Giovanni Marchegiani

Pancreas Surgeon @UniPadova 😷 @BJSOpen Editor 🗞️ @ISGPS_news Secretary 🎓 @YouppiePancreas Coordinator @EAHPBA board 🪡@MGHSurgery @PancreasVerona trained

[Giovanni Marchegiani @Gio_Marchegiani]

Peritoneal patch 🩹 after venous resection for PDAC on the uncinate process 😮

[Giovanni Marchegiani @Gio_Marchegiani]

Diagnosis and follow-up of IPMN 🍇 bringing the ethical issues into focus

Major ethical concerns include
🤔 diagnostic uncertainty
🙊 communication
😰 anxiety / difensive medicine
🏥 resource utilization

👉We need answers from politicians👈

https://t.co/idv7FbiuJT

[Giovanni Marchegiani @Gio_Marchegiani]

🍒 Small p-NET <2cm always a challenge

🇮🇹 🇯🇵 🇫🇷 🇹🇷 🇬🇧 🇩🇪 460 resected / 35% enucleation

⚠️ Central panc morbidity 25% 🆚 enucleation 10% and ⬆️ POPF / LOS

🫐 LN Mets 14% 🙃

My take: less (no surgery) is MORE!

https://t.co/o4qt6EZMZW

[Giovanni Marchegiani @Gio_Marchegiani]

Of surgical dogma and lemonade 🍋 managing the drain left after pancreatoduodenectomy

✍️ Beautiful commentary by @HalletJulie in @BjsOpen a pleasure to read!

↓↓↓

https://t.co/DN5pAeJb13

[Giovanni Marchegiani @Gio_Marchegiani]

🆕 Drain management risk-stratified dynamic algorithm after Whipple 🆕

💦 Drain fluid amylase still key but pathways different based on intraop risk assessment

🚨 800 PD included / 32% high risk

Check out the thread 👉 practice changing algorithm

https://t.co/aqskbzXT8Y

[Giovanni Marchegiani @Gio_Marchegiani]

A man who changed so many other’s life, including mine

Prof. Paolo Pederzoli was the founder of the Verona school of pancreatology. One of the fathers of modern pancreas surgery

He was an example. A master. A leader. Countless memories that shaped my life forever. Thank you 🖤

[Giovanni Marchegiani @Gio_Marchegiani]

Masterclass training for 🤖 PD from @YosukeInoueHPB 🇯🇵 at Teikyo University

👈 Left approach to SMA after meticulous preop surgical planning with drawing ✍️

The rest.. is just Japanese hospitality at its best 🎎 so honored !!!

[Giovanni Marchegiani @Gio_Marchegiani]

Honored to represent @EurPancClub at the 53 Japan Pancreas Society 🇪🇺🤝🇯🇵 in Fukuoka

✋ STOP surveillance in IPMN was a hot topic 🔥 but controversial

💰 Current policies not cost effective but concomitant PDAC is a big issue in long run … more evidence needed!

[Giovanni Marchegiani @Gio_Marchegiani]

🥇 Artery first approach in 🤖 robot PD

👉 right or left 👈 ?! But also mesenteric / anterior / posterior

🔴 Still heterogeneity BUT never compromising with safety and oncological radicality 🔴

A stellar ⭐️ session at Japan 🇯🇵 Pancreas Society 👏 in Fukuoka today

[Giovanni Marchegiani @Gio_Marchegiani]

🎓 A real honor to have hosted at @HPDsurgery 🔴🔴 sir @prabir_maharjan🇳🇵 for his HPB fellowship

🙏 to @EurPancClub for the grant that made this possible and his supervisors @PrabinBikramTh2 @dhireshmaharjan for sending such a great surgeon and a special person ❤️

[Giovanni Marchegiani @Gio_Marchegiani]

Is this the World Cup 🏆 for PDAC studies?!

💉 First in human #Kras vaccine for PDAC interception in high risk cohort 😱

👮 T Cell response in 90% persisting up to 2 years - no participants developed PDAC

🍿 and now we can enjoy 🇪🇸 🇦🇷 … 😜

https://t.co/OCswwJrgAD

[Giovanni Marchegiani @Gio_Marchegiani]

What do we mean with "recurrence" of IPMN 🍇 after surgery ?!

☝️ word - ✌️ different scenario

🆕 IPMN after resection of non-invasive are "de novo" in 50% cases

🦀 Recurrence of invasive IPMN was 42%, most systemic if 🍒 node + and tubular type

https://t.co/IgxtRGW9hZ

[Giovanni Marchegiani @Gio_Marchegiani]

Mesopancreas excision ✂️ International consensus

🗺️ Defined as retropancreatic compartment of lymphatic neurovascular and adipose tissue

👍 Both artery- and mesenteric-first approach OK

🧼 Total excision more curative?! to be investigated further

https://t.co/n3laFwAe77

[Giovanni Marchegiani @Gio_Marchegiani]

⚫️ Risk of pancreas cancer associated with GLP-1 receptor agonist therapy

🤔 For IPMN in surveillance 🍇 under this drug.. What to advise?

🐀 Initial animal studies suggest potential mechanism - no data on humans / long term needed

🫵 Your practice?

https://t.co/gR0Kp1hUCe

[Giovanni Marchegiani @Gio_Marchegiani]

Interesting 🧐 86% responders use stents!
📈 Half of them only in high risk cases 💪

[Giovanni Marchegiani @Gio_Marchegiani]

💦 Do you use Trans-anastomotic stents to protect your PJ?

🫡 Predictive value of drain amylase 🧪 still valid!

🧯1.1k PD / 40% stents both POD1 POD3 predictive but must integrate with risk factors

https://t.co/A6QD8l4OPc

[Giovanni Marchegiani @Gio_Marchegiani]

Do you use Trans-anastomotic stents to protect your PJ?

[Giovanni Marchegiani @Gio_Marchegiani]

🧪 Serum CA19.9 in IPMN 🍇 to detect High-Grade Dysplasia and Invasive Carcinoma

🌎 Included in upcoming global GL!

🚨 In 4.6k pts CA19.9 POORLY 🙈 performed in excluding HGD / cancer

👎 No use as standalone / screening test!

🆓 @JAMANetworkOpen

https://t.co/gnTkj3JLfN

[Giovanni Marchegiani @Gio_Marchegiani]

Chyle leak 🍼 after pancreas surgery is never fatal but increases in vascular dissections …

🔴 1k cases > 11% chyle leak (most grade B as per @ISGPS_news)

❌🥛 Minimally invasive approach + drain volume risk factors / Not milky appearance!

https://t.co/5t0kaAnM3z

[Giovanni Marchegiani @Gio_Marchegiani]

@rajibaji1983 @Giampaolo_Perri @BjsOpen @MalinASund @evanscolorectal @me4_so @SoMeHPBNepal @T4UGIS @for_surgeons @HPDsurgery @BannoneElisa Thank you for your comment @rajibaji1983
1) OK to remove drains on POD1 in low risk (we are doing a RCT ) but then don't use them at all 🤷‍♂️
2) While drainless LP are standard; not sure this applies as well to low risk PD (discrepancy btw claiming vs. actually doing it) 😅

[Giovanni Marchegiani @Gio_Marchegiani]

🆕 Drain management risk-stratified dynamic algorithm after Whipple 🆕

💦 Drain fluid amylase still key but pathways different based on intraop risk assessment

🚨 800 PD included / 32% high risk

Check out the thread 👉 practice changing algorithm

https://t.co/aqskbzXT8Y