The impact of neoadjuvant therapy in patients with left-sided resectable pancreatic cancer: an international multicenter study
Por:
Rangelova E, Stoop TF, van Ramshorst TME, Ali M, van Bodegraven EA, Javed AA, Hashimoto D, Steyerberg E, Banerjee A, Jain A, Sauvanet A, Serrablo A, Giani A, Giardino A, Zerbi A, Arshad A, Wijma AG, Coratti A, Zironda A, Socratous A, Rojas A, Halimi A, Ejaz A, Oba A, Patel BY, Björnsson B, Reames BN, Tingstedt B, Goh BKP, Payá-Llorente C, Del Pozo CD, González-Abós C, Medin C, van Eijck CHJ, de Ponthaud C, Takishita C, Schwabl C, Månsson C, Ricci C, Thiels CA, Douchi D, Hughes DL, Kilburn D, Flanking D, Kleive D, Silva DS, Edil BH, Pando E, Moltzer E, Kauffman EF, Warren E, Bozkurt E, Sparrelid E, Thoma E, Verkolf E, Ausania F, Giannone F, Hüttner FJ, Burdio F, Souche FR, Berrevoet F, Daams F, Motoi F, Saliba G, Kazemier G, Roeyen G, Nappo G, Butturini G, Ferrari G, Kito Fusai G, Honda G, Sergeant G, Karteszi H, Takami H, Suto H, Matsumoto I, Mora-Oliver I, Frigerio I, Fabre JM, Chen J, Sham JG, Davide J, Urdzik J, de Martino J, Nielsen K, Okano K, Kamei K, Okada K, Tanaka K, Labori KJ, Goodsell KE, Alberici L, Webber L, Kirkov L, de Franco L, Miyashita M, Maglione M, Gramellini M, Ramera M, Amaral MJ, Ramaekers M, Truty MJ, van Dam MA, Stommel MWJ, Petrikowski M, Imamura M, Hayashi M, D'Hondt M, Brunner M, Hogg ME, Zhang C, Suárez-Muñoz MÁ, Luyer MD, Unno M, Mizuma M, Janot M, Sahakyan MA, Jamieson NB, Busch OR, Bilge O, Belyaev O, Franklin O, Sánchez-Velázquez P, Pessaux P, Holka PS, Ghorbani P, Casadei R, Sartoris R, Schulick RD, Grützmann R, Sutcliffe R, Mata R, Patel RB, Takahashi R, Rodriguez Franco S, Cabús SS, Hirano S, Gaujoux S, Festen S, Kozono S, Maithel SK, Chai SM, Yamaki S, van Laarhoven S, Mieog JSD, Murakami T, Codjia T, Sumiyoshi T, Karsten TM, Nakamura T, Sugawara T, Boggi U, Hartman V, de Meijer VE, Bartholomä W, Kwon W, Koh YX, Cho Y, Takeyama Y, Inoue Y, Nagakawa Y, Kawamoto Y, Ome Y, Soonawalla Z, Uemura K, Wolfgang CL, Jang JY, Padbury R, Satoi S, Messersmith W, Wilmink JW, Abu Hilal M, Besselink MG, Del Chiaro M
Publicada:
1 may 2025
Ahead of Print:
1 abr 2025
Resumen:
Background: Left-sided pancreatic cancer is associated with worse overall survival (OS) compared with right-sided pancreatic cancer. Although neoadjuvant therapy is currently seen as not effective in patients with resectable pancreatic cancer (RPC), current randomized trials included mostly patients with right-sided RPC. The purpose of this study was to assess the association between neoadjuvant therapy and OS in patients with left-sided RPC compared with upfront surgery.
Patients and methods: This was an international multicenter retrospective study including consecutive patients after left-sided pancreatic resection for pathology-proven RPC, either after neoadjuvant therapy or upfront surgery in 76 centers from 18 countries on 4 continents (2013-2019). The primary endpoint was OS from diagnosis. Time-dependent Cox regression analysis was carried out to investigate the association of neoadjuvant therapy with OS, adjusting for confounders at the time of diagnosis. Adjusted OS probabilities were calculated.
