Giovanni Marchegiani

• MD, Phd
• Academic Surgeon at University of Padua

of Background Data Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer is typically managed like pancreatic intraepithelial neoplasia (PanIN)-derived pancreatic cancer. However, in IPMN-derived pancreatic cancer, the role of chemotherapy remains controversial, particularly in the neoadjuvant setting (NAT). Objective To evaluat...

Background Low muscle mass is negatively associated with survival in patients undergoing surgery for colorectal cancer. Current evidence is limited regarding whether the surgical approach for liver resection of colorectal metastasis impacts postoperative changes in body composition and whether preoperative body composition can impact complication r...

Objective To identify strategies to prevent and treat delayed gastric emptying (DGE) after pancreatic surgery. Background Among all complications of pancreatic surgery, DGE has the largest impact on prolonged hospital stay. Several randomized controlled trials (RCTs) have addressed DGE after pancreatic surgery, either as primary or as secondary ou...

Background The use of minimally invasive (laparoscopic and robotic) pancreatoduodenectomy (PD) is being increasingly adopted despite the lack of hard evidence to support its utilisation. With recent randomised controlled trials (RCTs) comparing open pancreatoduodenectomy (OPD) with robotic or laparoscopic pancreatoduodenectomy (RPD or LPD), we unde...

Background and Aim For branch‐duct intraductal papillary mucinous neoplasms (BD‐IPMNs) without worrisome features (WFs) or high‐risk stigmata (HRS), current guidelines recommend surveillance. However, these intraductal papillary mucinous neoplasm (IPMNs), especially the small and stable‐sized ones, carry a low risk of malignant transformation. Our...

Background Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of d...

PURPOSE The benefit of adjuvant therapy for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) remains unclear because of severely limited evidence. Although biologically distinct entities, adjuvant therapy practices for IPMN-derived PDAC are largely founded on pancreatic intraepithelial neoplasia-derived...

Background Little is known about the prognostic significance of pancreatic duct (PD) dilation following pancreatoduodenectomy for intraductal papillary mucinous neoplasms (IPMN). Although PD dilation is typically the hallmark radiographic feature of IPMN, other causes of PD dilation exist, including anastomotic stricture, pancreatitis, senescence,...

Objective To determine the interobserver variability for complications of pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery (ISGPS) and others. Summary background data Good interobserver variability for the definitions of surgical complications is of major importance in comparing surgical outcomes between and...

Objective The ISGPS aims to develop a universally accepted complexity and experience grading system to guide the safe implementation of robotic and laparoscopic minimally-invasive pancreatoduodenectomy (MIPD). Background Despite the perceived advantages of MIPD, its global adoption has been slow due to the inherent complexity of the procedure and...

Objective Our investigation on in-hospital mortality after 4474 pancreatoduodenectomies aimed to identify time-dependent risks as well as windows of opportunity to rescue patients from complications. Background Pancreatoduodenectomy is generally considered a safe procedure with a 1-10% perioperative mortality based on complexity and surgical volum...

Background: Postoperative fluid collections (POFC) at the resection margin of the pancreatic stump are frequent after distal pancreatectomy (PD), yet their clinical impact is unclear. Aim: To assess the 30-day prevalence of POFCs after DP and factors associated with a clinically relevant condition. Methods: Patients enrolled in a randomized contro...

Objective Cost-effectiveness of surveillance for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) is debated. We combined different categories of risks of IPMN progression and of IPMN-unrelated mortality to improve surveillance strategies. Design Retrospective analysis of 926 presumed BD-IPMNs lacking worrisome features (WFs)/high-r...

Objective The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Summary Background Data Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic...

Objectives The aim of this international multicentric study is to characterize postoperative hyperamylasemia (POH) after distal pancreatectomy (DP), with particular focus on its relationship with postoperative pancreatic fistula (POPF) occurrence and severity. Background The clinical relevance of POH after DP and its relationship with the occurren...

Importance Despite the increasing prevalence of intraductal papillary mucinous neoplasm (IPMN), data on the growth and malignant conversion rates based on long-term surveillance cohorts are limited. Many international guidelines recommend surveillance for benign lesions, but the optimal interval and duration are unclear. Objective To determine the...

Background International guidelines on intraductal papillary mucinous neoplasm (IPMN) recommend a formal oncological resection including splenectomy when distal pancreatectomy is indicated. This study aimed to compare oncological and surgical outcomes after distal pancreatectomy with or without splenectomy in patients with presumed IPMN. Methods A...

Background: Pancreatic cancer is notorious for its aggressive nature and low survival rate, with less than 10% of patients surviving beyond five years. Early detection is difficult, but skin metastases can be a rare but significant indicator. This systematic review focuses on the epidemiology, clinical features, and histology of skin metastases fro...

