara / Ridolfi, Cristina / Nappo, Gennaro / Donisi, Greta / Evangelista, Andrea / Zerbi, Alessandro

    World journal of surgery

    2020  Volume 44, Issue 11, Page(s) 3600–3606

    Abstract: Background: The inability to comply with enhanced recovery protocols (ERp) after pancreaticoduodenectomy (PD) is a real but understated issue. Our goal is to report our experience and a potential tool to predict ERp failure in order to better ... ...

    Abstract Background: The inability to comply with enhanced recovery protocols (ERp) after pancreaticoduodenectomy (PD) is a real but understated issue. Our goal is to report our experience and a potential tool to predict ERp failure in order to better characterize this problem.
    Methods: From January 1, 2014, to January 31, 2016, 205 consecutive patients underwent PD in our center and were managed according to an ERp. Failure to comply with postoperative protocol items was defined as any of: no active ambulation on postoperative day 1 (POD1); less than 4 h out of bed on POD2; removal of nasogastric tube and bladder catheter after POD1 and POD3, respectively; reintroduction of oral feeding after POD4; and continuation of intravenous infusions after POD4. Data were collected in a prospective database.
    Results: Taking in consideration the number of failed items and the length of stay, we defined failure of the ERp as no compliance to two or more items. A total of 116 patients (56.6%) met this definition of failure. We created a predictive model consisting of age, BMI, operative time, and pancreatic stump consistency. These variables were independent predictors of failure (OR 1.03 [1.001-1.06] p = 0.01; OR 1.11 [1.01-1.22] p = 0.03; OR 1.004 [1.001-1.009] p = 0.02 and OR 2.89 [1.48-5.67] p = 0.002, respectively). Patient final score predicted the failure of the ERp with an area under the ROC curve of 0.747.
    Conclusions: It seems to be possible to predict ERp failure after PD. Patients at high risk of failure may benefit more from a specific ERp.
    MeSH term(s) Aged, 80 and over ; Anastomosis, Surgical ; Enhanced Recovery After Surgery ; Female ; Humans ; Length of Stay ; Male ; Pancreas/surgery ; Pancreaticoduodenectomy/adverse effects ; Postoperative Complications ; Postoperative Period
    Language English
    Publishing date 2020-07-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-020-05693-x
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  6. Article ; Online: Exploring a novel composite method using non-contrast EUS enhanced microvascular imaging and cyst fluid analysis to differentiate pancreatic cystic lesions.

    Carrara, Silvia / Fantin, Alberto / Khalaf, Kareem / Rizkala, Tommy / Koleth, Glenn / Andreozzi, Marta / Spadaccini, Marco / Colombo, Matteo / Gruppo, Mario / Bonifacio, Cristiana / Gavazzi, Francesca / Capretti, Giovanni Luigi / Ridolfi, Cristina / Nappo, Gennaro / Spaggiari, Paola / Tommaso, Luca Di / Sollai, Mauro / Zerbi, Alessandro / Maselli, Roberta /
    Fugazza, Alessandro / Hassan, Cesare / Facciorusso, Antonio / Repici, Alessandro

    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

    2023  Volume 55, Issue 11, Page(s) 1548–1553

    Abstract: Background and aims: Differentiating pancreatic cystic lesions (PCLs) remains a diagnostic challenge. The use of high-definition imaging modalities which detect tumor microvasculature have been described in solid lesions. We aim to evaluate the ... ...

