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Article ; Online: ASO Author Reflections: The Beneficial Effect of High-Volume Center Experience on Surgical Outcomes After Total Pancreatectomy.

Stoop, Thomas F / Del Chiaro, Marco

2020 Volume 27, Issue Suppl 3, Page(s) 878–879

MeSH term(s)	Humans ; Pancreatectomy ; Pancreatic Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2020-08-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-020-08986-6
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Article ; Online: Surgical management of severe pancreatic fistula after pancreatoduodenectomy: a comparison of early versus late rescue pancreatectomy.

Stoop, Thomas F / Fröberg, Klara / Sparrelid, Ernesto / Del Chiaro, Marco / Ghorbani, Poya

Langenbeck's archives of surgery

2022 Volume 407, Issue 8, Page(s) 3467–3478

Abstract: Background: Rescue pancreatectomy for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) is associated with high mortality. However, in-depth literature is scarce and hard to interpret. This study aimed to evaluate the indications, ...

Abstract	Background: Rescue pancreatectomy for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) is associated with high mortality. However, in-depth literature is scarce and hard to interpret. This study aimed to evaluate the indications, timing and perioperative outcomes of rescue pancreatectomy for severe POPF after PD. Methods: Retrospective single-centre study from all consecutive patients (2008-2020) with POPF-C after PD (ISGPS 2016 definition). Major morbidity and mortality during hospitalization or within 90 days after index surgery were evaluated. Time from index surgery to rescue pancreatectomy was dichotomized in early and late (≤ 11 versus > 11 days). Results: From 1076 PDs performed, POPF-B/C occurred in 190 patients (17.7%) of whom 53 patients (4.9%) with POPF-C were included. Mortality after early rescue pancreatectomy did not differ significantly compared to late rescue pancreatectomy (13.6% versus 35.3%; p = 0.142). Timing of a rescue pancreatectomy did not change significantly during the study period: 11 (IQR, 8-14) (2008-2012) versus 14 (IQR, 7-33) (2013-2016) versus 8 days (IQR, 6-11) (2017-2020) (p = 0.140). Over time, the mortality in patients with POPF grade C decreased from 43.5% in 2008-2012 to 31.6% in 2013-2016 up to 0% in 2017-2020 (p = 0.014). However, mortality rates after rescue pancreatectomy did not differ significantly: 31.3% (2008-2012) versus 28.6% (2013-2016) versus 0% (2017-2020) (p = 0.104). Conclusions: Rescue pancreatectomy for severe POPF is associated with high mortality, but an earlier timing might favourably influence the mortality. Hypothetically, this could be of value for pre-existent vulnerable patients. These findings must be carefully interpreted considering the sample sizes and differences among subgroups by patient selection.
Language	English
Publishing date	2022-11-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-022-02708-0
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Article ; Online: Risk Factors, Management, and Outcome of Gastric Venous Congestion After Total Pancreatectomy: An Underestimated Complication Requiring Standardized Identification, Grading, and Management.

Stoop, Thomas F / von Gohren, André / Engstrand, Jennie / Sparrelid, Ernesto / Gilg, Stefan / Del Chiaro, Marco / Ghorbani, Poya

Annals of surgical oncology

2023 Volume 30, Issue 12, Page(s) 7700–7711

Abstract: Background: Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, ... ...

