Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms

Buscarini, Elisabetta; Pezzilli, Raffaele; Cannizzaro, Renato; Angelis, Claudio De; Gion, Massimo; Morana, Giovanni; Zamboni, Giuseppe; Arcidiacono, Paolo Giorgio; Balzano, Gianpaolo; Barresi, Luca; Basso, Daniela; Buracco, Paolo; Calculli, Lucia; Capurso, Gabriele; Canzonieri, Vincenzo; Casadei, Riccardo; Crippa, Stefano; D’Onofrio, Mirko; Frulloni, Luca; Fusaroli, Pietro; Manfredi, Guido; Pacchioni, Donatella; Pasquali, Claudio; Rocca, Rodolfo; Ventrucci, Maurizio; Venturini, S.; Villanacci, Vincenzo; Zerbi, Alessandro; Falconi, Massimo; Albarello, Luca; Camellini, Lorenzo; Cantù, P.; Conigliaro, Rita; Costamagna, Guido; Favero, G. Del; Blanco, Giovanna Del Vecchio; Sebastiano, Pierluigi di; Fabbri, Carlo; Federici, Paolo; Funel, Niccola; Galli, Andrea; Gabbrielli, Armando; Graziani, Rossella; Guadagnini, Tiziana; Laghi, Andréa; Macarri, Giampiero; Magnolfi, Fabrizio; Marzioni, Marco; Monica, Fabio; Muscatiello, Nicola; Mutignani, Massimiliano; Pisani, Antonio; Scarano, Enrico; Serra, Carla; Spada, Marco; Visconti, M.; Zambelli, A.

doi:10.1016/j.dld.2013.12.019

Cited by 108 publications

(86 citation statements)

References 200 publications

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“…Notwithstanding, this technique has been used to establish consensus statements in many other therapeutic areas, such as musculoskeletal ultrasonography [50,51], mild-to-severe psoriasis [18], Anderson-Fabry disease [17], supportive care in advanced cancer [52], dyspnea in lung or heart disease [53], and cystic pancreatic neoplasms [54]. Third, since the study was limited to Italian nephrologists, the results may be biased by the Italian knowledge and experience in the nutritional treatment of CKD, i.e.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

A Delphi consensus panel on nutritional therapy in chronic kidney disease

et al. 2016

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The conservative management of chronic kidney disease (CKD) includes nutritional therapy (NT) with the aim to reduce the intake of proteins, phosphorus, organic acids, sodium, and potassium, while ensuring adequate caloric intake. While there is evidence that NT may help to prevent and control metabolic alterations in CKD, the criteria for implementing a low-protein regimen in CKD are still debated. There is no final consensus on the composition of the diet, nor indications for specific patient settings or different stages of CKD. Also when and how to start dietary manipulation of different nutrients in CKD is not well defined. A group of Italian nephrologists participated, under the auspices of the Italian Society of Nephrology, in a Delphi exercise to explore the consensus on some open questions regarding the nutritional treatment in CKD in Italy, generating a consensus opinion for 23 statements on: (1) general principles of NT; (2) indications for and initiation of NT; (3) role of protein-free products; (4) NT safety; (5) integrated management of NT. This Delphi exercise shows that there is broad consensus regarding NT in CKD across a wide range of management areas. These clinician-led consensus statements provide a framework for appropriate guidance on NT in patients with CKD, and are intended as a guide in decision-making whenever possible.

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Section: Strengths and Limitationsmentioning

confidence: 99%

A Delphi consensus panel on nutritional therapy in chronic kidney disease

et al. 2016

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“…The values of the guidelines included in the subset with the highest score are shown in bold. 6.0 ± 0.9 Buscarini 2014 [19] 6.0 ± 1.0 Overall 4.8 ± 1.6 P value <0.001 case for BD-IPMN, with a recommendation of evaluation but no immediate resection; for MPD of 5e9 mm and presence of any one of thickened enhancing walls, intraductal mucin or mural nodules, resection is indicated. MPD 10 mm is considered as a "high-risk stigmata" and represents an indication for resection [17] (Percent of agreement: 60.0).…”

Section: Guidelines Assessmentmentioning

confidence: 97%

“…For the IAP guidelines, the updated version of 2012 [17] replaced the old version of 2006 [7]. Of note only two guidelines report the evidence levels and the grade of recommendation [8,19].…”

Section: Guidelines Assessmentmentioning

confidence: 99%

“…More recent guidelines appeared to have higher scores across all domains; however, regarding the Rigor of Development all guidelines had scores lower than the minimum AGREE standardized score. The Italian Consensus Guidelines received the best score for Stakeholder involvement [19] whereas the Society for Surgery of the Alimentary Tract (SSAT) guideline [14] received the lower score regarding the Scope and Purpose, Rigor of Development and Clarity and Presentation. No differences were found among different guidelines regarding their Applicability.…”

Section: Guidelines Assessmentmentioning

confidence: 99%

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Quality assessment of the guidelines on cystic neoplasms of the pancreas

et al. 2015

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“…(2) The indication for resection in a mucinous cystadenoma of the pancreas is justified by the relatively high risk for malignant transformation, particularly in patients with a familial history of pancreatic cancer. (35,36) Functional neuroendocrine pancreatic tumors such as insulinoma can be safely resected with parenchyma-sparing procedures such as CP, when a simple enucleation is not possible. (28) A recent study has shown that almost 90% of the insulinomas have a benign biological behavior, and loco-regional lymph nodes dissection appears to have no benefit.…”

Section: Indications and Contraindications For A Central Pancreatectomentioning

confidence: 99%

Central pancreatectomy revisited

Dumitraşcu¹,

Popescu²

2015

JTMR

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Central pancreatectomy (CP) is a parenchyma-sparing alternative resection to distal pancreatectomy, for benign and low malignant potential tumors located on the pancreatic isthmus and/ or body. Pancreatic metastases of other neoplasia might also benefit after a CP, in selected patients. Dagradi and Serio described the modern technique of CP, while Iacono introduced it in current clinical practice. An open CP represents the standard, but there is an emerging role for the minimally-invasive approach, which might become a standard for CP in experienced centers, particularly for the robotic approach. The rationale of a CP was to preserve the postoperative pancreatic functions because it implies the loss of a minimal amount of normal pancreatic tissue. However, the real clinical benefit of a CP is still controversial. High overall morbidity and pancreatic fistula rates were reported after a CP. However, most of the complications after a CP have been conservatively managed, with almost zero mortality. A CP has a minimal impact on the postoperative pancreatic functions; the diabetes mellitus rate after a CP is significantly lower, compared with the distal pancreatectomies. A proper selection of candidates for a CP is recommended. Thus, tumors located on the pancreatic isthmus are more likely to benefit after a CP, because the alternative surgical technique in these patients is an extended left pancreatectomy, a procedure with increased risk of postoperative pancreatic insufficiencies. Individual patient-related factors should be taken into consideration in the selection of the patients. Thus, a CP should be used in young patients, non-obese and without diabetes mellitus, with a good biological status, which might be able to overcome the potential postoperative complications. A CP can be safely incorporated into an experienced pancreatic surgeon armamentarium, albeit it represents an uncommon pancreatic resection. Abbreviations: Central pancreatectomy (CP); Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM).

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Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms

Cited by 108 publications

References 200 publications

A Delphi consensus panel on nutritional therapy in chronic kidney disease

A Delphi consensus panel on nutritional therapy in chronic kidney disease

Quality assessment of the guidelines on cystic neoplasms of the pancreas

Central pancreatectomy revisited

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