Results: Overall, 2282 patients after left-sided pancreatic resection for RPC were included of whom 290 patients (13%) received neoadjuvant therapy. The most common neoadjuvant regimens were (m)FOLFIRINOX (38%) and gemcitabine-nab-paclitaxel (22%). After upfront surgery, 72% of patients received adjuvant chemotherapy, mostly a single-agent regimen (74%). Neoadjuvant therapy was associated with prolonged OS compared with upfront surgery (adjusted hazard ratio 0.69, 95% confidence interval 0.58-0.83) with an adjusted median OS of 53 versus 37 months (P = 0.0003) and adjusted 5-year OS rates of 47% versus 35% (P = 0.0001) compared with upfront surgery. Interaction analysis demonstrated a stronger effect of neoadjuvant therapy in patients with a larger tumor (P-interaction = 0.003) and higher serum carbohydrate antigen 19-9 (CA19-9; P-interaction = 0.005). In contrast, the effect of neoadjuvant therapy was not enhanced for splenic artery (P-interaction = 0.43), splenic vein (P-interaction = 0.30), retroperitoneal (P-interaction = 0.84), and multivisceral (P-interaction = 0.96) involvement.
Conclusions: Neoadjuvant therapy in patients with left-sided RPC was associated with improved OS compared with upfront surgery. The impact of neoadjuvant therapy increased with larger tumor size and higher serum CA19-9 at diagnosis. Randomized controlled trials on neoadjuvant therapy specifically in patients with left-sided RPC are needed.
Filiaciones:
Rangelova E:
Department of Upper Abdominal Surgery at Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
Stoop TF:
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Amsterdam, the Netherlands
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
van Ramshorst TME:
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Amsterdam, the Netherlands
Department of Surgery, Fondazione Poliambulanza, Instituto Ospedaliero, Brescia, Italy
Ali M:
Cancer Center Amsterdam, Amsterdam, the Netherlands
Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands
van Bodegraven EA:
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Amsterdam, the Netherlands
Javed AA:
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Amsterdam, the Netherlands
Department of Surgical Oncology, Department of Surgery, New York University Medical Center, New York, USA
Hashimoto D:
Department of Surgery, Kansai Medical University, Osaka, Japan
Steyerberg E:
Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
Banerjee A:
HPB & Liver Transplant Unit, Royal Free Hospital, London, UK
Jain A:
Division of Surgical Oncology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
Sauvanet A:
Department of HPB Surgery and Liver Transplantation, APHP Beaujon Hospital, University of Paris Cité, Clichy, France
Serrablo A:
HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain
Giani A:
Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Giardino A:
Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Peschiera, Italy
Zerbi A:
Humanitas University, Department of Biomedical Sciences, Milan, Italy
Pancreatic Surgery Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
Arshad A:
Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
Wijma AG:
Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
Coratti A:
General and Emergency Surgery Unit, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy
Zironda A:
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, USA
Socratous A:
Department of Upper Abdominal Surgery at Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
Rojas A:
Department of Surgery, NorthShore University Health System, Evanston, USA
Halimi A:
Department of Surgery, Umeå University, Umeå, Sweden
Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
Ejaz A:
Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, USA
Oba A:
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo
Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
Patel BY:
Hepatopancreatobiliary Unit, University Hospitals Southampton NHS Trust, Southampton General Hospital, Southampton, UK
Björnsson B:
Department of Surgery, Linköping University Hospital, Linköping, Sweden
Reames BN:
Department of Surgery, University of Nebraska Medical Center, Omaha, USA
Tingstedt B:
Department of Clinical Sciences Lund, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
Goh BKP:
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
Payá-Llorente C:
General and Digestive Surgery, Hospital Doctor Peset, Valencia, Spain
Del Pozo CD:
General and Digestive Surgery, Hospital Doctor Peset, Valencia, Spain
González-Abós C:
Hepatobiliopancreatic Department, Hospital Clinic de Barcelona, Barcelona, Spain
Medin C:
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, USA
van Eijck CHJ:
Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
de Ponthaud C:
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
Takishita C:
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
Schwabl C:
Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
Månsson C:
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
Ricci C:
Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
Thiels CA:
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, USA
Douchi D:
Department of Surgery, Tohoku University, Sendai, Japan
Hughes DL:
Department of Hepatobiliary and Pancreatic Surgery, Oxford Radcliffe Hospitals NHS Foundation Trust, Oxford, UK
Kilburn D:
Department of Surgery, Flinders Medical Centre, Adelaide, Australia
Flanking D:
Department of Upper Abdominal Surgery at Sahlgrenska University Hospital, Gothenburg, Sweden
Kleive D:
Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
Silva DS:
HEBIPA Surgery, Centro Hospitalar Universitário de Santo António, Porto, Portugal
Edil BH:
Division of Surgical Oncology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
Pando E:
Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Moltzer E:
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
Kauffman EF:
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