    Abstract Background and aims: Differentiating pancreatic cystic lesions (PCLs) remains a diagnostic challenge. The use of high-definition imaging modalities which detect tumor microvasculature have been described in solid lesions. We aim to evaluate the usefulness of cystic microvasculature when used in combination with cyst fluid biochemistry to differentiate PCLs.
    Methods: We retrospectively analyzed 110 consecutive patients with PCLs from 2 Italian Hospitals who underwent EUS with H-Flow and EUS fine needle aspiration to obtain cystic fluid. The accuracy of fluid biomarkers was evaluated against morphological features on radiology and EUS. Gold standard for diagnosis was surgical resection. A clinical and radiological follow up was applied in those patients who were not resected because not surgical indication and no signs of malignancy were shown.
    Results: Of 110 patients, 65 were diagnosed with a mucinous cyst, 41 with a non-mucinous cyst, and 4 with an undetermined cyst. Fluid analysis alone yielded 76.7% sensitivity, 56.7% specificity, 77.8 positive predictive value (PPV), 55.3 negative predictive value (NPV) and 56% accuracy in diagnosing pancreatic cysts alone. Our composite method yielded 97.3% sensitivity, 77.1% specificity, 90.1% PPV, 93.1% NPV, 73.2% accuracy.
    Conclusions: This new composite could be applied to the holistic approach of combining cyst morphology, vascularity, and fluid analysis alongside endoscopist expertise.
    MeSH term(s) Humans ; Cyst Fluid ; Retrospective Studies ; Pancreatic Neoplasms/pathology ; Pancreas/diagnostic imaging ; Pancreas/pathology ; Pancreatic Cyst/diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
    Language English
    Publishing date 2023-08-21
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1459373-7
    ISSN 1878-3562 ; 1125-8055
    ISSN (online) 1878-3562
    ISSN 1125-8055
    DOI 10.1016/j.dld.2023.08.038
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  7. Article ; Online: The evolution of post-operative pancreatic fistula (POPF) classification: A single-center experience.

    Nappo, Gennaro / Capretti, Giovanni Luigi / Petitti, Tommasangelo / Gavazzi, Francesca / Ridolfi, Cristina / Cereda, Marco / Montorsi, Marco / Zerbi, Alessandro

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

    2019  Volume 19, Issue 3, Page(s) 449–455

    Abstract: Background: The ISGPS classification of post-operative pancreatic fistula (POPF) was recently revised, introducing the concept of biochemical leak (BL) which replaced grade A POPF. More recently, an additional distinction on three different subclasses ... ...

    Abstract Background: The ISGPS classification of post-operative pancreatic fistula (POPF) was recently revised, introducing the concept of biochemical leak (BL) which replaced grade A POPF. More recently, an additional distinction on three different subclasses for grade B (B1-B3) POPF was proposed. The aim of this study was to evaluate the impact of these modifications in clinical practice.
    Methods: All pancreatico-duodenectomies (PD) and distal pancreatectomies (DP) performed between 2010 and 2016 were retrospectively evaluated. Incidence and grade of POPF using the old and new ISGPS classification were evaluated. Three grade B subclasses (B1: maintenance of abdominal drain >3 weeks; B2: adoption of specific medical treatments for POPF; B3: use of radiological procedures) were evaluated for clinical severity.
    Results: A total of 716 patients (502 PD, 214 DP) were evaluated. The new ISGPS classification reduced the reported rate of POPF (30.7% vs 35.2% for PD, p > 0.05; 28% vs 44.9% for DP, p < 0.05), due to the abolition of grade A POPF. Grade B1, B2 and B3 rates were 3.1%, 73.8% and 23.1% in PD and 12.3%, 47.4% and 40.3% in DP, respectively. Passing from B1 to B3, significant increases in wound infection (0-40%), mean length of stay in PD (14.7-22.5 days; p < 0.05) and readmission rate in DP (0-39.1%) were observed.
    Conclusions: The new ISGPS classification significantly reduces the reported rate of POPF, particularly after DP. The three different grade B subclasses (B1-B3) better discriminate the severity of post-operative course, especially after PD.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy/adverse effects ; Pancreatic Fistula/etiology ; Pancreatic Fistula/pathology ; Pancreaticoduodenectomy/adverse effects ; Postoperative Complications/pathology ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2019-03-14
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2056680-3
    ISSN 1424-3911 ; 1424-3903
    ISSN (online) 1424-3911
    ISSN 1424-3903
    DOI 10.1016/j.pan.2019.03.004
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  8. Article ; Online: Trans-duodenal ampullectomy for ampullary neoplasms: early and long-term outcomes in 36 consecutive patients.

    Nappo, Gennaro / Gentile, Damiano / Galvanin, Jacopo / Capretti, Giovanni / Ridolfi, Cristina / Petitti, Tommasangelo / Spaggiari, Paola / Carrara, Silvia / Gavazzi, Francesca / Repici, Alessandro / Zerbi, Alessandro

    Surgical endoscopy

    2019  Volume 34, Issue 10, Page(s) 4358–4368

    Abstract: Background: Trans-duodenal ampullectomy (TDA) is a surgical option for the treatment of selected ampullary neoplasms. The aim of this study was to evaluate our experience with TDA for the treatment of ampullary neoplasms, focusing on indications, ... ...

