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, Fusai, GK, 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, MA, 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, Franco, SR, 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:
Sahlgrens Univ Hosp, Dept Upper Abdominal Surg, Gothenburg, Sweden
Univ Gothenburg, Inst Clin Sci, Dept Surg, Sahlgrenska Acad, Gothenburg, Sweden
Stoop, TF:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Univ Colorado, Sch Med, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA
van Ramshorst, TME:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Fdn Poliambulanza, Inst Osped, Dept Surg, Brescia, Italy
Ali, M:
Canc Ctr Amsterdam, Amsterdam, Netherlands
Vrije Univ, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
van Bodegraven, EA:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Javed, AA:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
NYU, Med Ctr, Dept Surg, Dept Surg Oncol, New York, NY USA
Hashimoto, D:
Kansai Med Univ, Dept Surg, Osaka, Japan
Steyerberg, E:
Leiden Univ, Med Ctr, Dept Biomed Data Sci, Leiden, Netherlands
Banerjee, A:
Royal Free Hosp, HPB & Liver Transplant Unit, London, England
Jain, A:
Univ Oklahoma, Hlth Sci Ctr, Stephenson Canc Ctr, Div Surg Oncol, Oklahoma City, OK USA
Sauvanet, A:
Univ Paris Cite, Beaujon Hosp, APHP, Dept HPB Surg & Liver Transplantat, Clichy, France
Serrablo, A:
Miguel Servet Univ Hosp, HPB Surg Div, Zaragoza, Spain
Giani, A:
ASST Grande Osped Metropolitano Niguarda, Div Minimally Invas Surg Oncol, Milan, Italy
Giardino, A:
Pederzoli Hosp, Dept HPB Surg, Peschiera Del Garda, Peschiera, Italy
Zerbi, A:
Humanitas Univ, Dept Biomed Sci, Milan, Italy
IRCCS, Humanitas Clin & Res Ctr, Pancreat Surg Unit, Milan, Italy
Arshad, A:
Univ Hosp Southampton NHS Trust, Southampton Gen Hosp, Hepatopancreatobiliary Unit, Southampton, Hants, England
Wijma, AG:
Univ Groningen, Dept Surg, Groningen, Netherlands
Univ Med Ctr Groningen, Groningen, Netherlands
Coratti, A:
Azienda USL Toscana Sud Est, Misericordia Hosp, Gen & Emergency Surg Unit, Grosseto, Italy
Zironda, A:
Mayo Clin, Div Hepatobiliary & Pancreas Surg, Rochester, MN USA
Socratous, A:
Sahlgrens Univ Hosp, Dept Upper Abdominal Surg, Gothenburg, Sweden
Univ Gothenburg, Inst Clin Sci, Dept Surg, Sahlgrenska Acad, Gothenburg, Sweden
Rojas, A:
NorthShore Univ Hlth Syst, Dept Surg, Evanston, IL USA
Halimi, A:
Umea Univ, Dept Surg, Umea, Sweden
Karolinska Univ Hosp, Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg & Oncol, Stockholm, Sweden
Ejaz, A:
Ohio State Univ, Dept Surg, Div Surg Oncol, Columbus, OH USA
Oba, A:
Univ Colorado, Sch Med, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA
Tokyo Med & Dent Univ, Grad Sch Med, Dept Hepatobiliary & Pancreat Surg, Tokyo, Japan
Japanese Fdn Canc Res, Canc Inst Hosp, Dept Hepatobiliary & Pancreat Surg, Tokyo, Japan
Patel, BY:
Univ Hosp Southampton NHS Trust, Southampton Gen Hosp, Hepatopancreatobiliary Unit, Southampton, Hants, England
Björnsson, B:
Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden
Reames, BN:
Univ Nebraska Med Ctr, Dept Surg, Omaha, NE USA
Tingstedt, B:
Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Lund, Sweden
Goh, BKP:
Singapore Gen Hosp, Dept Hepatopancreatobiliary & Transplant Surg, Singapore, Singapore
Natl Canc Ctr Singapore, Singapore, Singapore
Payá-Llorente, C:
Hosp Doctor Peset, Gen & Digest Surg, Valencia, Spain
Del Pozo, CD:
Hosp Doctor Peset, Gen & Digest Surg, Valencia, Spain
González-Abós, C:
Hosp Clin Barcelona, Hepatobiliopancreat Dept, Barcelona, Spain
Medin, C:
Emory Univ, Winship Canc Inst, Div Surg Oncol, Atlanta, GA USA
van Eijck, CHJ:
Erasmus MC Canc Inst, Dept Surg, Rotterdam, Netherlands
de Ponthaud, C:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Hepatobiliary & Pancreat Surg & Liver Transp, Paris, France
Takishita, C:
Tokyo Med Univ, Dept Gastrointestinal & Pediat Surg, Tokyo, Japan
Schwabl, C:
Med Univ Innsbruck, Dept Radiol, Innsbruck, Austria
Månsson, C:
Uppsala Univ, Dept Surg Sci, Uppsala, Sweden
Ricci, C:
Alma Mater Studiorum Univ Bologna, Dept Internal Med & Surg DIMEC, Bologna, Italy
Azienda Osped Univ Bologna, IRCCS, Div Pancreat Surg, Bologna, Italy
Thiels, CA:
Mayo Clin, Div Hepatobiliary & Pancreas Surg, Rochester, MN USA
Douchi, D:
Tohoku Univ, Dept Surg, Sendai, Miyagi, Japan
Hughes, DL:
Oxford Radcliffe Hosp NHS Fdn Trust, Dept Hepatobiliary & Pancreat Surg, Oxford, England
Kilburn, D:
Flinders Med Ctr, Dept Surg, Adelaide, SA, Australia
Flanking, D:
Sahlgrens Univ Hosp, Dept Upper Abdominal Surg, Gothenburg, Sweden
Kleive, D:
Oslo Univ Hosp, Dept Hepatopancreatobiliary Surg, Oslo, Norway
Silva, DS:
Ctr Hosp Univ Santo Antonio, HEBIPA Surg, Porto, Portugal
Edil, BH:
Univ Oklahoma, Hlth Sci Ctr, Stephenson Canc Ctr, Div Surg Oncol, Oklahoma City, OK USA
Pando, E:
Univ Autonoma Barcelona, Barcelona, Spain
Hosp Univ Vall dHebron, Dept Hepatopancreatobiliary & Transplant Surg, Barcelona, Spain
Moltzer, E:
Radboud Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands
Kauffman, EF:
Univ Pisa, Div Gen & Transplant Surg, Pisa, Italy
Warren, E:
Emory Univ, Winship Canc Inst, Div Surg Oncol, Atlanta, GA USA
Bozkurt, E:
Koc Univ, Sch Med, Dept Gen Surg, Istanbul, Turkiye
Sparrelid, E:
Karolinska Univ Hosp, Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg & Oncol, Stockholm, Sweden
Thoma, E:
Ulm Univ Hosp, Dept Gen & Visceral Surg, Ulm, Germany
Verkolf, E:
Erasmus MC Canc Inst, Dept Surg, Rotterdam, Netherlands
Ausania, F:
Hosp Clin Barcelona, Hepatobiliopancreat Dept, Barcelona, Spain
Inst Invest Biomed August Pi I Sunyer IDIBAPS, Barcelona, Spain
Giannone, F:
Univ Hosp Strasbourg, Dept Visceral & Digest Surg, Strasbourg, France
Hüttner, FJ:
Ulm Univ Hosp, Dept Gen & Visceral Surg, Ulm, Germany
Burdio, F:
Hosp del Mar Barcelona, Dept Surg, Hepatobiliary & Pancreat Unit, Barcelona, Spain
Univ Pompeu Fabra, Hosp del Mar Res Inst IMIM, Barcelona, Spain
Souche, FR:
Univ Montpellier, CHU Montpellier, Oncol & Minimally Invas Digest Surg, Montpellier, France
Berrevoet, F:
Ghent Univ Hosp, Dept Gen & HPB Surg & Liver Transplantat, Ghent, Belgium
Daams, F:
Canc Ctr Amsterdam, Amsterdam, Netherlands
Vrije Univ, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Motoi, F:
Yamagata Univ, Dept Surg, Yamagata, Japan
Saliba, G:
Karolinska Univ Hosp, Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg & Oncol, Stockholm, Sweden
Kazemier, G:
Canc Ctr Amsterdam, Amsterdam, Netherlands
