RADPs were equivalent to LDPs in nearly all measures of outcome and safety but significantly reduced the risk of conversion to open resection, despite a statistically greater probability of malignancy in the robotic cohort. We concluded that robotic assistance may broaden indications for minimally invasive pancreatectomy.

Background and Objectives Computer Assisted Robotic Surgery allows complex resections and anastomotic reconstructions to be performed with nearly identical standards to open surgery. We applied this technology to a variety of pancreatic resections to assess the safety, feasibility, versatility and reliability of this technology. Methods A retrospective review of a prospective database of robotic pancreatic resections at a single institution between August 2008 and November 2012 was performed. Peri-operative outcomes were analyzed. Results 250 consecutive robotic pancreatic resections were analyzed; pancreaticoduodenectomy (PD =132), distal pancreatectomy (DP=83), central pancreatectomy (CP=13), pancreatic enucleation (10), total pancreatectomy (TP=5), Appleby resection (4), and Frey procedure (3). Thirty day and 90 day mortality was 0.8 % and 2.0%. Rate of Clavien 3 and 4 complications was 14 and 6 %. The ISGPF grade C fistula rate was 4%. Mean operative time for the two most common procedures was 529 ± 103 mins for PD, and 257 ± 93 mins for DP. Continuous improvement in operative times was observed over the course of the experience. Conversion to open procedure was required in 16 patients (6%);(11 PD, 2 DP, 2 CP, 1 TP) for failure to progress (14) and bleeding (2). Conclusions This represents to our knowledge the largest series of robotic pancreatic resections. Safety and feasibility metrics including the low incidence of conversion support the robustness of this platform and suggest no unanticipated risks inherent to this new technology. By defining these early outcome metrics this report begins to establish a framework for comparative effectiveness studies of this platform.

Continuous assessment of quality metrics allows for safe implementation of RPD. We identified several inflexion points corresponding to optimization of performance metrics for RPD that can be used as benchmarks for surgeons who are adopting this technology.

This study suggests that surgical therapy improves survival among patients with localized, as well as metastatic, NF-pNEC. Enucleation may be oncologically equivalent to resection.

Purpose Autophagy is a cell survival mechanism that plays a critical role in pancreatic carcinogenesis. Murine studies have previously demonstrated that treatment with the late-autophagy inhibitor chloroquine in combination with chemotherapy limited tumor growth. Methods In this Phase I/II trial we examined treatment with hydroxychloroquine (HCQ) with gemcitabine for patients with pancreatic adenocarcinoma. The primary endpoints were the safety and tolerability, evaluated with Storer's dose escalation design. Secondary endpoints were CA 19-9 biomarker response, R0 resection rates, survival and correlative studies of autophagy. Results Thirty-five patients were enrolled. There were no dose-limiting toxicities and no Grade 4/5 events related to treatment. 19 patients (61%) had a decrease in CA19-9 following treatment. 29 patients (94%) underwent surgical resection as scheduled with a 77% R0 resection rate. Median overall survival was 34.8 months (95% CI: (11.57 months, not reached)). Patients who had more than a 51% increase in the autophagy marker LC3-II in circulating peripheral blood mononuclear cells had improvement in disease-free (15.03 vs. 6.9 months, p<0.05) and overall survival (34.83 vs. 10.83 months, p<0.05). No outcome differences were demonstrated in the 81% of patients with abnormal p53 expression assessed by immunohistochemistry in the resected specimens. Conclusion Pre-operative autophagy inhibition with HCQ plus gemcitabine is safe and well-tolerated. Surrogate biomarker responses (CA19-9) and surgical oncologic outcomes were enouraging. p53 status was not associated with adverse outcomes.

SBRT is feasible, with minimal grade ≥3 toxicity. The overall FFLP rate for all patients was 64.8%, comparable to rates with external beam radiotherapy. This shorter treatment course can be delivered without delay in adjuvant systemic therapy.

In this experience, RDP outcomes were optimized after 40 cases. Familiarity with the platform and dedicated training are likely to contribute to significantly shorter learning curves in future adopters.

OBJECTIVE -To compare two subcutaneous insulin strategies for glycemic management of hyperglycemia in non-critically ill hospitalized patients with diabetes during enteral nutrition therapy (ENT).RESEARCH DESIGN AND METHODS -Fifty inpatients were prospectively randomized to receive sliding-scale regular insulin (SSRI) alone (n ϭ 25) or in combination with insulin glargine (n ϭ 25). NPH insulin was added for persistent hyperglycemia in the SSRI group (glucose Ͼ10 mmol/l).RESULTS -Glycemic control was similar in the SSRI and glargine groups (mean Ϯ SD study glucose 8.9 Ϯ 1.6 vs. 9.2 Ϯ 1.6 mmol/l, respectively; P ϭ 0.71). NPH insulin was added in 48% of the SSRI group subjects. There were no group differences in frequency of hypoglycemia (1.3 Ϯ 4.1 vs. 1.1 Ϯ 1.8%; P ϭ 0.35), total adverse events, or length of stay.CONCLUSIONS -Both insulin strategies (SSRI with the addition of NPH for persistent hyperglycemia and glargine) demonstrated similar efficacy and safety in non-critically ill hospitalized patients with type 2 diabetes during ENT.