    Abstract Background: Trans-duodenal ampullectomy (TDA) is a surgical option for the treatment of selected ampullary neoplasms. The aim of this study was to evaluate our experience with TDA for the treatment of ampullary neoplasms, focusing on indications, technical aspects, and short- and long-term outcomes.
    Methods: All TDAs for ampullary neoplasms performed between January 2010 and December 2018 at our institution were retrospectively evaluated. Patients had ampullary neoplasms with low-grade dysplasia or in situ carcinoma (Tis) not suitable for an endoscopic approach, ampullary carcinoma unfit for pancreaticoduodenectomy (PD), or ampullary neuroendocrine G1-tumours.
    Results: Thirty-six patients were included in the study: 9 (25.0%) with neoplasms with low-grade dysplasia, 4 (11.1%) with G1 neuroendocrine tumours and 23 (63.9%) with Tis or invasive carcinoma. Mean operative time was 252.5 min. Overall and severe (Clavien-Dindo > IIIa) morbidity rate was 44.4% and 13.9%, respectively. No 90-day mortality was observed. At follow-up, no deaths were observed and local recurrence rate was 11.1% for patients with ampullary adenomas with low-grade dysplasia. Among four patients with neuroendocrine neoplasms, only one developed recurrence (pulmonary). Tis, T1 and T2 lesions were found in 16 (69.6%), 2 (8.7%) and 5 (21.7%) patients, respectively: recurrence occurred in 3 patients with Tis lesions (one malignant), no patients with T1 neoplasms and 2 patients with T2 lesions (3 patients had a survival of > 3 years).
    Conclusions: TDA is a feasible and effective surgical procedure for the treatment of ampullary adenomas with low-grade dysplasia when endoscopic approach is contraindicated or has failed. For lesions with evidence of malignancy, TDA seems to be an oncological safe procedure for Tis ampullary cancer and a good palliative procedure for patients unfit for PD. Moreover, TDA may be appropriate for the treatment of G1 ampullary neuroendocrine neoplasms. A large multicentre study of TDA for early ampullary cancers is needed.
    MeSH term(s) Aged ; Ampulla of Vater/pathology ; Ampulla of Vater/surgery ; Duodenal Neoplasms/surgery ; Female ; Humans ; Intraoperative Care ; Male ; Middle Aged ; Neoplasm Recurrence, Local/surgery ; Neuroendocrine Tumors/surgery ; Operative Time ; Postoperative Care ; Retrospective Studies ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2019-10-23
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-019-07206-x
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  9. Article ; Online: Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in surgical site infections after pancreaticoduodenectomy.

    Gavazzi, Francesca / Ridolfi, Cristina / Capretti, Giovanni / Angiolini, Maria Rachele / Morelli, Paola / Casari, Erminia / Montorsi, Marco / Zerbi, Alessandro

    BMC gastroenterology

    2016  Volume 16, Page(s) 43

    Abstract: Background: The routine use of preoperative biliary drainage before pancreaticoduodenectomy (PD) remains controversial. This observational retrospective study compared stented and non-stented patients undergoing PD to assess any differences in post- ... ...

