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  • 1.
    Arnelo, Urban
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Valente, Roberto
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
    Scandavini, Chiara Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Halimi, Asif
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Mucelli, Raffaella M.Pozzi
    Department of Radiology Huddinge, Karolinska University Hospital, O-huset 42, Stockholm, Sweden; Division of Radiology, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Rangelova, Elena
    Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Section for Upper Abdominal Surgery at Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Svensson, Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Schulick, Richard D.
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Torphy, Robert J.
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Fagerström, Niklas
    Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Moro, Carlos Fernández
    Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Huddinge, Sweden; Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Huddinge, Sweden.
    Vujasinovic, Miroslav
    Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Matthias Löhr, Johannes
    Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Del Chiaro, Marco
    Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, CO, Aurora, United States.
    Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: a pilot study2023Ingår i: Pancreatology (Print), ISSN 1424-3903, E-ISSN 1424-3911, Vol. 23, nr 6, s. 704-711Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Intraoperative pancreatoscopy is a promising procedure that might guide surgical resection for suspected main duct (MD) and mixed type (MT) intraductal papillary mucinous neoplasms (IPMNs). The aim of the present study was to assess the diagnostic yield and clinical impact of intraoperative pancreatoscopy in patients operated on for MD and MT-IPMNs.

    Methods: This is a retrospective cohort study. Patients undergoing surgery for suspected MD or MT-IPMN underwent intraoperative pancreatoscopy and frozen section analysis. In all patients who required extended resection due to pancreatoscopic findings, we compared the final histology with the results of the intraoperative frozen section analysis.

    Results: In total, 46 patients, 48% females, mean age (range) 67 years (45–82 years) underwent intraoperative pancreatoscopy. No mortality or procedure related complications were observed. Pancreatoscopy changed the operative course in 30 patients (65%), leading to extended resections in 20 patients (43%) and to parenchyma sparing procedures in 10 patients (22%). Analyzing the group of patients who underwent extended resections, 7 (35%) displayed lesions that needed further surgical treatment (six high grade dysplasia and one with G1 pancreatic neuroendocrine tumor) and among those 7, just 1 (14%) would have been detected exclusively with histological frozen section analysis of the transection margin. The combination of both pancreatoscopy and frozen section analysis lead to 86% sensitivity and 92% specificity for the detection of pathological tissue in the remnant pancreas.

    Conclusion: Intraoperative pancreatoscopy is a safe and feasible procedure and might allow the detection of skip lesions during surgery for suspect MD-involving IPMNs.

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  • 2.
    Valente, Roberto
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, CO, USA.
    Zarantonello, Laura
    Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Del Chiaro, Marco
    Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, CO, USA.
    Vujasinovic, Miroslav
    Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Baldaque Silva, Francisco
    Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Scandavini, Chiara M.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Rangelova, Elena
    Department of Surgery, Sahlgrenska Hospital, Gothenburg, Sweden.
    Vespasiano, Francesca
    Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Anzillotti, Giuseppe
    Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Löhr, Johannes M.
    Department of Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Arnelo, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Karolinska Institutet, Stockholm, Sweden.
    Lumen apposing metal stents vs double pigtail plastic stents for the drainage of pancreatic walled-off necrosis2022Ingår i: Minerva gastroenterology, ISSN 2724-5365Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Few studies compared lumen-apposing metal stents (LAMS) and standard double pigtail plastic stents (PS) for the endoscopic drainage of pancreatic walled-off necrosis (WON). Albeit sometimes large, previously described cohorts display considerable heterogeneity and often pooled together data from several centers, involving multiple operators and techniques. Moreover, they often lack a control group for the comparison of outcomes.

    AIM: to compare clinical efficacy and safety of PS versus LAMS for the endoscopic drainage of infected WON.

    METHODS: Single-centre, 1:1 case-control study. We compared patients undergoing endoscopic drainages of infected WON through LAMS (cases) or PS (controls). The primary endpoint was the clinical efficacy (resolution of the WON/sepsis), the secondary endpoint was safety (procedure-related complications).

    RESULTS: Thirty patients were enrolled between 2011 and 2017. Cases and controls were homogeneous in terms of etiology and clinical characteristics. 93% of cases and 86.7% of controls were clinically successfully treated, with no significant differences in rates of post-operative infections, bleedings and stent migrations (respectively 13.3% vs 21.4%; p=0.65; 13.3% vs 0%; p=0.48; 13.3% vs 7.1%; p=1.00). No difference was shown regarding the need for additional percutaneous or surgical treatments (33.3% vs 13.3%; p=0.39). Cases, however, displayed a significantly prolonged mean hospital stay (90.2 days vs 18.5 days; p<0.01) and a higher mean number of endoscopic procedures per patient (4.8 vs 1.5; p<0.01).

    CONCLUSIONS: PS might be not inferior to LAMS for the treatment WONs. Further prospective RCT is needed to compare clinical efficacy and safety in the two groups.

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