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1. Unconventional treatment of inoperable biliary IPMN with an oesophageal stent in the common bile duct: case report

Author

Antti Siiki, Anne Antila, Yrjö Vaalavuo, Johanna Ronkainen, Irina Rinta-Kiikka, and Johanna Laukkarinen

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Biliary intraductal papillary mucinous neoplasm (IPMN) is a rare biliary neoplasia preferably treated with oncologic resection. Endoscopic radio frequency (RF) ablation may be used as a palliative measure. We present a rare case, where heavy co-morbidities prevented surgery. Continuous mucus production caused recurrent episodes of severe cholangitis. Several ERCPs (endoscopic retrograde cholangio pancretography) were necessary due to recurrent biliary obstruction. RF ablation was not effective in the dilated common bile duct without a stricture. Standard biliary stents failed due to either migration or occlusion. When other options failed, an exceptional decision was made: a covered large diameter oesophageal stent was inserted in ERCP into the bile duct to secure bile flow and stop mucus production. Digital cholangioscopy was crucial adjunct to standard ERCP in endoscopic management. The palliative treatment method was successful: there were no stent-related adverse events or readmissions for cholangitis. The follow-up in the palliative care lasted until patient’s last 10 months of lifetime.

Published
2023
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2. Bile-volatile organic compounds in the diagnostics of pancreatic cancer and biliary obstruction: A prospective proof-of-concept study

Author

Ville Teränen, Samuli Nissinen, Antti Roine, Anne Antila, Antti Siiki, Yrjö Vaalavuo, Pekka Kumpulainen, Niku Oksala, and Johanna Laukkarinen

Subjects
VOC, pancreatic cancer, biliary obstruction, FAIMS, bile, ERCP, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

ObjectivesDetection of volatile organic compounds (VOCs) from bodily fluids with field asymmetric waveform ion mobility spectrometry (FAIMS) and related methods has been studied in various settings. Preliminary results suggest that it is possible to detect prostate, colorectal, ovarian and pancreatic cancer from urine samples. In this study, our primary aim was to differentiate pancreatic cancer from pancreatitis and benign tumours of the pancreas by using bile samples obtained during endoscopic retrograde cholangiopancreatography (ERCP). Secondarily, we aimed to differentiate all pancreatic region malignancies from all other kinds of benign causes of biliary obstruction.MethodsA bile sample was successfully aspirated from 94 patients during ERCP in Tampere University Hospital. Hospital and patient records were prospectively followed up for at least two years after ERCP. Bile samples were analysed using a Lonestar chemical analyser (Owlstone, UK) using an ATLAS sampling system and a split-flow box. Diagnoses and corresponding data from the analyses were matched and divided into two subcategories for comparison. Statistical analysis was performed using linear discriminant analysis, support vector machines, and 5-fold cross-validation.ResultsPancreatic cancers (n=8) were differentiated from benign pancreatic lesions (n=9) with a sensitivity of 100%, specificity of 77.8%, and correct rate of 88%. All pancreatic region cancers (n=19) were differentiated from all other kinds of benign causes of biliary obstruction (n=75) with corresponding values of 21.1%, 94.7%, and 80.7%. The sample size was too small to try to differentiate pancreatic cancers from adjacent cancers.ConclusionAnalysing bile VOCs using FAIMS shows promising capability in detecting pancreatic cancer and other cancers in the pancreatic area.

