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- Lluis, Nuria, et al.
(författare)
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Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)
- 2023
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Ingår i: International Journal of Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 1743-9191 .- 1743-9159. ; 109:4, s. 760-771
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Tidskriftsartikel (refereegranskat)abstract
- Background/Purpose:Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. Methods:A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien-Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. Results:A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55-72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50-82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 (P=0.016), intrahepatic versus extrahepatic tumor (P=0.027), single versus multiple tumors (P=0.007), those who underwent hepatic versus pancreatic resection (P=0.017), or achieved versus failed TO (P=0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11-15.94; P=0.03) was an independent prognostic factor of poor overall survival. Conclusions:Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.
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| 2. |
- D'Souza, Melroy A., et al.
(författare)
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Hepatopancreatoduodenectomy –a controversial treatment for bile duct and gallbladder cancer from a European perspective
- 2020
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Ingår i: HPB. - : Elsevier BV. - 1365-182X. ; 22:9, s. 1339-1348
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist. The purpose of this study was to evaluate safety and efficacy for HPD in European centers. Method: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed. Results: In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90-day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival. Conclusion: HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer. To achieve negative resection margins is paramount for an improved survival outcome.
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| 3. |
- Morin, Samuel, et al.
(författare)
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Pan-European meteorological and snow indicators of climate change impact on ski tourism
- 2021
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Ingår i: Climate Services. - : Elsevier. - 2405-8807. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Ski tourism plays a major socio-economic role in the snowy and mountainous areas of Europe such as the Alps, the Pyrenees, Nordic Europe, Eastern Europe, Anatolia, etc. Past and future climate change has an impact on the operating conditions of ski resorts, due to their reliance on natural snowfall and favorable conditions for snowmaking. However, there is currently a lack of assessment of past and future operating conditions of ski resorts at the pan-European scale in the context of climate change. The presented work aims at filling this gap, as part of the ”European Tourism” Sectoral Information System (SIS) of the Copernicus Climate Change Services (C3S). The Mountain Tourism Meteorological and Snow Indicators (MTMSI) were co-designed with representatives of the ski tourism industry, including consulting companies. They were derived from statistically adjusted EURO-CORDEX climate projections (multiple GCM/RCM pairs for RCP2.6, RCP4.5 and RCP8.5) using the UERRA 5.5 km resolution surface reanalysis as a reference, used as input to the snow cover model Crocus, with and without accounting for snow management (grooming, snowmaking). Results are generated for 100 m elevation bands for NUTS-3 geographical areas spanning all areas relevant to ski tourism in Europe. This article introduces the underpinning elements for the generation of this product, and illustrates results at the pan-European scale as well as for smaller scale case studies. A dedicated visualization app allows for easy navigation into the multiple dimensions of this dataset, thereby fulfilling the needs of a broad range of users.
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| 4. |
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| 5. |
- Morin, Samuel, et al.
(författare)
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The Mountain Component of the Copernicus Climate Change Services - Sectoral Information Service "European Tourism" : Towards Pan-European Analysis and Projections of Natural and Managed Snow Conditions
- 2018
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Ingår i: International Snow Science Workshop Proceedings 2018. - : Montana State University Library.
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Konferensbidrag (refereegranskat)abstract
- Ski tourism plays a major role in European mountain areas such as the Alps, Pyrenees, Scandinavia, Turkey, Eastern European Mountains etc. Meteorological conditions govern the operating conditions of ski resorts, due to their reliance on natural snow fall and favorable conditions for snowmaking. However, there is currently a major lack of assessment of past and future operating conditions of ski resorts at the pan-European scale in the context of climate change. The presented work aims at filling this gap, as part of the ongoing development of « European Tourism » Sectoral Information Service (SIS) of the Copernicus Climate Change Services (C3S). C3S is run by the European Center for Medium-range Weather Forecast (ECMWF) on behalf of the European Commission. Such an endeavor requires combining state-of-the-art meteorological reanalysis with regional climate projections, followed by the application of a snowpack model accounting for grooming and snowmaking. Emphasis will be placed on the workflow making it possible to analyze the data with various levels of aggregation (from daily data to annual scale indicators, to their statistical moments accounting for multiple climate scenarios and lead times), in order to address the needs of various stakeholders, at the European, national, regional and local scales. The data will be made available freely through the Copernicus Data Store in various ways (download of raw data, download or graphics based on post-processed information accounting for user specific needs). It is expected that the data and the tools developed within this project will not only make it possible to analyze the climate sensitivity of ski tourism in Europe as a topical yet academic research question, but would also help third-parties in developing climate services specifically targeting the ski tourism industry in Europe. This contribution introduces the scientific background and general strategy for generating the products, and delivers preliminary information relevant to this upcoming operational service, planned to open to users from 2019 onwards.
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