Publications by authors named "Nicolo Pecorelli"
Background And Aims: Factors predicting the need for step-up procedures after EUS-guided drainage (EUS-FCD) of peripancreatic fluid collections (PFCs) were explored in retrospective studies restricted to Walled-Off Necrosis (WON) and Lumen Apposing Metal Stents (LAMS).
Methods: All consecutive candidates for EUS-FCD between 2020-2024 were included in a Prospective Registry of Therapeutic EUS (PROTECT, NCT04813055), with prospective monthly follow-up evaluating clinical success, adverse events and recurrences. Prospectively assessed baseline clinical and morphological factors, including the Quadrant-Necrosis-Infection (QNI) classification, were included in a stepwise logistic regression model to predict the need for step-up.
Objective: To validate the ISGPS definition and grading system of PPAP after pancreatoduodenectomy (PD).
Summary Background Data: In 2022, the International Study Group for Pancreatic Surgery (ISGPS) defined post-pancreatectomy acute pancreatitis (PPAP) and recommended a prospective validation of its diagnostic criteria and grading system.
Methods: This was a prospective, international, multicenter study including patients undergoing PD at 17 referral pancreatic centers across Europe, Asia, Oceania, and the United States.
Article Synopsis
- The study surveyed Italian pancreatic surgeons to assess their use of intraperitoneal prophylactic drains (IPDs) during distal pancreatectomy (DP) and to understand their regrets associated with drain decisions.
- Out of 106 respondents, 59.4% used at least one drain, but only a small percentage changed their strategies based on patient risk categories for postoperative pancreatic complications.
- Results showed that the median regret for not using an IPD when it would have been beneficial was high (80), while regret for using it unnecessarily was low (2.5), indicating a clear preference for cautious management in high-risk patients.
Background: The lack of preoperative prognostic factors to accurately predict tumour aggressiveness in non-functioning pancreatic neuroendocrine tumours may result in inappropriate management decisions. This study aimed to critically evaluate the adequacy of surgical treatment in patients with resectable non-functioning pancreatic neuroendocrine tumours and investigate preoperative features of surgical appropriateness.
Methods: A retrospective study was conducted on patients who underwent curative surgery for non-functioning pancreatic neuroendocrine tumours at San Raffaele Hospital (2002-2022).
Objective: To evaluate the extent to which postoperative complications impact patient health-related quality of life (HRQoL) and survival after pancreatic surgery.
Background: Pancreatectomy is frequently associated with severe postoperative morbidity, which can affect patient recovery. Few and conflicting data are available regarding the effect of post-pancreatectomy complications on patient-reported HRQoL.
Article Synopsis
- A survey was conducted with surgeons to explore their use of intraperitoneal prophylactic drains (IPDs) during pancreaticoduodenectomy (PD), revealing varying practices and significant levels of regret associated with the decision to use or omit drains.
- The results showed that most surgeons (97.2%) used IPDs, with a high median regret score (84) for omitting the drain but much lower for using it (10).
- The study suggested that for low-risk patients, omitting IPDs could be a viable option, and the acceptance of this practice varies based on factors like surgical technique and perceptions of risk assessment.
Background: Pancreatogenic diabetes, a consequence of pancreatic tissue loss following pancreatectomy, poses a significant challenge for patients undergoing pancreatic surgery. Islet autotransplantation (IAT) offers a promising approach to prevent or alleviate pancreatogenic diabetes, but its application has been limited to individuals with painful chronic pancreatitis.
Methods: This study presents a 15-y clinical experience with the Milan Protocol, which expands IAT after pancreatectomy to a broader spectrum of patients with malignant and nonmalignant pancreatic diseases.
Purpose: Very early recurrence after radical surgery for pancreatic ductal adenocarcinoma (PDAC) has been poorly investigated. This study was designed to evaluate this group of patients who developed recurrence, within 12 weeks after surgery, defined as "biological R2 resections (bR2)."
Methods: Data from patients who underwent surgical resection as upfront procedure or after neoadjuvant treatment for PDAC between 2015 and 2019 were analyzed.
Article Synopsis
- The study examined how clear communication during the diagnosis of pancreatic adenocarcinoma (PDAC) affects patient engagement and adherence to treatment.
- Researchers enrolled 30 patients and found a high engagement level, with 70% actively participating and nearly all patients compliant with treatment, though many experienced misunderstandings during discussions about their diagnosis and treatment.
- Key findings highlighted the dynamics of doctor-patient conversations, showing that doctors spoke significantly more than patients or caregivers, and that regional background influenced engagement levels, necessitating further research into communication improvements.
Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis.