Vrije Univ, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Roeyen, G:
Univ Hosp Antwerp, Dept HPB Endocrine & Transplantat Surg, Antwerp, Belgium
Nappo, G:
Humanitas Univ, Dept Biomed Sci, Milan, Italy
IRCCS, Humanitas Clin & Res Ctr, Pancreat Surg Unit, Milan, Italy
Butturini, G:
Pederzoli Hosp, Dept HPB Surg, Peschiera Del Garda, Peschiera, Italy
Ferrari, G:
ASST Grande Osped Metropolitano Niguarda, Div Minimally Invas Surg Oncol, Milan, Italy
Fusai, GK:
Royal Free Hosp, HPB & Liver Transplant Unit, London, England
Honda, G:
Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan
Sergeant, G:
Univ Hasselt, Jessa Hosp, Dept Abdominal Surg, Hasselt, Belgium
Univ Hasselt, Fac Med & Hlth Sci, Hasselt, Belgium
Karteszi, H:
Univ Hosp Bristol & Weston NHS Fdn Trust, Dept Radiol, Bristol, Avon, England
Takami, H:
Nagoya Univ, Dept Gastroenterol Surg Surg 2, Nagoya, Aichi, Japan
Suto, H:
Kagawa Univ, Dept Gastroenterol Surg, Takamatsu, Kagawa, Japan
Matsumoto, I:
Kindai Univ, Dept Surg, Osakasayama, Japan
Mora-Oliver, I:
Hosp Clin Univ Valencia, Dept Surg, Liver & Pancreatobiliary Unit, Biomed Res Inst,INCLIVA, Valencia, Spain
Frigerio, I:
Pederzoli Hosp, Dept HPB Surg, Peschiera Del Garda, Peschiera, Italy
Fabre, JM:
Univ Montpellier, CHU Montpellier, Oncol & Minimally Invas Digest Surg, Montpellier, France
Chen, J:
Flinders Med Ctr, Dept Surg, Adelaide, SA, Australia
Sham, JG:
Univ Washington, Dept Surg, Seattle, WA USA
Fred Hutchinson Canc Res Ctr, Seattle, WA USA
Davide, J:
Ctr Hosp Univ Santo Antonio, HEBIPA Surg, Porto, Portugal
Urdzik, J:
Uppsala Univ, Dept Surg Sci, Uppsala, Sweden
de Martino, J:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Hepatobiliary & Pancreat Surg & Liver Transp, Paris, France
Nielsen, K:
Univ Hosp Birmingham NHS Fdn Trust, Dept Hepatopancreatobiliary Surg, Birmingham, W Midlands, England
Okano, K:
Kagawa Univ, Dept Gastroenterol Surg, Takamatsu, Kagawa, Japan
Kamei, K:
Kindai Univ, Dept Surg, Osakasayama, Japan
Okada, K:
Hiroshima Univ, Grad Sch Biomed & Hlth Sci, Dept Surg, Hiroshima, Japan
Tanaka, K:
Hokkaido Univ, Fac Med, Dept Gastroenterol Surg 2, Sapporo, Hokkaido, Japan
Labori, KJ:
Oslo Univ Hosp, Dept Hepatopancreatobiliary Surg, Oslo, Norway
Univ Oslo, Inst Clin Med, Oslo, Norway
Goodsell, KE:
Univ Washington, Dept Surg, Seattle, WA USA
Alberici, L:
Uppsala Univ, Dept Surg Sci, Uppsala, Sweden
Alma Mater Studiorum Univ Bologna, Dept Internal Med & Surg DIMEC, Bologna, Italy
Webber, L:
Fiona Stanley Hosp, Dept Upper GI Surg, Perth, WA, Australia
Kirkov, L:
Univ Montpellier, CHU Montpellier, Oncol & Minimally Invas Digest Surg, Montpellier, France
de Franco, L:
Azienda USL Toscana Sud Est, Misericordia Hosp, Gen & Emergency Surg Unit, Grosseto, Italy
Miyashita, M:
Japanese Fdn Canc Res, Canc Inst Hosp, Dept Hepatobiliary & Pancreat Surg, Tokyo, Japan
Maglione, M:
Med Univ Innsbruck, Dept Visceral Transplant & Thorac Surg, Innsbruck, Austria
Gramellini, M:
Humanitas Univ, Dept Biomed Sci, Milan, Italy
IRCCS, Humanitas Clin & Res Ctr, Pancreat Surg Unit, Milan, Italy
Ramera, M:
Fdn Poliambulanza, Inst Osped, Dept Surg, Brescia, Italy
Univ Brescia, Dept Clin & Expt Sci, Brescia, Italy
Amaral, MJ:
Ctr Hosp & Univ Coimbra, Gen Surg Dept, Coimbra, Portugal
Univ Coimbra, Fac Med, Coimbra, Portugal
Ramaekers, M:
Catharina Hosp, Dept Surg, Eindhoven, Netherlands
Truty, MJ:
Mayo Clin, Div Hepatobiliary & Pancreas Surg, Rochester, MN USA
van Dam, MA:
Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands
Stommel, MWJ:
Radboud Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands
Petrikowski, M:
Ruhr Univ Bochum, Dept Surg, St Josef Hosp, Bochum, Germany
Imamura, M:
Sapporo Med Univ, Dept Surg Surg Oncol & Sci, Sapporo, Hokkaido, Japan
Hayashi, M:
Nagoya Univ, Dept Gastroenterol Surg Surg 2, Nagoya, Aichi, Japan
D'Hondt, M:
Groeninge Hosp, Dept Digest & Hepatobiliarypancreat Surg, Kortrijk, Belgium
Brunner, M:
Friedrich Alexander Univ Erlangen Nurnberg, Dept Surg, Univ Klinikum Erlangen, Erlangen, Germany
Hogg, ME:
NorthShore Univ Hlth Syst, Dept Surg, Evanston, IL USA
Zhang, C:
Univ Nebraska Med Ctr, Dept Surg, Omaha, NE USA
Suárez-Muñoz, MA:
Univ Hosp Virgen de la Victoria, HPB Surg Unit, Malaga, Spain
Luyer, MD:
Catharina Hosp, Dept Surg, Eindhoven, Netherlands
Unno, M:
Tohoku Univ, Dept Surg, Sendai, Miyagi, Japan
Mizuma, M:
Tohoku Univ, Dept Surg, Sendai, Miyagi, Japan
Janot, M:
Ruhr Univ Bochum, Dept Surg, St Josef Hosp, Bochum, Germany
Sahakyan, MA:
Oslo Univ Hosp, Rigshosp, Intervent Ctr, Oslo, Norway
Jamieson, NB:
Univ Glasgow, Sch Canc Sci, Wolfson Wohl Canc Res Ctr, Glasgow, Lanark, Scotland
Busch, OR:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Bilge, O:
Koc Univ, Sch Med, Dept Gen Surg, Istanbul, Turkiye
Belyaev, O:
Ruhr Univ Bochum, Dept Surg, St Josef Hosp, Bochum, Germany
Franklin, O:
Univ Colorado, Sch Med, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA
Umea Univ, Dept Surg, Umea, Sweden
Sánchez-Velázquez, P:
Hosp del Mar Barcelona, Dept Surg, Hepatobiliary & Pancreat Unit, Barcelona, Spain
Univ Pompeu Fabra, Hosp del Mar Res Inst IMIM, Barcelona, Spain
Pessaux, P:
Univ Hosp Strasbourg, Dept Visceral & Digest Surg, Strasbourg, France
Holka, PS:
Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Lund, Sweden
Ghorbani, P:
Karolinska Univ Hosp, Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg & Oncol, Stockholm, Sweden
Casadei, R:
Alma Mater Studiorum Univ Bologna, Dept Internal Med & Surg DIMEC, Bologna, Italy
Azienda Osped Univ Bologna, IRCCS, Div Pancreat Surg, Bologna, Italy
Sartoris, R:
Univ Paris Cite, Beaujon Hosp, APHP, Dept Radiol, Clichy, France
Schulick, RD:
Univ Colorado, Sch Med, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA
Grützmann, R:
Oslo Univ Hosp, Rigshosp, Intervent Ctr, Oslo, Norway
Sutcliffe, R:
Univ Hosp Birmingham NHS Fdn Trust, Dept Hepatopancreatobiliary Surg, Birmingham, W Midlands, England
Mata, R:
Univ Autonoma Barcelona, Barcelona, Spain
Hosp Univ Vall dHebron, Dept Hepatopancreatobiliary & Transplant Surg, Barcelona, Spain
Patel, RB:
Ohio State Univ, Dept Surg, Div Surg Oncol, Columbus, OH USA
Franco, SR:
Univ Colorado, Sch Med, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA
Cabús, SS:
Hosp Santa Creu & Sant Pau, Dept HPB Surg, Barcelona, Spain
Hirano, S:
Hokkaido Univ, Fac Med, Dept Gastroenterol Surg 2, Sapporo, Hokkaido, Japan
Gaujoux, S:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Hepatobiliary & Pancreat Surg & Liver Transp, Paris, France
