Surgery for Intraductal Papillary Mucinous Neoplasms of the Pancreas: Preoperative Factors Tipping the Scale of Decision-Making

Background: Decision-making in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas depends on scaling the risk of malignancy with the surgical burden of a pancreatectomy. This study aimed to develop a preoperative, disease-specific tool to predict surgical morbidity for IPMNs. Methods: Based on preoperative variables of resected IPMNs at two high-volume institutions, classification tree analysis was applied to derive a predictive model identifying the risk factors for major morbidity (Clavien-Dindo ≥3) and postoperative pancreatic insufficiency. Results: Among 524 patients, 289 (55.2%) underwent pancreaticoduodenectomy (PD), 144 (27.5%) underwent distal pancreatectomy (DP), and 91 (17.4%) underwent total pancreatectomy (TP) for main-duct (18.7%), branch-duct (12.6%), or mixed-type (68.7%) IPMN. For 98 (18.7%) of the patients, major morbidity developed. The classification tree distinguished different probabilities of major complications based on the type of surgery (area under the surve [AUC] 0.70; 95% confidence interval [CI], 0.63-0.77). Among the DP patients, the presence of preoperative diabetes identified two risk classes with respective probabilities of 5% and 25% for the development of major morbidity, whereas among the PD/TP patients, three different classes with respective probabilities of 15%, 20%, and 36% were identified according to age and body mass index (BMI). Overall, history of diabetes, age, and cyst size segregated three different risk classes for new-onset/worsening diabetes. Conclusions: In presumed IPMNs, the disease-specific risk of major morbidity and pancreatic insufficiency can be determined in the preoperative setting and used to personalize the possible surgical indication. Age and overweight status in case of PD/TP and diabetes in case of DP tip the scale toward less aggressive clinical management in the absence of features suggestive for malignancy

Prediction of early distant recurrence in upfront resectable pancreatic adenocarcinoma: A multidisciplinary, machine learning-based approach

Despite careful selection, the recurrence rate after upfront surgery for pancreatic adenocarcinoma can be very high. We aimed to construct and validate a model for the prediction of early distant recurrence (<12 months from index surgery) after upfront pancreaticoduodenectomy. After exclusions, 147 patients were retrospectively enrolled. Preoperative clinical and radiological (CT-based) data were systematically evaluated; moreover, 182 radiomics features (RFs) were extracted. Most significant RFs were selected using minimum redundancy, robustness against delineation uncertainty and an original machine learning bootstrap-based method. Patients were split into training (n = 94) and validation cohort (n = 53). Multivariable Cox regression analysis was first applied on the training cohort; the resulting prognostic index was then tested in the validation cohort. Clinical (serum level of CA19.9), radiological (necrosis), and radiomic (SurfAreaToVolumeRatio) features were significantly associated with the early resurge of distant recurrence. The model combining these three variables performed well in the training cohort (p = 0.0015,HR = 3.58,95%CI = 1.98–6.71) and was then confirmed in the validation cohort (p = 0.0178,HR = 5.06,95%CI = 1.75–14.58). The comparison of survival curves between low and high-risk patients showed a p-value <0.0001. Our model may help to better define resectability status, thus providing an actual aid for pancreatic adenocarcinoma patients’ management (upfront surgery vs. neoadjuvant chemotherapy). Independent validations are warranted

La ripresa degli scavi sull’acropoli di Butrinto. Considerazioni preliminari sullo scavo delle mura arcaiche

Il contributo nasce nell’ambito della missione italo-albanese dell’Università di Bologna e dell’Istituto di Archeologia di Tirana presso il sito archeologico di Butrinto (Albania meridionale) come presentazione preliminare dei risultati della campagna 2021. A seguito di un inquadramento storicotopografico dell’acropoli di Butrinto e di un riesame delle attività susseguitesi in quest’area del sito, lo studio analizza le evidenze emerse durante lo scavo nell’area della terrazza centrale della collina dell’acropoli. Si presentano i dati ottenuti dai saggi effettuati a ridosso delle mura arcaiche, lungo il margine meridionale dell’acropoli, e alcuni contesti significativi all’interno dell’emplekton delle mura, utili a definire la loro cronologia di costruzione grazie alla presenza di evidenze riferibili alle fasi di frequentazione di età arcaica. Lo studio dei materiali ceramici ha infatti permesso di confermare la datazione tra la fine del VII e l’inizio del VI secolo a.C. dei contesti rinvenuti. Inoltre, la loro analisi funzionale, unitamente all’interpretazione di un deposito di un gruppo di ghiande missili all’interno dell’emplekton, permette di avanzare alcune considerazioni circa la definizione dell’acropoli e il suo carattere sacro. I dati presentati, coerenti con il resto delle evidenze note, concorrono a delineare con maggior precisione la strutturazione dell’acropoli di Butrinto in età arcaica, le sue prime fasi di vita e le relazioni con la antistante isola di Corfù.The contribution is born within the activities of the Italian and Albanian archaeological mission of the University of Bologna and the Archaeological Institute of Tirana in the archaeological site of Butrint (Southern Albania) as a preliminary presentation of the results of the 2021 excavation campaign. Following the historical and topographic background of the acropolis of Butrint and a review of the activities carried out in this area of the site, the study analyses the findings coming from the excavation on the central terrace of the acropolis hill. We present data from trenches dug just behind the Archaic walls on the southern slope of the acropolis, along with some relevant contexts inside the walls emplekton, useful for defining the chronology of construction thanks to the presence of findings related to the attendance of the area during the Archaic age. The study of pottery findings confirmed the end of 7th century and the beginning of 6th century BC as chronology for these contexts. Furthermore, their functional analysis, together with the interpretation of a deposit of slingshots found inside the emplekton, allows to suggest some considerations on the definition of the acropolis and its sacred nature. These data, coherent with other known evidence, contribute to define the organization of the acropolis of Butrint during the Archaic age, its early stages of life and its relations with the island of Corfu

ASO Visual Abstract: Long-Term Survivors After Upfront Resection for Pancreatic Ductal Adenocarcinoma: An Actual 5-Year Analysis of Disease-Specific and Post-Recurrence Survival

No abstract availabl

Long-Term Survivors after Upfront Resection for Pancreatic Ductal Adenocarcinoma: An Actual 5-Year Analysis of Disease-Specific and Post-Recurrence Survival

Data on long-term actual survival in patients with surgically resected pancreatic ductal adenocarcinoma (PDAC) are limited. The aim of this study was to evaluate the actual 5-year disease-specific survival (DSS) and post-recurrence survival (PRS) in patients who underwent pancreatectomy for PDAC

Main Duct Thresholds For Malignancy Are Different In Intraductal Papillary Mucinous Neoplasms Of The Pancreatic Head And Body-Tail

The risk of malignancy is uncertain for of intraductal papillary mucinous neoplasms (IPMNs) with main pancreatic duct (MPD) of 5-9 mm. No study has correlated MPD size and malignancy considering the anatomic site of the gland (head versus body-tail). Our aim was to analyze the significance of MPD in pancreatic head/body-tail as a predictor of malignancy in main-duct/mixed IPMNs