Abstract	Background: Gastric venous congestion (GVC) after total pancreatectomy (TP) is rarely studied despite its high 5% to 28% incidence and possible association with mortality. This study aimed to provide insight about incidence, risk factors, management, and outcome of GVC after TP. Methods: This retrospective observational single-center study included all patients undergoing elective TP from 2008 to 2021. The exclusion criteria ruled out a history of gastric resection, concomitant (sub)total gastrectomy for oncologic indication(s) or celiac axis resection, and postoperative (sub)total gastrectomy for indication(s) other than GVC. Results: The study enrolled 268 patients. The in-hospital major morbidity (Clavien-Dindo grade ≥IIIa) rate was 28%, and the 90-day mortality rate was 3%. GVC was identified in 21% of patients, particularly occurring during index surgery (93%). Intraoperative GVC was managed with (sub)total gastrectomy for 55% of the patients. The major morbidity rate was higher for the patients with GVC (44% vs 24%; p = 0.003), whereas the 90-day mortality did not differ significantly (5% vs 3%; p = 0.406). The predictors for major morbidity were intraoperative GVC (odds ratio [OR], 2.207; 95% confidence interval [CI], 1.142-4.268) and high TP volume (> 20 TPs/year: OR, 0.360; 95% CI, 0.175-0.738). The predictors for GVC were portomesenteric venous resection (PVR) (OR, 2.103; 95% CI, 1.034-4.278) and left coronary vein ligation (OR, 11.858; 95% CI, 5.772-24.362). Conclusions: After TP, GVC is rather common (in 1 of 5 patients). GVC during index surgery is predictive for major morbidity, although not translating into higher mortality. Left coronary vein ligation and PVR are predictive for GVC, requiring vigilance during and after surgery, although gastric resection is not always necessary. More evidence on prevention, identification, classification, and management of GVC is needed.
MeSH term(s)	Humans ; Pancreatectomy/adverse effects ; Retrospective Studies ; Hyperemia/etiology ; Hyperemia/surgery ; Stomach Neoplasms ; Risk Factors ; Gastrectomy/adverse effects ; Postoperative Complications/epidemiology
Language	English
Publishing date	2023-08-19
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-023-13847-z
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Article ; Online: ASO Author Reflections: Gastric Venous Congestion After Total Pancreatectomy is an Underestimated Complication.

Stoop, Thomas F / von Gohren, André / Engstrand, Jennie / Sparrelid, Ernesto / Gilg, Stefan / Del Chiaro, Marco / Ghorbani, Poya

Annals of surgical oncology

2023 Volume 30, Issue 12, Page(s) 7758–7759

Language	English
Publishing date	2023-08-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-023-13979-2
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Article ; Online: ASO Author Reflections: Nationwide Experience on Locally Advanced Pancreatic Cancer Surgery After Induction Chemotherapy in the Netherlands: A Stepping Stone for the PREOPANC-4 Trial.

Stoop, Thomas F / Seelen, Leonard W F / van 't Land, Freek R / van Eijck, Casper H J / van Santvoort, Hjalmar C / Besselink, Marc G

Annals of surgical oncology

2023 Volume 31, Issue 4, Page(s) 2658–2659

MeSH term(s)	Humans ; Induction Chemotherapy ; Neoadjuvant Therapy ; Netherlands ; Pancreas/surgery ; Pancreatectomy ; Pancreatic Hormones ; Pancreatic Neoplasms/drug therapy ; Pancreatic Neoplasms/surgery ; Clinical Trials as Topic
Chemical Substances	Pancreatic Hormones
Language	English
Publishing date	2023-12-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-023-14704-9
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Article ; Online: ASO Author Reflections: Acceptable Impact of Endocrine and Exocrine Insufficiency on Quality of Life After Total Pancreatectomy.

Stoop, Thomas F / Del Chiaro, Marco

Annals of surgical oncology

2019 Volume 27, Issue 2, Page(s) 597–598

MeSH term(s)	Exocrine Pancreatic Insufficiency/epidemiology ; Humans ; Incidence ; Islets of Langerhans/pathology ; Pancreatectomy/adverse effects ; Pancreatic Neoplasms/surgery ; Prognosis ; Quality of Life
Language	English
Publishing date	2019-10-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-019-08008-0
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Article ; Online: ASO Author Reflections: The Value of Serum CEA for Prognostication at Staging and Response Evaluation in Patients with Localized Pancreatic Adenocarcinoma and Nonelevated CA19-9.

Stoop, Thomas F / Doppenberg, Deesje / Katz, Matthew H G / Tzeng, Ching-Wei D / Wei, Alice C / Zureikat, Amer H / Groot Koerkamp, Bas / Besselink, Marc G

Annals of surgical oncology

2024 Volume 31, Issue 3, Page(s) 1842–1843

MeSH term(s)	Humans ; CA-19-9 Antigen ; Pancreatic Neoplasms/pathology ; Adenocarcinoma/pathology ; Biomarkers, Tumor ; Carcinoembryonic Antigen ; Prognosis ; Neoplasm Staging
Chemical Substances	CA-19-9 Antigen ; Biomarkers, Tumor ; Carcinoembryonic Antigen
Language	English
Publishing date	2024-01-05
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-023-14815-3
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Article ; Online: Impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX: Trans-Atlantic Pancreatic Surgery (TAPS) Consortium study.