    Abstract Background: The routine use of preoperative biliary drainage before pancreaticoduodenectomy (PD) remains controversial. This observational retrospective study compared stented and non-stented patients undergoing PD to assess any differences in post-operative morbidity and mortality.
    Methods: A total of 180 consecutive patients who underwent PD and had intra-operative bile cultures performed between January 2010 and February 2013 were retrospectively identified. All patients received peri-operative intravenous antibiotic prophylaxis, primarily cefazolin.
    Results: Overall incidence of post-operative surgical complications was 52.3 %, with no difference between stented and non-stented patients (53.4 % vs. 51.1 %; p = 0.875). However, stented patients had a significantly higher incidence of deep incisional surgical site infections (SSIs) (p = 0.038). In multivariate analysis, biliary stenting was confirmed as a risk factor for deep incisional SSIs (p = 0.044). Significant associations were also observed for cardiac disease (p = 0.010) and BMI ≥25 kg/m(2) (p = 0.045). Enterococcus spp. were the most frequent bacterial isolates in bile (74.5 %) and in drain fluid (69.1 %). In antimicrobial susceptibilty testing, all Enterococci isolates were cefazolin-resistant.
    Conclusion: Given the increased risk of deep incisional SSIs, preoperative biliary stenting in patients underging PD should be used only in selected patients. In stented patients, an antibiotic with anti-enterococcal activity should be chosen for PD prophylaxis.
    MeSH term(s) Adenocarcinoma/surgery ; Adenoma/surgery ; Aged ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Bile/microbiology ; Biliary Tract Surgical Procedures/utilization ; Cefazolin/therapeutic use ; Cholangiopancreatography, Endoscopic Retrograde/utilization ; Comorbidity ; Databases, Factual ; Duodenal Neoplasms/surgery ; Enterococcus/isolation & purification ; Female ; Heart Diseases/epidemiology ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Multivariate Analysis ; Overweight/epidemiology ; Pancreatic Diseases/surgery ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Preoperative Care/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Stents ; Surgical Wound Infection/epidemiology
    Chemical Substances Anti-Bacterial Agents ; Cefazolin (IHS69L0Y4T)
    Language English
    Publishing date 2016-03-31
    Publishing country England
    Document type Journal Article ; Observational Study
    ISSN 1471-230X
    ISSN (online) 1471-230X
    DOI 10.1186/s12876-016-0460-1
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  10. Article ; Online: Role of C-Reactive Protein Assessment as Early Predictor of Surgical Site Infections Development after Pancreaticoduodenectomy.

    Angiolini, Maria Rachele / Gavazzi, Francesca / Ridolfi, Cristina / Moro, Matteo / Morelli, Paola / Montorsi, Marco / Zerbi, Alessandro

    Digestive surgery

    2016  Volume 33, Issue 4, Page(s) 267–275

    Abstract: Background: Surgical site infections (SSIs) are extremely common in pancreatic surgery and explain its considerable morbidity and mortality, even in tertiary centers. Early detection of these complications, with the help of laboratory assays, improve ... ...

    Abstract Background: Surgical site infections (SSIs) are extremely common in pancreatic surgery and explain its considerable morbidity and mortality, even in tertiary centers. Early detection of these complications, with the help of laboratory assays, improve clinical outcome. The aim of the present study is to evaluate C-reactive protein (CRP) diagnostic accuracy as early predictor of SSIs after pancreaticoduodenectomy (PD).
    Methodology: We considered 251 consecutive PD. We prospectively recorded preoperative clinical and anthropometric data, intraoperative details and the postoperative outcome. In the first pool of consecutive patients (n = 150), we analyzed CRP levels from postoperative day 1 to 7 and investigated the prediction of SSIs. We then validated the diagnostic accuracy on the following 101 consecutive cases.
    Results: At multivariate analysis, high BMI and preoperative biliary stenting appeared to be independently associated with SSIs and organ-space SSI development. The CRP cutoff of 17.27 mg/dl on postoperative day 3 (78% sensitivity, 79% specificity) and of 14.72 mg/dl on postoperative day 4 (87% sensitivity, 82% specificity) was in a position to predict the course of 78.2 and 80.2% of patients, respectively.
    Conclusions: CRP on postoperative days 3 and 4 seems able to predict postoperative course, selecting patients deserving intensification of diagnostic assessment; patients not satisfying these conditions could be reasonably directed toward early discharge.
    MeSH term(s) Aged ; C-Reactive Protein/metabolism ; Female ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy/adverse effects ; Predictive Value of Tests ; Prospective Studies ; Surgical Wound Infection/blood ; Surgical Wound Infection/diagnosis ; Surgical Wound Infection/etiology ; Time Factors
    Chemical Substances C-Reactive Protein (9007-41-4)
    Language English
    Publishing date 2016
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 605888-7
    ISSN 1421-9883 ; 0253-4886
    ISSN (online) 1421-9883
    ISSN 0253-4886
    DOI 10.1159/000445006
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