J Hepatobiliary Pancreat Sci
May 2024
Background: This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD).
Methods: Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included.
Article Synopsis
- Insulinoma is a complex disease that presents challenges in diagnosis and surgical treatment; this study evaluated patients who underwent surgery at San Raffaele Hospital between 2008 and 2022.
- A total of 98 patients were analyzed, with a median diagnosis delay of 10 months; early referrals significantly reduced this delay, particularly for those seeking help within 6 months of symptom onset.
- The study highlighted that various imaging tests, especially endoscopic ultrasound (EUS), are crucial for accurate diagnosis, and that parenchyma-sparing surgeries are preferred when possible to minimize complications.
Background: Limited data comparing recovery of health-related quality of life (HRQoL) after laparoscopic (LDP) versus open distal pancreatectomy (ODP) are available. The aim of this study was to assess the impact of laparoscopy on postoperative HRQOL after DP using the Patient-Reported Outcomes Measurement Information System (PROMIS).
Methods: Data from consecutive patients who underwent DP (2020-2022) enrolled in a prospective clinical trial were reviewed.
Objective: To contribute evidence for the reliability, construct validity, and responsiveness of the Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) profile questionnaire as a measure of recovery after pancreatic surgery.
Background: PROMIS questionnaires have been recommended to evaluate postdischarge recovery after surgery. Evidence supporting their measurement properties in pancreatic surgery is missing.
Background: The oncological safety of minimally invasive surgery has been questioned for several abdominal cancers. Concerns also exist regarding the use of minimally invasive distal pancreatectomy (MIDP) in patients with resectable pancreatic cancer as randomised trials are lacking.
Methods: In this international randomised non-inferiority trial, we recruited adults with resectable pancreatic cancer from 35 centres in 12 countries.
Patients requiring complex treatments, such as pancreatic surgery, may need to travel long distances and spend extended periods of time away from home, particularly when healthcare provision is geographically dispersed. This raises concerns about equal access to care. Italy is administratively divided into 21 separate territories, which are heterogeneous in terms of healthcare quality, with provision generally decreasing from north to south.
View Article and Find Full Text PDFIntroduction: Few studies analysed the impact of different venous resection techniques on recurrence in patients with pancreatic ductal adenocarcinoma (PDAC). Primary aim was to compare local recurrence rate and disease-free survival (DFS) between patients who underwent pancreatectomy with tangential versus segmental resection of portal vein/superior mesenteric vein.
Materials And Methods: All consecutive patients who underwent pancreatectomy with venous resection for PDAC between 2009 and 2019 were included.
Purpose: The role of supplemental artificial nutrition in patients perioperatively treated according to enhanced recovery programs (ERAS) on surgery-related morbidity is not known. Therefore, there is a need of a clinical trials specifically designed to explore whether given a full nutritional requirement by parenteral feeding after surgery coupled with oral food "at will" compared to oral food "at will" alone, within an established ERAS program, could achieve a reduction of the morbidity burden.
Materials And Analysis: RASTA will be a multicenter, randomized, parallel-arm, open labeled, superiority trial.
Background: It remains unclear whether preoperative body composition may affect the prognosis of pancreatic cancer patients undergoing surgery. The aim of the present study was to assess the extent to which preoperative body composition impacts on postoperative complication severity and survival in patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC).
Methods: A retrospective cohort study was performed on consecutive patients who underwent pancreatoduodenectomy with preoperative CT scan imaging available.
Background: The prognosis of nodal recurrence after surgery for non-functioning pancreatic neuroendocrine tumors (NF-PanNETs) and its predictors have been poorly investigated. This study aimed to compare clinicopathologic features and survival between patients with nodal relapse and those with distant relapse and to identify predictors of nodal relapse after surgery for NF-PanNETs.
Methods: All patients (n = 321) submitted to surgery for NF-PanNETs were included.
Pancreatic cancer (PC) is an aggressive disease, with a growing incidence, and a poor prognosis. Neoadjuvant treatments in PC are highly recommended in borderline resectable and recently in upfront resectable PC. PC is characterized by exocrine insufficiency and nutritional imbalance, leading to malnutrition/sarcopenia.
View Article and Find Full Text PDFBackground: It is unclear whether routine postoperative admission to the intensive care unit (ICU) can improve outcomes for patients undergoing elective pancreatic surgery. Aim of the study was to determine preoperative and intraoperative predictors of unplanned ICU access in patients undergoing pancreatectomy treated within an established enhanced recovery pathway (ERP) and compare outcomes between direct and late ICU admission.
Methods: A retrospective observational study was conducted on adult patients who underwent pancreatic resection (2015-2019) within an ERP.