Peter Szatmary

University of Liverpool | UoL · Department of Molecular and Clinical Cancer Medicine

Background: Trauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical characteristics and patient-reported long-term outcomes for pancreatic injury. Methods: A retrospective...

Background: Acute pancreatitis in pregnancy (APIP) is associated with increased maternal and fetal mortality. Objectives: We sought to determine whether a low threshold for cesarean section (C-section) in severe acute pancreatitis (SAP) or Predict SAP improves maternal and fetal outcomes in patients with APIP. Methods: We identified patients w...

Acute pancreatitis is a common gastrointestinal disease with increasing incidence worldwide. COVID-19 is a potentially life-threatening contagious disease spread throughout the world, caused by severe acute respiratory syndrome coronavirus 2. More severe forms of both diseases exhibit commonalities with dysregulated immune responses resulting in am...

Acute pancreatitis is a common gastrointestinal disease characterized by inflammation of the exocrine pancreas and manifesting itself through acute onset of abdominal pain. It is frequently associated with organ failure, pancreatic necrosis, and death. Mounting evidence describes monocytes - phagocytic, antigen presenting, and regulatory cells of t...

Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires t...

Background: Acute pancreatitis (AP) is a potentially severe or even fatal inflammation of the pancreas. Early identification of patients at high risk for developing a severe course of the disease is crucial for preventing organ failure and death. Most of the former predictive scores require many parameters or at least 24 h to predict the severity;...

Background: Current approaches to predicting intervention needs and mortality have reached 65-85% accuracy, which falls below clinical decision-making requirements in patients with acute pancreatitis (AP). We aimed to accurately predict therapeutic intervention needs and mortality on admission, in AP patients, using machine learning (ML). Methods...

Background Acute pancreatitis in pregnancy (APIP) is associated with increased maternal and fetal mortality. We sought to determine whether a low threshold for cesarean section (C-section) in severe acute pancreatitis (SAP) improves maternal and fetal outcomes in patients with APIP. Methods We identified patients with APIP at a single institution...

There is little evidence around the potentially protective role of previous Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 vaccination. Prior BCG vaccination did not protect SARS-CoV-2 infected patients against postoperative pulmonary complications and 30-day mortality.

Background: Post-hepatectomy liver failure (PHLF) represents the major determinant for death after liver resection. Early recognition is essential. Perioperative lactate dynamics for risk assessment of PHLF and associated morbidity were evaluated. Methods: This was a multicentre observational study of patients undergoing hepatectomy with validatio...

Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This internati...

Objective: UK national guidelines recommend pancreatic enzyme replacement therapy (PERT) in pancreatic cancer. Over 80% of pancreatic cancers are unresectable and managed in non-surgical units. The aim was to assess variation in PERT prescribing, determine factors associated with its use and identify potential actions to improve prescription rates....

Targeted therapy for acute pancreatitis (AP) remains absent from the essential management toolkit, despite an increasing worldwide disease burden, an extensive range of preclinical research, and numerous clinical trials. A critical mass of international researchers has now gathered with the common goal of successfully establishing pharmacological t...

Objective UK national guidelines recommend pancreatic enzyme replacement therapy (PERT) in pancreatic cancer. Over 80% of pancreatic cancers are unresectable and managed in non-surgical units. The aim was to assess variation in PERT prescribing, determine factors associated with its use and identify potential actions to improve prescription rates....

Aim This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicio...

The vascular anatomy of the pancreas permits its partial resection, thereby greatly enhancing life expectancy of patients with pancreatic cancer while limiting morbidity associated with a total pancreatectomy. Variations in arterial anatomy are common, directly relate to the embryology of the pancreas, and need to be understood by the surgeon to pr...

Background Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Methods This international cohort study included adult patients undergoing elective surge...

As the global pandemic of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) continues, nuances of the disease it precipitates in humans continue to emerge. After early reports of presentation with gastrointestinal-type symptoms in China and Italy, a group from Wuhan reported a series of 9 patients with purported pancreatic injury in the c...

Pancreatic acinar cells require high rates of amino acid uptake for digestive enzyme synthesis, but excessive concentrations can trigger acute pancreatitis (AP) by mechanisms that are not well understood. We have used three basic natural amino acids L-arginine, L-ornithine, and L-histidine to determine mechanisms of amino acid-induced pancreatic in...