Theijse, Rutger T / Stoop, Thomas F / Janssen, Quisette P / Prakash, Laura R / Katz, Matthew H G / Doppenberg, Deesje / Tzeng, Ching-Wei D / Wei, Alice C / Zureikat, Amer H / Groot Koerkamp, Bas / Besselink, Marc G

The British journal of surgery

2024 Volume 111, Issue 3

Abstract: Background: Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not ...

Abstract	Background: Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy. Methods: This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012-2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C). Results: Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1%) in group A, 425 patients (64.1%) in group B, and 171 patients (25.8%) in group C). A non-therapeutic laparotomy occurred in 28.2% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8%) and a 90-day mortality rate of 3.0% (2 of 67). Administration of palliative therapy (65.9% versus 73.1%; P = 0.307) and median overall survival (20.4 [95% c.i. 15.9 to 27.3] versus 20.2 [95% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4%, 8.7%, and 24.7% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95% c.i. 0.61 to 1.27]). Conclusion: More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes.
MeSH term(s)	Humans ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Pancreatic Neoplasms/drug therapy ; Pancreatic Neoplasms/surgery ; Pancreatic Neoplasms/pathology ; Laparotomy ; Retrospective Studies ; Fluorouracil ; Leucovorin/therapeutic use ; Neoadjuvant Therapy ; Irinotecan ; Oxaliplatin
Chemical Substances	folfirinox ; Fluorouracil (U3P01618RT) ; Leucovorin (Q573I9DVLP) ; Irinotecan (7673326042) ; Oxaliplatin (04ZR38536J)
Language	English
Publishing date	2024-03-08
Publishing country	England
Document type	Multicenter Study ; Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znae033
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Article ; Online: Serum CEA as a Prognostic Marker for Overall Survival in Patients with Localized Pancreatic Adenocarcinoma and Non-Elevated CA19-9 Levels Treated with FOLFIRINOX as Initial Treatment: A TAPS Consortium Study.

Doppenberg, Deesje / Stoop, Thomas F / van Dieren, Susan / Katz, Matthew H G / Janssen, Quisette P / Nasar, Naaz / Prakash, Laura R / Theijse, Rutger T / Tzeng, Ching-Wei D / Wei, Alice C / Zureikat, Amer H / Groot Koerkamp, Bas / Besselink, Marc G

Annals of surgical oncology

2024 Volume 31, Issue 3, Page(s) 1919–1932

Abstract: Introduction: About 25% of patients with localized pancreatic adenocarcinoma have non-elevated serum carbohydrate antigen (CA) 19-9 levels at baseline, hampering evaluation of response to preoperative treatment. Serum carcinoembryonic antigen (CEA) is a ...

Abstract	Introduction: About 25% of patients with localized pancreatic adenocarcinoma have non-elevated serum carbohydrate antigen (CA) 19-9 levels at baseline, hampering evaluation of response to preoperative treatment. Serum carcinoembryonic antigen (CEA) is a potential alternative. Methods: This retrospective cohort study from five referral centers included consecutive patients with localized pancreatic adenocarcinoma (2012-2019), treated with one or more cycles of (m)FOLFIRINOX, and non-elevated CA19-9 levels (i.e., < 37 U/mL) at baseline. Cox regression analyses were performed to assess prognostic factors for overall survival (OS), including CEA level at baseline, restaging, and dynamics. Results: Overall, 277 patients were included in this study. CEA at baseline was elevated (≥5 ng/mL) in 53 patients (33%) and normalized following preoperative therapy in 14 patients (26%). In patients with elevated CEA at baseline, median OS in patients with CEA normalization following preoperative therapy was 33 months versus 19 months in patients without CEA normalization (p = 0.088). At time of baseline, only elevated CEA was independently associated with (worse) OS (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.04-1.98). At time of restaging, elevated CEA at baseline was still the only independent predictor for (worse) OS (HR 1.44, 95% CI 1.04-1.98), whereas elevated CEA at restaging (HR 1.16, 95% CI 0.77-1.77) was not. Conclusions: Serum CEA was elevated in one-third of patients with localized pancreatic adenocarcinoma having non-elevated CA19-9 at baseline. At both time of baseline and time of restaging, elevated serum CEA measured at baseline was the only predictor for (worse) OS. Therefore, serum CEA may be a useful tool for decision making at both initial staging and time of restaging in patients with non-elevated CA19-9.
MeSH term(s)	Humans ; Pancreatic Neoplasms/surgery ; Carcinoembryonic Antigen ; CA-19-9 Antigen ; Antineoplastic Combined Chemotherapy Protocols ; Biomarkers, Tumor ; Prognosis ; Retrospective Studies ; Adenocarcinoma/surgery ; Irinotecan ; Oxaliplatin ; Leucovorin ; Fluorouracil
Chemical Substances	Carcinoembryonic Antigen ; CA-19-9 Antigen ; folfirinox ; Biomarkers, Tumor ; Irinotecan (7673326042) ; Oxaliplatin (04ZR38536J) ; Leucovorin (Q573I9DVLP) ; Fluorouracil (U3P01618RT)
Language	English
Publishing date	2024-01-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-023-14680-0
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Article ; Online: Surgical outcome of a double versus a single pancreatoduodenectomy per operating day.