Published
2022
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3. The European evidence-based guidelines on pancreatic cystic neoplasms (PCN) in clinical practice : The development of relative and absolute indications for surgery during prospective IPMN surveillance

Author

Irina Rinta-Kiikka, Anne Antila, Johanna Laukkarinen, Antti Siiki, Yrjö Vaalavuo, Juhani Sand, Tampere University, Department of Gastroenterology, Department of Radiology, Clinical Medicine, and Department of General Administration

Subjects
Adult, Male, medicine.medical_specialty, Evidence-based practice, Endocrinology, Diabetes and Metabolism, Clinical Decision-Making, Guidelines as Topic, Cohort Studies, Pancreatectomy, Pancreatic cancer, Medicine, Humans, Cyst, Neoplasm Invasiveness, Prospective Studies, Prospective cohort study, Watchful Waiting, Finland, Aged, Aged, 80 and over, Invasive carcinoma, Evidence-Based Medicine, Hepatology, business.industry, Gastroenterology, Middle Aged, medicine.disease, University hospital, 3126 Surgery, anesthesiology, intensive care, radiology, Surgery, Clinical Practice, Pancreatic Neoplasms, Cohort, Female, business, Carcinoma, Pancreatic Ductal, Follow-Up Studies
Abstract

Introduction The European evidence-based guidelines on PCN recommend surveillance for IPMN patients who are fit for surgery but who have no indication for immediate surgery. Our aim was to demonstrate the feasibility of the new guidelines in clinical practice. Methods This is a prospective cohort study of patients included in the IPMN register in Tampere University Hospital, Finland. IPMN was diagnosed from January 1, 2013 to December 31, 2018. Patients were analyzed for surveillance and indications for surgery according to the European guidelines on PCN. Results Out of 128 patients in register 23 was decided to operate upfront and 105 patients were included in the surveillance programme. Invasive carcinoma was found in 4/23 of operated patients. Median follow-up time was 26 months (6–69). Median size of the cyst at the beginning and end of the surveillance was 16 mm (4–58 mm). During surveillance 0/105 (0.0%) patients had or developed an absolute indication for surgery. Relative indication for surgery was present in 8/105 (7.6%) patients in the beginning surveillance and 9/105 (8.6%) patients developed at least one relative indication for surgery during surveillance. From the surveillance cohort 2/105 patients were operated. Surveillance was abandoned in 15/105 (14.1%) patients all due to poor general condition or other medical conditions. Conclusions In clinical practice, surveillance of IPMN according to the European guidelines on PCN is feasible. Among our patients 16% were detected to have relative indications for surgery during the median 26 (range 3–135) months of surveillance. Nearly 15% became surgically unfit during surveillance period.

Published
2020

4. Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors – a multi-institutional study

Author

Ville Sallinen, Stuart Robinson, Oskar Franklin, Francesca Muffatti, Bertrand Dousset, Shamil Galeev, Anne Antila, Dominik Wiese, Zahar Kovalenko, Alain Sauvanet, Falconi Massimo, Philippe Ruszniewski, G.O. Ceyhan, Nicolas Regenet, Detlef K. Bartsch, Tessa T. Y. Le Large, Francesco Panzuto, Stefano Partelli, Bjørn Edwin, Sven-Petter Haugvik, Elke Tieftrunk, Emma Martínez-Moneo, Sébastien Gaujoux, Pertti Panula / Principal Investigator, Clinicum, IV kirurgian klinikka, Department of Surgery, University of Helsinki, HUS Abdominal Center, CCA - Cancer Treatment and quality of life, Medical oncology laboratory, Sallinen, V. J., Le Large, T. T. Y., Tieftrunk, E., Galeev, S., Kovalenko, Z., Haugvik, S. -P., Antila, A., Franklin, O., Martinez-Moneo, E., Robinson, S. M., Panzuto, F., Regenet, N., Muffatti, F., Partelli, S., Wiese, D., Ruszniewski, P., Dousset, B., Edwin, B., Bartsch, D. K., Sauvanet, A., Massimo, F., Ceyhan, G. O., Gaujoux, S., CCA - Cancer Treatment and Quality of Life, AGEM - Re-generation and cancer of the digestive system, and Graduate School