Effects of necroptosis modulator on pancreatic cell death caused by basic amino acids in vitro. Necroptosis modulators: 50 μM of RIPK1 inhibitor necrostatin-1 (Nec-1), 25 μM of pan-caspase inhibitor z-VAD-FMK (z-VAD), 3 μM of RIPK3 inhibitor GSK-872, and 0.5 μM of MLKL inhibitor necrosulfonamide (NSA). Necrotic cell death pathway activation (presen...

The procedure of calculating time to half-maximal response (HMR) of necrotic cell death in vitro. (A) Traces of propidium iodide (PI) fluorescence uptake from the individual experiments of cells treated with L-arginine that correspond to Figure 1Fi. (B) The mean ± SEM for L-arginine and L-arginine plus caffeine (2 and 5 mM) treatment groups corresp...

Effect of allosteric modulators of GPCR Class C on biochemical markers of L-arginine-induced acute pancreatitis in vivo. Mice received intraperitoneal injections of either 8% L-arginine (pH 7.4, 2 × 4 g/kg, at 1 h interval) and were sacrificed at 72 h after the first L-arginine injection: (A) serum amylase, (B) pancreatic trypsin activity, (C) panc...

Representative histopathological images for experimental groups in the L-arginine- and L-histidine-induced acute pancreatitis. Cyclophilin D knock-out (Ppif-/-) or wild type (Wt) mice received either intraperitoneal injections of either 8% L-arginine or 7% L-histidine (both: pH 7.4, 2 × 4 g/kg, at 1 h intervals) and were sacrificed at 72 h after th...

Histones are positively charged nuclear proteins that facilitate packaging of DNA into nucleosomes common to all eukaryotic cells. Upon cell injury or cell signalling processes, histones are released passively through cell necrosis or actively from immune cells as part of extracellular traps. Extracellular histones function as microbicidal proteins...

Background: To date, there still is a lack of specific acute pancreatitis markers and specifically an early marker that can reliably predict disease severity. The inflammatory response in acute pancreatitis is mediated in part through oxidative stress and calcineurin-NFAT (Nuclear Factor of Activated T-cells) signaling, which is inducing its own n...

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The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non...

Background Clinical and experimental acute pancreatitis feature histone release within the pancreas from innate immune cells and acinar cell necrosis. In this study, we aimed to detail the source of circulating histones and assess their role in the pathogenesis of acute pancreatitis. Methods Circulating nucleosomes were measured in patient plasma,...

Background: Early prediction of acute pancreatitis severity remains a challenge. Circulating levels of histones are raised early in mouse models and correlate with disease severity. It was hypothesized that circulating histones predict persistent organ failure in patients with acute pancreatitis. Methods: Consecutive patients with acute pancreat...

This chapter discusses the current understanding of the pathogenesis of acute pancreatits (AP) and preclinical and clinical studies undertaken in the light of this. It also highlights potential novel therapeutic targets and makes proposal for future clinical trial design that may contribute to the successful development of effective therapies. Panc...

Objective The benefits of pancreatic enzyme replacement therapy (PERT) in chronic pancreatitis (CP) are inadequately defined. We have undertaken a systematic review and meta-analysis of randomised controlled trials of PERT to determine the efficacy of PERT in exocrine pancreatic insufficiency (EPI) from CP. Design Major databases were searched fro...

Enhanced recovery after surgery (ERAS) pathways are multimodal, evidence-based approaches to optimize patient outcome after surgery. However, the use of ERAS protocols to improve morbidity and recovery time without compromising safety following pancreaticoduodenectomy (PD) remains to be elucidated. We conducted a systemic review and meta-analysis t...

Objective: Caffeine reduces toxic Ca(2+) signals in pancreatic acinar cells via inhibition of inositol 1,4,5-trisphosphate receptor (IP3R)-mediated signalling, but effects of other xanthines have not been evaluated, nor effects of xanthines on experimental acute pancreatitis (AP). We have determined effects of caffeine and its xanthine metabolites...

Acute pancreatitis (AP) is an inflammatory disorder of the exocrine pancreas frequently associated with metabolic causes, contributing factors, or consequences, including hypertriglyceridemia, obesity, and disorders of intermediary metabolism, respectively. To date, there is no specific therapy for this disease. Future optimal therapy should correc...

