3c727d78ad0f4da28bbe6265b0687ebf 305604.pdf c789e98e4bcd7fca54397c8efd26e28038017df1 305604.pdf bd47c8ee256040a3cf2a3120a02b31cab22346d173054a746cdf6875c5f6e5c9 305604.pdf Title: Different Periampullary Types and Subtypes Leading to Different Perioperative Outcomes of Pancreatoduodenectomy: Reality and Not a Myth; An International Multicenter Cohort Study Subject: This international multicenter cohort study included 30 centers. Patients with duodenal adenocarcinoma (DAC), intestinal-type (AmpIT) and pancreatobiliary-type (AmpPB) ampullary adenocarcinoma, distal cholangiocarcinoma (dCCA), and pancreatic ductal adenocarcinoma (PDAC) were included. The primary outcome was 30-day or in-hospital mortality, and secondary outcomes were major morbidity (Clavien-Dindo 3b), clinically relevant post-operative pancreatic fistula (CR-POPF), and length of hospital stay (LOS). Results: Overall, 3622 patients were included in the study (370 DAC, 811 AmpIT, 895 AmpPB, 1083 dCCA, and 463 PDAC). Mortality rates were comparable between DAC, AmpIT, AmpPB, and dCCA (ranging from 3.7% to 5.9%), while lower for PDAC (1.5%, p = 0.013). Major morbidity rate was the lowest in PDAC (4.4%) and the highest for DAC (19.9%, p < 0.001). The highest rates of CR-POPF were observed in DAC (27.3%), AmpIT (25.5%), and dCCA (27.6%), which were significantly higher compared to AmpPB (18.5%, p = 0.001) and PDAC (8.3%, p < 0.001). The shortest LOS was found in PDAC (11 d vs. 14–15 d, p < 0.001). Discussion: In conclusion, this study shows significant variations in perioperative mortality, post-operative complications, and hospital stay among different periampullary cancers, and between the ampullary subtypes. Further research should assess the biological characteristics and tissue reactions associated with each type of periampullary cancer, including subtypes, in order to improve patient management and personalized treatment. Keywords: non-pancreatic periampullary cancer; complications; pancreatoduodenectomy; tumor behavior Author: Bas A. Uijterwijk, Daniël H. Lemmers, Giuseppe Kito Fusai, Bas Groot Koerkamp, Sharnice Koek, Alessandro Zerbi, Ernesto Sparrelid, Ugo Boggi, Misha Luyer, Benedetto Ielpo, Roberto Salvia, Brian K. P. Goh, Geert Kazemier, Bergthor Björnsson, Mario Serradilla-Martín, Michele Mazzola, Vasileios K. Mavroeidis, Santiago Sánchez-Cabús, Patrick Pessaux, Steven White, Adnan Alseidi, Raffaele Dalla Valle, Dimitris Korkolis, Louisa R. Bolm, Zahir Soonawalla, Keith J. Roberts, Miljana Vladimirov, Alessandro Mazzotta, Jorg Kleeff, Miguel Angel Suarez Muñoz, Marc G. Besselink and Mohammed Abu Hilal Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Thu Feb 29 11:31:46 2024 CET ModDate: Thu Feb 29 11:34:04 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 666383 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- JGBJTI+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 LZHZZJ+VnURWPalladioL Type 1 Custom yes yes yes 16 0 TYLTWF+URWPalladioL-Bold Type 1 Custom yes yes yes 21 0 AXRAYX+URWPalladioL-Roma Type 1 Custom yes yes yes 27 0 WUGJYK+URWPalladioL-Ital Type 1 Custom yes yes yes 32 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 49 0 EILUJF+CMSY10 Type 1 Builtin yes yes yes 66 0 ONQSBW+URWPalladioL-BoldItal Type 1 Custom yes yes yes 80 0 RIJDHR+CMBSY10 Type 1 Builtin yes yes yes 88 0 AKOGMG+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 96 0 AKOIPC+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 102 0 AKOGMH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 105 0 AKOGMI+PalatinoLinotype CID TrueType Identity-H yes yes yes 108 0 AKOGMJ+PalatinoLinotype TrueType WinAnsi yes yes no 114 0 AKOGML+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 117 0 AKOHNG+PalatinoLinotype TrueType MacRoman yes yes no 120 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-01-10 02:43:13 CET RepresentationInformation: 305604.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-01-09 08:01:03 CET Size: 666383 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 279 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Patients Destination: subsection.2.2 Item: Title: Data Collection and Definitions Destination: subsection.2.3 Item: Title: Surgical Techniques and Post-Operative Care Destination: subsection.2.4 Item: Title: Statistical Analyses Destination: subsection.2.5 Item: Title: Results Destination: section.3 Children: Item: Title: Demographics Destination: subsection.3.1 Item: Title: Intraoperative Outcomes Destination: subsection.3.2 Item: Title: Post-Operative Outcomes Destination: subsection.3.3 Item: Title: Multivariate Analyses Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Different Periampullary Types and Subtypes Leading to Different Perioperative Outcomes of Pancreatoduodenectomy: Reality and Not a Myth; An International Multicenter Cohort Study Author: Bas A. Uijterwijk, Daniël H. Lemmers, Giuseppe Kito Fusai, Bas Groot Koerkamp, Sharnice Koek, Alessandro Zerbi, Ernesto Sparrelid, Ugo Boggi, Misha Luyer, Benedetto Ielpo, Roberto Salvia, Brian K. P. Goh, Geert Kazemier, Bergthor Björnsson, Mario Serradilla-Martín, Michele Mazzola, Vasileios K. Mavroeidis, Santiago Sánchez-Cabús, Patrick Pessaux, Steven White, Adnan Alseidi, Raffaele Dalla Valle, Dimitris Korkolis, Louisa R. Bolm, Zahir Soonawalla, Keith J. Roberts, Miljana Vladimirov, Alessandro Mazzotta, Jorg Kleeff, Miguel Angel Suarez Muñoz, Marc G. Besselink and Mohammed Abu Hilal Subject: This international multicenter cohort study included 30 centers. Patients with duodenal adenocarcinoma (DAC), intestinal-type (AmpIT) and pancreatobiliary-type (AmpPB) ampullary adenocarcinoma, distal cholangiocarcinoma (dCCA), and pancreatic ductal adenocarcinoma (PDAC) were included. The primary outcome was 30-day or in-hospital mortality, and secondary outcomes were major morbidity (Clavien-Dindo 3b), clinically relevant post-operative pancreatic fistula (CR-POPF), and length of hospital stay (LOS). Results: Overall, 3622 patients were included in the study (370 DAC, 811 AmpIT, 895 AmpPB, 1083 dCCA, and 463 PDAC). Mortality rates were comparable between DAC, AmpIT, AmpPB, and dCCA (ranging from 3.7% to 5.9%), while lower for PDAC (1.5%, p = 0.013). Major morbidity rate was the lowest in PDAC (4.4%) and the highest for DAC (19.9%, p < 0.001). The highest rates of CR-POPF were observed in DAC (27.3%), AmpIT (25.5%), and dCCA (27.6%), which were significantly higher compared to AmpPB (18.5%, p = 0.001) and PDAC (8.3%, p < 0.001). The shortest LOS was found in PDAC (11 d vs. 14 15 d, p < 0.001). Discussion: In conclusion, this study shows significant variations in perioperative mortality, post-operative complications, and hospital stay among different periampullary cancers, and between the ampullary subtypes. Further research should assess the biological characteristics and tissue reactions associated with each type of periampullary cancer, including subtypes, in order to improve patient management and personalized treatment. 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