Distal pancreatectomy (DP) is associated with a high complication rate of 30–50% with postoperative pancreatic fistula (POPF) as a dominant contributor. Adequate risk estimation for POPF enables surgeons to use a tailor-made approach. Assessment of the risk of POPF prior to DP can lead to the application of preventive strategies. The current study...

Background Post-pancreatectomy hemorrhage (PPH) is a leading cause for surgical mortality after pancreatic surgery. Several strategies for the prevention and management of PPH have been studied in randomized controlled trials (RCTs) but a systematic review is lacking. We systematically reviewed RCTs regarding the impact of treatment strategies on t...

Background Accurately predicting the risk of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy before surgery may assist surgeons in making more informed treatment decisions and improved patient counselling. The aim was to evaluate the predictive accuracy of a radiomics-based preoperative-Fistula Risk Score (RAD-FRS)...

Background Pancreatic surgery is increasingly moving towards centralization in high-volume centres, supported by evidence on the volume–outcome relationship. At the same time, minimally invasive pancreatic surgery is becoming more and more established worldwide, and interest in new techniques, such as robotic pancreatoduodenectomy, is growing. Such...

Objective: To generate an up-to-date bundle to manage acute biliary pancreatitis using an evidence-based, artificial intelligence (AI)-assisted GRADE method. Summary background data: A care bundle is a set of core elements of care that are distilled from the most solid evidence-based practice guidelines and recommendations. Methods: The resear...

Introduction Estimated blood loss (EBL) represents a key intraoperative outcome metric in pancreatic surgery1–3. It has been directly correlated with postoperative morbidity and mortality⁴, particularly postoperative pancreatic fistula (POPF)⁵, which is the principal driver of outcomes after pancreatoduodenectomy (PD)⁶. However, blood loss currentl...

Background and aims: Currently, most patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMN) are offered indefinite surveillance, resulting in health care costs with questionable benefits regarding cancer prevention. This study sought to identify patients where the risk of cancer is equivalent to an age-matched population, the...

Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variabil...

Background: Pancreatic acinar content has been associated with pancreas-specific complications after pancreatoduodenectomy (PD). The aim of this study was to improve the prediction ability of intraoperative risk stratification by integrating the pancreatic acinar score. Methods: A training and a validation cohort underwent PD with subsequent his...

Simple Summary The treatment of periampullary tumors is becoming increasingly multimodal. Surgical interventions must be weighed against alternative therapeutic options, including ablative radiation and systemic chemotherapy. An operation should not jeopardize the receipt of adjuvant therapies. Therefore, a multiparametric risk assessment is crucia...

The aim of this study is to describe the current utilization of artificial nutrition [enteral (EN) or total parenteral (TPN)] for pancreatic fistula (POPF) after pancreatoduodenectomy (PD). Prospective data of 311 patients who consecutively underwent PD at a tertiary referral center for pancreatic surgery were collected. Data included the use of EN...

The overall prevalence of pancreatic cysts (PCs) is high in the general population. In clinical practice PCs are often incidentally discovered and are classified into benign, premalignant, and malignant lesions according to the World Health Organization. For this reason, in the absence of reliable biomarkers, to date clinical decision-making relies...

Background: Postpancreatectomy acute pancreatitis is challenging to diagnose and poorly characterized in its early phases. However, it represents the ideal target for novel therapeutic opportunities possibly gleaned from medical acute pancreatitis. This study aims to systematically investigate early radiologic, biochemical, and clinical features o...

The implementation of composite scores for risk stratification in routine daily practice has opened a new era of pancreatic surgery. Personalized risk assessment methods pave the way to a tailored approach during each stage of the surgical itinerary. Simple and easily detectable preoperative parameters allow engaging different risk-stratified clini...

Background: Mucinous Cystic Neoplasms (MCN) of the pancreas are premalignant cysts for which current guidelines support pancreatic resection. The primary aim of this systematic review and meta-analysis is to define the pooled rate of malignancy for MCN. Methods: A systematic review of eligible studies published between 2000 and 2021 was performe...

Background: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy associated with a low complication burden but a prolonged hospital stay. The present study aimed to characterize DGE, with a particular focus on its subtypes and related predictors. Methods: A 2-center retrospective analysis was performed including cons...

Acinar cystic transformation (ACT) of the pancreas, previously called acinar cell cystadenoma, is a poorly understood and rare entity among pancreatic cystic lesions. This study aims to clarify its real nature. This research cohort included 25 patients with pancreatic ACT, representing the largest series in the literature. We describe their clinico...

Background Several variables have been described as prognostic factors for resected distal cholangiocarcinoma (dCC), including lymph node metastases (N status) and lymph node ratio (LNR). This study aimed to evaluate the prognostic value of LNR on survival and to establish a novel prognostic nomogram to predict the cancer-specific recurrence-free s...