Extracellular histones are rapidly cleared by the liver and rarely detectable in the circulation unless there is extensive cell death, as in severe trauma and sepsis. This study investigated whether circulating histones are elevated in experimental acute pancreatitis models and correlate to disease severity. Acute pancreatitis was induced in mice b...

Background & Aims Sustained activation of the cytosolic calcium concentration induces injury to pancreatic acinar cells and necrosis. The calcium release–activated calcium modulator ORAI1 is the most abundant Ca2+ entry channel in pancreatic acinar cells; it sustains calcium overload in mice exposed to toxins that induce pancreatitis. We investigat...

Introduction Cytosolic calcium overload triggers pancreatic acinar injury induced by pancreatitis toxins. Sustained Ca2+elevation depends on Ca2+entry through store-operated Ca2+entry (SOCE) channel Orai1, but the role of which in experimental acute pancreatitis (EAP) and human pancreatic acinar cell injury has not been determined. Method Confocal...

To investigate the differences in outcome following pylorus preserving pancreaticoduodenectomy (PPPD) and subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). Major databases including PubMed (Medline), EMBASE and Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were se...

Introduction Increased intestinal permeability and endotoxaemia occur in acute pancreatitis (AP) but have yet to be confirmed in chronic pancreatitis (CP). Confocal endomicroscopy (CEM) is a novel technology that has identified epithelial gaps and leakage of intravenously administered fluorescein from small intestinal mucosa in inflammatory bowel d...

Therapy advances are constantly improving survival rates of cancer patients, however the toxic effects of chemotherapy drugs can seriously affect patients' quality of life. In women, fertility and premature ovarian endocrine dysfunction are of particular concern. It is urgently we find methods to preserve or reconstruct ovarian function for these w...

Although oxidative stress has been strongly implicated in the development of acute pancreatitis (AP), antioxidant therapy in patients has so far been discouraging. The aim of this study was to assess potential protective effects of a mitochondria-targeted antioxidant, MitoQ, in experimental AP using in vitro and in vivo approaches. MitoQ blocked H2...

To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy (PD) with or without prophylactic drainage. Relevant comparative randomized and non-randomized studies were systemically searched based on specific inclusion and exclusion criteria. Postoperative outcomes were compared between patients with and those without routine drainag...

Heat shock proteins (HSPs) are overexpressed in human hepatocellular carcinoma (HCC) tissue and correlate with aggressiveness and prognosis of HCC. Using the GSE14520 microarray expression profile from Gene Expression Omnibus, we compared HSP gene expression between tumour and non-tumour tissues and correlated this with outcomes in HCC patients. We...

Convincing arguments for either removing or leaving in-situ a macroscopically normal appendix have been made, but rely on surgeons' accurate intra-operative assessment of the appendix. This study aimed to determine the inter-rater reliability between surgeons and pathologists from a large, multicentre cohort of patients undergoing appendicectomy. T...

Background Surgical reconstruction following pancreaticoduodenectomy (PD) is associated with significant morbidity and mortality. Because of great variability in definitions of specific complications, it remains unclear whether there is a difference in complication rates following the two commonest types of reconstruction, pancreaticogastrostomy (P...

Background. Resident surgeons have been identified as a risk factor for worse outcome after appendectomy. The context of grade of resident and impact of supervision require further investigation. The objective of this study was to determine whether grade and supervision level of resident-performed appendectomy affects patient outcome. Methods. A mu...

Objective: To determine safety of short in-hospital delays before appendicectomy. Background: Short organizational delays before appendicectomy may safely improve provision of acute surgical services. Methods: The primary endpoint was the rate of complex appendicitis (perforation, gangrene, and/or abscess). The main explanatory variable was ti...

Background Appendicectomy for acute appendicitis in children may be performed in specialist centres by paediatric surgeons or in general surgery units. Service provision and outcome of appendicectomy in children may differ between such units.Methods This multicentre observational study included all children (aged less than 16 years) who had an appe...

Background There is evidence to suggest that patients undergoing treatment at weekends may be subject to different care processes and outcomes compared with weekdays. This study aimed to determine whether clinical outcomes from weekend appendicectomy are different from those performed on weekdays. Method Multicentre cohort study during May–June 201...