Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation

Incidental diagnosis of pancreatic neuroendocrine tumors (PanNETs) greatly increased in the last years. In particular, more frequent diagnosis of small PanNETs leads to many challenging clinical decisions. These tumors are mostly indolent, although a percentage (up to 39%) may reveal an aggressive behaviour despite the small size. Therefore, there is still no unanimity about the best management of tumor smaller than 2 cm. The risks of under/overtreatment should be carefully evaluated with the patient and balanced with the potential morbidities related to surgery. The importance of the Ki-67 index as a prognostic factor is still debated as well. Whenever technically feasible, parenchyma-sparing surgeries lead to the best chance of organ preservation. Lymphadenectomy seems to be another important prognostic issue and, according to recent findings, should be performed in noninsulinoma patients. In the case of enucleation of the lesion, a lymph nodal sampling should always be considered. The relatively recent introduction of minimally invasive techniques (robotic) is a valuable option to deal with these tumors. The current management of PanNETs is analysed throughout the many available published guidelines and evidences with the aim of helping clinicians in the difficult decision-making process

The S0_0(0) structure in highly compressed hydrogen and the orientational transition

A calculation of the rotational S$_0$(0) frequencies in high pressure solid para-hydrogen is performed. Convergence of the perturbative series at high density is demonstrated by the calculation of second and third order terms. The results of the theory are compared with the available experimental data to derive the density behaviour of structural parameters. In particular, a strong increase of the value of the lattice constant ratio $c/a$ and of the internuclear distance is determined. Also a decrease of the anisotropic intermolecular potential is observed which is attributed to charge transfer effects. The structural parameters determined at the phase transition may be used to calculate quantum properties of the rotationally ordered phase.Comment: accepted Europhysics Letter

Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study

Background: The use of robot -assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot -assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort. Methods: An international multicenter retrospective study including patients after robot -assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009-2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien-Dindo >= III). Results: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot -assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/inhospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot -assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot -assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P < .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P < .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P < .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P < .001), and a higher R0 -resection rate (73.2% vs 84.4%; P < .001). Conclusion: This European multicenter study found no differences in overall major morbidity and 30day/in-hospital mortality after robot -assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot -assisted pancreatoduodenectomy. In contrast, robot -assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Robot-assisted versus laparoscopic pancreatoduodenectomy:a pan-European multicenter propensity-matched study

Background: The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort. Methods: An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009–2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien–Dindo ≥III). Results: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P &lt; .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P &lt; .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P &lt; .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P &lt; .001), and a higher R0-resection rate (73.2% vs 84.4%; P &lt; .001). Conclusion: This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.</p

Robot-Assisted Pancreatic Surgery: Safety and Feasibility.

The recent advent of robotic surgery has changed the surgical perspective in operating theatres worldwide. The main innovation is that a computer-based interface, located between patient and surgeon, is able to improve his/her dexterity. The goal of robotic surgery is, therefore, to reduce intraoperative complications, overcome some limits of pure laparoscopy, and, definitively, reduce the postoperative impact of surgery on the patients. A shorter hospital stay is expected to reduce the interval between access to adjuvant therapies when dealing with oncologic diseases, leading to a potential survival increase. Nevertheless, the broad clinical application of robotics to pancreatic surgery has many peculiarities. The intrinsic difficulties of this kind of surgery, the lack of specific expertise (pancreatic surgery and robotic skills), together with the need for regional centralization are the major drawbacks. However, robotic surgery has been demonstrated to be safe and feasible in pancreaticoduodenectomy, distal pancreatectomy (with or without spleen preservation), enucleation, and atypical resections

Safety of Laparoscopic Cholecistectomy performed by Residents

Introduction: Laparoscopic cholecistectomy is becoming widely performed by Italian surgical residents, but specific outcomes have been poorly investigated, as compared to those carried out by experienced surgeons. Methods: Data from 188 consecutive, unselected patients who underwent LC performed by residents between 2000 and 2006 at our institution were collected. An equal number of LC performed over the same period by experienced surgeons were randomly extracted from the database. Demographics, periopeoperative parameters and complications were matched among the two groups. Results: Age, gender, ASA score, length of stay, proportion of urgent operation and cholecystitis were all well matched in the two groups. No major complications were collected in both series. The number of IOC, rendez-vous, drainages, and minor complications were also equal. Nevertheless, the overall conversion rate and the mean difficulty score (0–20) were lower among residents (1 vs. 5%, p 0.03 and 6.65 vs. 7.32, p 0.04 respectively). On the other hand, the mean duration of surgery was significantly longer in the residents group (71 vs. 62 minutes, p 0.000). Discussion: Italian residents have fewer possibilities to gain sufficient skills at the end of their residentship, as compared to their foreign colleagues due to social, cultural, political and academic troubles. However, LC is a safe and common procedure even in the hands of Italian trainees, although patients’ selection is strictly required. In fact, tthis study found that residents performed less complex operations in more time, as compared to senior surgeons

Chronic hidradenitis suppurativa the inguinal, perineal and scrital regions. A case report and review of the literature.

Hidradenitis suppurativa is a chronic, recurrent, debilitating disease that presents with inflamed lesions in the apocrine glands of the body. The most common locations are the axillary, inguinal and anogenital areas. Hidradenitis suppurativa is caused primarily by follicular occlusion with secondary involvement of the apocrine glands. The authors report a case of 47-old-man with an 18-year history of multiple sclerosis complicated by spastic paraparesis, who presented with hidradenitis suppurativa in the inguinal, perineal, and scrotal areas which was treated by wide surgical excision. A review of the most recent literature is include

Safety of laparoscopic cholecystectomy performed by surgical residents

Laparoscopic cholecystectomy is being widely performed by surgical residents, but specific outcomes have been poorly investigated. Data from 171 consecutive, unselected patients who underwent laparoscopic cholecystectomy performed by surgical residents were collected and matched with an equal number of randomly extracted laparoscopic cholecystectomies performed by experienced senior staff surgeons between 2000 and 2006 at our institution. Demographic data, emergency procedures, cholangiographies, complications and length of stay were not significantly different between the two groups. However, surgical residents performed the operations in less complicated patients (ASA group 3-4 2% vs. 8%, respectively, p = 0.04). Moreover, the median duration of surgery was significantly longer in the resident group (67 vs. 50 minutes, p < 0.001), with fewer additional contemporary procedures (3% vs. 7%, respectively, p = 0.009). This study established that although surgical residents operated on less complex patients with longer operative times, the intraoperative difficulties and main outcomes were the same as for the senior surgeons