Festen, S:
OLVG, Dept Surg, Amsterdam, Netherlands
Kozono, S:
Tokyo Med Univ, Dept Gastrointestinal & Pediat Surg, Tokyo, Japan
Maithel, SK:
Emory Univ, Winship Canc Inst, Div Surg Oncol, Atlanta, GA USA
Chai, SM:
PathWest Lab Med, Dept Anat Pathol, Perth, WA, Australia
Yamaki, S:
Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands
Univ Hosp Bristol & Weston NHS Fdn Trust, Dept HPB Surg, Bristol, Avon, England
van Laarhoven, S:
Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands
Univ Hosp Bristol & Weston NHS Fdn Trust, Dept HPB Surg, Bristol, Avon, England
Mieog, JSD:
Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands
Murakami, T:
Sapporo Med Univ, Dept Surg Surg Oncol & Sci, Sapporo, Hokkaido, Japan
Codjia, T:
Rouen Univ Hosp, Dept Digest Surg, Rouen, France
Sumiyoshi, T:
Hiroshima Univ, Grad Sch Biomed & Hlth Sci, Dept Surg, Hiroshima, Japan
Karsten, TM:
OLVG, Dept Surg, Amsterdam, Netherlands
Nakamura, T:
Hokkaido Univ, Fac Med, Dept Gastroenterol Surg 2, Sapporo, Hokkaido, Japan
Sugawara, T:
Univ Colorado, Sch Med, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA
Tokyo Med & Dent Univ, Grad Sch Med, Dept Hepatobiliary & Pancreat Surg, Tokyo, Japan
Boggi, U:
Univ Pisa, Div Gen & Transplant Surg, Pisa, Italy
Hartman, V:
Univ Hosp Antwerp, Dept HPB Endocrine & Transplantat Surg, Antwerp, Belgium
de Meijer, VE:
Univ Groningen, Dept Surg, Groningen, Netherlands
Bartholomä, W:
Linkoping Univ, Dept Radiol, Linkoping, Sweden
Kwon, W:
Seoul Natl Univ Hosp, Dept Surg, Seoul, South Korea
Koh, YX:
Singapore Gen Hosp, Dept Hepatopancreatobiliary & Transplant Surg, Singapore, Singapore
Natl Canc Ctr Singapore, Singapore, Singapore
Cho, Y:
Seoul Natl Univ Hosp, Dept Surg, Seoul, South Korea
Takeyama, Y:
Kindai Univ, Dept Surg, Osakasayama, Japan
Inoue, Y:
Japanese Fdn Canc Res, Canc Inst Hosp, Dept Hepatobiliary & Pancreat Surg, Tokyo, Japan
Nagakawa, Y:
Tokyo Med Univ, Dept Gastrointestinal & Pediat Surg, Tokyo, Japan
Kawamoto, Y:
Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan
Ome, Y:
Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan
Soonawalla, Z:
Oxford Radcliffe Hosp NHS Fdn Trust, Dept Hepatobiliary & Pancreat Surg, Oxford, England
Uemura, K:
Hiroshima Univ, Grad Sch Biomed & Hlth Sci, Dept Surg, Hiroshima, Japan
Wolfgang, CL:
NYU, Med Ctr, Dept Surg, Dept Surg Oncol, New York, NY USA
Jang, JY:
Seoul Natl Univ Hosp, Dept Surg, Seoul, South Korea
Padbury, R:
Flinders Med Ctr, Dept Surg, Adelaide, SA, Australia
Satoi, S:
Univ Colorado, Sch Med, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA
Kansai Med Univ, Dept Surg, Osaka, Japan
Messersmith, W:
Univ Colorado, Sch Med, Dept Med, Div Med Oncol, Aurora, CO USA
Wilmink, JW:
Canc Ctr Amsterdam, Amsterdam, Netherlands
Univ Amsterdam, Dept Med Oncol, Amsterdam UMC, Amsterdam, Netherlands
Abu Hilal, M:
Pederzoli Hosp, Dept HPB Surg, Peschiera Del Garda, Peschiera, Italy
Besselink, MG:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Del Chiaro, M:
Univ Colorado, Sch Med, Dept Surg, Div Surg Oncol, Anschutz Med Campus, Aurora, CO USA
Green Submitted, Green Published, hybrid
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