Warren E:
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, USA
Bozkurt E:
Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
Sparrelid E:
Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
Thoma E:
Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
Verkolf E:
Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
Ausania F:
Hepatobiliopancreatic Department, Hospital Clinic de Barcelona, Barcelona, Spain
Instituto de Investigaciones Biomédicas August Pi I Sunyer (IDIBAPS), Barcelona, Spain
Giannone F:
Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Strasbourg, France
Hüttner FJ:
Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
Burdio F:
Department of Surgery, Hepatobiliary and Pancreatic Unit, Hospital del Mar de Barcelona, Barcelona, Spain
Hospital del Mar Research Institute (IMIM), University Pompeu-Fabra, Barcelona, Spain
Souche FR:
Oncologic & Minimally-Invasive Digestive Surgery, CHU Montpellier, University of Montpellier, Montpellier, France
Berrevoet F:
Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
Daams F:
Cancer Center Amsterdam, Amsterdam, the Netherlands
Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands
Motoi F:
Department of Surgery, Yamagata University, Yamagata, Japan
Saliba G:
Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
Kazemier G:
Cancer Center Amsterdam, Amsterdam, the Netherlands
Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands
Roeyen G:
Department of HPB, Endocrine and Transplantation Surgery, University Hospital Antwerp, Antwerp, Belgium
Nappo G:
Humanitas University, Department of Biomedical Sciences, Milan, Italy
Pancreatic Surgery Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
Butturini G:
Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Peschiera, Italy
Ferrari G:
Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Kito Fusai G:
HPB & Liver Transplant Unit, Royal Free Hospital, London, UK
Honda G:
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
Sergeant G:
Department of Abdominal Surgery, Jessa Hospital, Faculty of Medicine and Health Sciences, Universiteit Hasselt, Hasselt, Belgium
Karteszi H:
Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Takami H:
Department of Gastroenterological Surgery (Surgery II), Nagoya University, Nagoya, Japan
Suto H:
Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
Matsumoto I:
Department of Surgery, Kindai University, Osakasayama, Japan
Mora-Oliver I:
Department of Surgery, Liver and Pancreato-Biliary Unit, Hospital Clínico Universitario Valencia, Biomedical Research Institute, INCLIVA, Valencia, Spain
Frigerio I:
Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Peschiera, Italy
Fabre JM:
Oncologic & Minimally-Invasive Digestive Surgery, CHU Montpellier, University of Montpellier, Montpellier, France
Chen J:
Department of Surgery, Flinders Medical Centre, Adelaide, Australia
Sham JG:
Department of Surgery, University of Washington, Seattle, USA
Fred Hutchinson Cancer Center, Seattle, USA
Davide J:
HEBIPA Surgery, Centro Hospitalar Universitário de Santo António, Porto, Portugal
Urdzik J:
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
de Martino J:
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
Nielsen K:
Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Okano K:
Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
Kamei K:
Department of Surgery, Kindai University, Osakasayama, Japan
Okada K:
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
Tanaka K:
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Hokkaido, Japan
Labori KJ:
Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Goodsell KE:
Department of Surgery, University of Washington, Seattle, USA
Alberici L:
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
Webber L:
Department of Upper GI Surgery, Fiona Stanley Hospital, Perth, Austria
Kirkov L:
Oncologic & Minimally-Invasive Digestive Surgery, CHU Montpellier, University of Montpellier, Montpellier, France
de Franco L:
General and Emergency Surgery Unit, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy
Miyashita M:
Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
Maglione M:
Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
Gramellini M:
Humanitas University, Department of Biomedical Sciences, Milan, Italy
Pancreatic Surgery Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
Ramera M:
Department of Surgery, Fondazione Poliambulanza, Instituto Ospedaliero, Brescia, Italy
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
Amaral MJ:
General Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Ramaekers M:
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
Truty MJ:
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, USA
van Dam MA:
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
Stommel MWJ:
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
Petrikowski M:
Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
Imamura M:
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Hokkaido, Japan
Hayashi M:
Department of Gastroenterological Surgery (Surgery II), Nagoya University, Nagoya, Japan
D'Hondt M:
Department of Digestive and Hepatobiliary-Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
Brunner M:
Department of Surgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen Nürnberg, Erlangen, Germany
Hogg ME:
Department of Surgery, NorthShore University Health System, Evanston, USA
Zhang C:
Department of Surgery, University of Nebraska Medical Center, Omaha, USA
Suárez-Muñoz MÁ:
HPB Surgical Unit, University Hospital Virgen de la Victoria, Málaga, Spain
Luyer MD:
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
Unno M:
Department of Surgery, Tohoku University, Sendai, Japan
Mizuma M:
Department of Surgery, Tohoku University, Sendai, Japan
Janot M:
Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
Sahakyan MA:
The Intervention Center, Oslo University Hospital, Rigshospitalet, Oslo, Norway
Jamieson NB:
Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
Busch OR:
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Amsterdam, the Netherlands
Bilge O:
Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
Belyaev O:
Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
Franklin O:
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
Department of Surgery, Umeå University, Umeå, Sweden
Sánchez-Velázquez P:
Department of Surgery, Hepatobiliary and Pancreatic Unit, Hospital del Mar de Barcelona, Barcelona, Spain
Hospital del Mar Research Institute (IMIM), University Pompeu-Fabra, Barcelona, Spain
Pessaux P:
Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Strasbourg, France
Holka PS:
Department of Clinical Sciences Lund, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
Ghorbani P:
Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
Casadei R:
Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
Sartoris R:
Department of Radiology, APHP Beaujon Hospital, University of Paris Cité, Clichy, France
Schulick RD:
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
Grützmann R:
The Intervention Center, Oslo University Hospital, Rigshospitalet, Oslo, Norway
Sutcliffe R:
Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Mata R:
Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Patel RB:
Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, USA
Takahashi R:
Department of Surgery, Yamagata University, Yamagata, Japan
Rodriguez Franco S:
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
Cabús SS:
Department of HPB Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Hirano S:
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Hokkaido, Japan
Gaujoux S:
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
Festen S:
Department of Surgery, OLVG, Amsterdam, The Netherlands
Kozono S:
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
Maithel SK:
Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, USA
Chai SM:
Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia
Yamaki S:
Department of Surgery, Kansai Medical University, Osaka, Japan
van Laarhoven S:
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
Department of HPB Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Mieog JSD:
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
Murakami T:
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Hokkaido, Japan
Codjia T:
Department of Digestive Surgery, Rouen University Hospital, Rouen, France
Sumiyoshi T:
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
Karsten TM:
Department of Surgery, OLVG, Amsterdam, The Netherlands
Nakamura T:
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Hokkaido, Japan
Sugawara T:
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo
Boggi U:
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
Hartman V:
Department of HPB, Endocrine and Transplantation Surgery, University Hospital Antwerp, Antwerp, Belgium
de Meijer VE:
Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
Bartholomä W:
Department of Radiology, Linköping University, Linköping, Sweden
Kwon W:
Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Koh YX:
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
Cho Y:
Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Takeyama Y:
Department of Surgery, Kindai University, Osakasayama, Japan
Inoue Y:
Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
Nagakawa Y:
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
Kawamoto Y:
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
Ome Y:
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
Soonawalla Z:
Department of Hepatobiliary and Pancreatic Surgery, Oxford Radcliffe Hospitals NHS Foundation Trust, Oxford, UK
Uemura K:
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
Wolfgang CL:
Department of Surgical Oncology, Department of Surgery, New York University Medical Center, New York, USA
Jang JY:
Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Padbury R:
Department of Surgery, Flinders Medical Centre, Adelaide, Australia
Satoi S:
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
Department of Surgery, Kansai Medical University, Osaka, Japan
Messersmith W:
Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, USA
Wilmink JW:
Cancer Center Amsterdam, Amsterdam, the Netherlands
Amsterdam UMC, Location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
Abu Hilal M:
Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Peschiera, Italy
Besselink MG:
Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
Cancer Center Amsterdam, Amsterdam, the Netherlands
Del Chiaro M:
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
Michalski CW:
Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
de Wilde RF:
Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
Tufekci T:
Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey
Ishida H:
Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
Dennahy IS:
Division of Surgical Oncology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
Carter JA:
Department of Surgery, University of Washington, Seattle, Japan
Olapo JS:
Department of Surgery, University of Washington, Seattle, Japan
Caldera M:
Hepatobiliopancreatic Department, Hospital Clinic de Barcelona, Barcelona, Spain
Mazzola M:
Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, USA
Oshima M:
Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
Tanaka N:
Department of Gastroenterological Surgery (Surgery II), Nagoya University, Nagoya, Japan
Choi SH:
Department of Surgery, NorthShore University Health System, Evanston, USA
Sato S:
Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
Sugawara S:
Department of Surgery, Yamagata University, Yamagata, Japan
Abadia-Forcen T:
HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain
Pawlik TM:
Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, USA
Kimura Y:
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Hokkaido, Japan
Green Submitted, hybrid
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