Publications by authors named "Niccolo Napoli"
Objective: To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD).
Background: Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise.
The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice.
View Article and Find Full Text PDFBackground: Textbook outcome (TO) is a composite variable that can define the quality of pancreatic surgery. The aim of this study is to evaluate TO after pancreatoduodenectomy (PD) for nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs).
Patients And Methods: All patients who underwent PD for NF-PanNETs (2007-2016) in different centers were included in this retrospective study.
Article Synopsis
- The REDISCOVER consensus conference focused on creating guidelines for the perioperative care of patients with borderline-resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC).
- Using a structured methodology and expert consensus, the conference developed 34 recommendations on various aspects of surgical care, patient selection, and management of pancreatic cancer.
- Despite the low evidence quality for most recommendations, participants highlighted the importance of establishing an international registry to enhance understanding and care for this patient group.
Background: Newer chemotherapy regimens are reviving the role of pancreatectomy with arterial resection (PAR) in locally advanced pancreatic cancer. However, concerns about the early outcomes and learning curve of PAR remain. This study aimed to define the postoperative results and learning curve of PAR and provide preliminary data on oncologic outcomes.
View Article and Find Full Text PDFArticle Synopsis
- Living donor kidney transplantation (LDKTx) is endorsed by scientific societies for its effectiveness, with 40,663 kidney transplants done in Italy from 2001 to 2022, including 4731 from living donors.
- The study found no postoperative deaths among living donors, and a high 10-year donor survival rate of 93.38%, though 1.8% of donors developed renal disease post-surgery.
- The survey revealed that while many transplant centers use minimally invasive techniques and safety checklists, there is a need for improved donor safety protocols and increased experience among surgical teams in Italy.
Article Synopsis
- Lymph-nodal involvement (N+) is a negative prognostic factor for patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma, and existing preoperative diagnostic tools are not very effective at detecting it.
- This study analyzed data from 2034 patients to determine if preoperative levels of the tumor marker CA19.9 could predict N+ status in resectable pancreatic cancer (R-PDAC).
- The results indicated a significant association between elevated CA19.9 levels (above 37 U/L) and N+ status, particularly in patients classified as cT3, suggesting that high CA19.9 could help identify patients at greater risk for lymph-nodal involvement before surgery.
The prognostic value of carbohydrate antigen 125 (Ca 125) is emerging also in pancreatic cancer (PDAC). In this study, we aim to define the prognostic value of Ca 125 in resected PDAC of the head of the pancreas. This is a single-center, retrospective study.
View Article and Find Full Text PDFThis retrospective analysis of the prospective IGOMIPS registry reports on 1191 minimally invasive pancreatic resections (MIPR) performed in Italy between 2019 and 2022, including 668 distal pancreatectomies (DP) (55.7%), 435 pancreatoduodenectomies (PD) (36.3%), 44 total pancreatectomies (3.
View Article and Find Full Text PDFCareful preoperative planning is key in minimally invasive radical antegrade modular pancreatosplenectomy (MI-RAMPS). This retrospective study aims to show the practical implications of computed tomography distance between the right margin of the tumor and either the left margin of the spleno-mesenteric confluence (d-SMC) or the gastroduodenal artery (d-GDA). Between January 2011 and June 2022, 48 minimally invasive RAMPS were performed for either pancreatic cancer or malignant intraductal mucinous papillary neoplasms.
View Article and Find Full Text PDFPancreas sparing total duodenectomy (PSTD) is an exceedingly rare procedure that is performed mostly for benign disease, widely involving the duodenum, that cannot be treated otherwise. PSTD requires meticulous dissection as well as reconstruction of both biliary and pancreatic drainage. Despite these technical aspects appear to be ideal for robotic assistance, robotic PSTD has not been described yet.
View Article and Find Full Text PDFBackground: Difficulty scoring systems are important for the safe, stepwise implementation of new procedures. We designed a retrospective observational study for building a difficulty score for robotic pancreatoduodenectomy.
Methods: The difficulty score (PD-ROBOSCORE) aims at predicting severe postoperative complications after robotic pancreatoduodenectomy.
Article Synopsis
- - Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard for patients who respond to neoadjuvant therapies, and the feasibility of robotic pancreatoduodenectomy with vein resection (RPD-VR) has been demonstrated, yet detailed challenges have not been thoroughly addressed.
- - The study outlines various vascular techniques adopted from OPD-VR and robotic transplant procedures, providing a detailed classification of vein resections into four types, with video demonstrations of each.
- - Out of 783 pancreatoduodenectomies performed over 13 years, 36 were RPD-VR, showing a 90-day mortality of 8.3% and low conversion to open surgery
Purpose: A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort.
Methods: An observational multicenter European study from 2010 to 2015.
Background: This study aims to describe the technique and the results of double-layer continuous suture hepaticojejunostomy (HJ) following pancreatoduodenectomy (PD) and total pancreatectomy (TP).
Methods: A prospectively maintained database was analyzed retrospectively to identify incidence and severity of biliary leaks (BL) (ISGLS definition), as well as of HJ stenosis (HJS), cholangitis, and need for redo-HJ (in patients with a follow-up ≥3 years) in a consecutive series of 800 procedures (PD = 603; TP = 197). Predictors of biliary complications were also identified.
The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy With Concomitant Portomesenteric Venous Resection: An International Multicenter Analysis.
Ann Surg
November 2021
Article Synopsis
- The study aimed to determine the impact of neoadjuvant therapy (NAT) on the rates of complete tumor resection (R0) and long-term survival outcomes in patients with pancreatic ductal adenocarcinoma undergoing surgery with vein resection.
- Overall, results from 1192 patients showed that those who received NAT had significantly higher rates of R0 resection (57%) and better survival rates after 1, 3, and 5 years compared to those who did not receive NAT.
- The findings suggest that NAT should be considered routinely for patients with pancreatic ductal adenocarcinoma scheduled for surgery involving venous reconstruction.
Objective: To assess postoperative 90-day outcomes after minimally invasive (laparoscopic/robot-assisted) total pancreatectomy (MITP) in selected patients versus open total pancreatectomy (OTP) among European centers.
Background: Minimally invasive pancreatic surgery is becoming increasingly popular but data on MITP are scarce and multicenter studies comparing outcomes versus OTP are lacking. It therefore remains unclear if MITP is a valid alternative.
Article Synopsis
- * Both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplant alone enhance long-term survival and significantly improve recipients' quality of life, outweighing potential downsides.
- * SPK performed before dialysis offers better outcomes than after dialysis, which adversely affects survival rates, suggesting that kidney grafts should be preferentially allocated to SPK candidates.
Current evidence shows that robotic pancreatoduodenectomy (RPD) is feasible with a safety profile equivalent to either open pancreatoduodenectomy (OPD) or laparoscopic pancreatoduodenectomy (LPD). However, major intraoperative bleeding can occur and emergency conversion to OPD may be required. RPD reduces the risk of emergency conversion when compared to LPD.
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