Theijse, Rutger T / Stoop, Thomas F / Geerdink, Niek J / Daams, Freek / Zonderhuis, Babs M / Erdmann, Joris I / Swijnenburg, Rutger Jan / Kazemier, Geert / Busch, Olivier R / Besselink, Marc G

Surgery

2023 Volume 173, Issue 5, Page(s) 1263–1269

Abstract: Background: For logistical reasons, some high-volume centers have developed surgical programs wherein 1 surgical team performs 2 pancreatoduodenectomies on a single day. It is unclear whether this practice has a negative impact on surgical outcome.: ... ...

Abstract	Background: For logistical reasons, some high-volume centers have developed surgical programs wherein 1 surgical team performs 2 pancreatoduodenectomies on a single day. It is unclear whether this practice has a negative impact on surgical outcome. Methods: We conuducted a retrospective analysis including all consecutive open pancreatoduodenectomies in a single high-volume center (2014-2021). Pancreatoduodenectomies were grouped as the first (pancreatoduodenectomy-1) or second (pancreatoduodenectomy-2) pancreatoduodenectomy on a single day (ie, paired pancreatoduodenectomies) and as pancreatoduodenectomy-3 whenever 1 pancreatoduodenectomy was performed per day (ie, unpaired). Patients undergoing minimally invasive procedures were excluded. The primary outcomes were major morbidity (ie, Clavien-Dindo grade ≥IIIa) and mortality. Results: Among 689 patients, 151 patients had undergone minimally invasive pancreatoduodenectomy, leaving 538 patients after open pancreatoduodenectomy for inclusion. The overall rate of major morbidity was 37.4% (n = 200/538) and in-hospital/30-day mortality 1.7% (n = 9/538). Overall, 136 (25.3%) patients were operated in 68 pancreatoduodenectomy-1/ pancreatoduodenectomy-2 pairs and 402 (74.7%) patients as unpaired pancreatoduodenectomy (pancreatoduodenectomy-3). No differences were found between pancreatoduodenectomy-1 and pancreatoduodenectomy-2 regarding the rates of major morbidity (35.3% vs 26.5%; P = .265) and mortality (1.5% vs 0%; P = .999). Between the 68 pancreatoduodenectomy-1/ pancreatoduodenectomy-2 pairs and the 402 unpaired pancreatoduodenectomies, the rates of major morbidity (30.9% vs 39.6%; P = .071) and mortality (0.7% vs 2.0%; P = .461) did not differ significantly. In multivariable logistic regression analysis, pancreatoduodenectomy-1 was not associated with major morbidity (odds ratio = 0.913 [95% confidence interval 0.515-1.620]; P = .756), whereas pancreatoduodenectomy-2 was associated with less major morbidity (odds ratio = 0.522 [95% confidence interval 0.277-0.983]; P = .045). Conclusion: In a high-volume setting, performing 2 consecutive open pancreatoduodenectomies on a single operating day appears to be safe. This approach may be an option when logistically required.
MeSH term(s)	Humans ; Retrospective Studies ; Pancreaticoduodenectomy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Robotic Surgical Procedures ; Treatment Outcome
Language	English
Publishing date	2023-02-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.01.010
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