Subjects
Pancreatic Duct, Male, Pathology, Time Factors, Databases, Factual, 030230 surgery, Neuroendocrine tumors, surgery, 0302 clinical medicine, Retrospective Studie, Risk Factors, pancreatic endocrine tumors, Gastroenterology, Pancreatic Neoplasm, Bile Duct, Middle Aged, FISTULA, 3. Good health, Tumor Burden, ddc, Europe, Neuroendocrine Tumors, 030220 oncology & carcinogenesis, ENDOCRINE TUMORS, PANCREATICODUODENECTOMY, SURVIVAL, Female, Neuroendocrine Tumor, Human, Dilatation, Pathologic, NEOPLASMS, medicine.medical_specialty, Time Factor, UNITED-STATES, Gastroenterology and Hepatology, Disease-Free Survival, prognosis, Pancreaticoduodenectomy, 03 medical and health sciences, Pancreatectomy, medicine, Gastroenterologi, SINGLE INSTITUTION, MANAGEMENT, Humans, Aged, Retrospective Studies, Hepatology, business.industry, Risk Factor, MORTALITY, Pancreatic Ducts, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, 3 DECADES, Pancreatic Neoplasms, 3121 General medicine, internal medicine and other clinical medicine, Bile Ducts, Neoplasm Grading, Neoplasm Recurrence, Local, business
Abstract

Background: Malignant potential of small (

Published
2018
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5. Management of postoperative complications may favour the centralization of distal pancreatectomies. Nationwide data on pancreatic distal resections in Finland 2012-2014

Author

Reea Ahola, Juhani Sand, Johanna Laukkarinen, Anne Antila, HYKS erva, and Päijät-Häme Welfare Consortium

Subjects
Male, SURGERY, Endocrinology, Diabetes and Metabolism, Patient demographics, medicine.medical_treatment, Fistula, 0302 clinical medicine, Postoperative Complications, Child, Finland, Gastroenterology, OPERATIVE MORTALITY, Middle Aged, Pancreaticoduodenectomy, FISTULA, Optimal management, 3. Good health, Pancreatic distal resection, HOSPITAL VOLUME, Pancreatic fistula, 030220 oncology & carcinogenesis, Child, Preschool, PANCREATICODUODENECTOMY, 030211 gastroenterology & hepatology, Female, TRANSITION, Adult, medicine.medical_specialty, Adolescent, 03 medical and health sciences, Young Adult, MORBIDITY, Hospital volume, Pancreatectomy, medicine, Humans, Aged, Retrospective Studies, Hepatology, business.industry, Infant, Pancreatic Diseases, Centralization, medicine.disease, Surgery, Low volume, 3121 General medicine, internal medicine and other clinical medicine, Complication, business
Abstract

Background: Centralization of pancreatic surgery has proceeded in the last few years in many countries. However, information on the effect of hospital volume specifically on distal pancreatic resections (DP) is lacking. Aim: To investigate the effect of hospital volume on postoperative complications in DP patients in Finland. Methods: All DP performed in Finland during the period 2012-2014 were analyzed, information having been retrieved from the appropriate national registers. Hospital volumes, postoperative pancreatic fistulae (POPF) and overall complications were graded. High volume centre (HVC) was defined as performing > 10 DPs, median volume centre (MVC) 4-9 DPs and low volume centre (LVC) fewer than 4 DP annually. Results: A total of 194 DPs were performed at 18 different hospitals. Of these 42% (81) were performed in HVCs (2 hospitals), 43% (84) in MVCs (6 hospitals) and the remaining 15% (29) in LVCs (10 hospitals). Patient demographics did not differ between the hospital volume groups. The overall rate of clinically relevant POPF, Clavien-Dindo grade 3-5 complications, and 90-day mortality showed no significant differences between the different hospital volumes. Grade C POPF was found more often in LVCs, being 1.2% in HVCs, 0% in MCVs and 6.9% in LVCs, p = 0.030. More reoperations were performed in LVCs (10.3%) than in HVCs (1.2%) or MVCs (1.2%); p = 0.025. Conclusions: Even though the rate of postoperative complications after DP is not affected by hospital volume, reoperations were performed ten times more often in the low-volume centres. Optimal management of postoperative complications may favour centralization not only of PD, but also of DP. (C) 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Published
2019

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