iiinova — where your digital self keeps evolving

Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 29/01/2026

Harms 😈 and benefits 👼 of Pancreatic Cyst Surveillance Guidelines - 3 guidelines compared @amergastroassn.bsky.social @gastroenterology.bsky.social 👉 Overall Harm-to-benefit ratio disappointing 👈 ✋ STOP surveillance in stable cysts not harm www.sciencedirect.com/science/arti...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 25/01/2026

Amazing international team at the #Wirsung2026 Pancreas Conference in @hpdsurgery.bsky.social Padova Great minds - great connections - true friendship 🇮🇹🇳🇱🇯🇵🇰🇷 @marcbesselink.bsky.social

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 24/01/2026

🔵 Post pancreatectomy mortality: the new seminal paper from ISGPS 👉 occurring within 90 days from pancreatectomy linked to it through root-cause analysis 3️⃣ categories ✂️ vascular complexity 💦 pancreas specific 🫀 C/P sudden journals.lww.com/annalsofsurg... @marcbesselink.bsky.social

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 15/01/2026

Celiac axis stenosis 🕵️‍♀️ the unknown risk factors for additional morbidity after a pancreatoduodenectomy 🌵 CAS incidence 16% in 1.7k cases published in Annals of Surgery 🚨 Grade B/C associated bile leak, liver perfusion failure, gastric ischemia journals.lww.com/annalsofsurg...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 30/11/2025

✂️ Does venous resection affect the delivery of adjuvant chemoterapy? 🇮🇹 🇨🇳 280 resected veins / 68% ISGPS type 3 💉 70% received adjuvant chemo prolonging survival ✋ Disclaimer: authors favors neoadj chemo, conceptually always! link.springer.com/article/10.1...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 27/11/2025

Minimally Invasive 🤜 🤛 Open Pancreatoduodenectomy for Resectable Neoplasms @nejm.org @marcbesselink.bsky.social 🔴🔴 🏥 RCT 288 pts / 14 centers 🤖 Conversion 8% but ⤵️ time to functional recovery, POPF, SSI 🤝 MI not inferior (in expert hands - in both cases…) evidence.nejm.org/doi/full/10....

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 12/11/2025

💦 Use and management of drains in pancreas surgery remains controversial 🔎 MA of 17 RCT - 4k patients out now in @bjsopen.bsky.social 🏆 Whipple level 1a: selective early drain removal 🏆 Left panc: no drain policy 🎖️ Do you stick to highest level of evidence?! 🫵 academic.oup.com/bjsopen/arti...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 23/10/2025

A great honor to serve as faculty for the course in advanced pancreas surgery at @umeauniversitet.bsky.social 🇸🇪 led by @asifhalimi.bsky.social 🫶 An amazing experience to learn and exchange knowledge on an evolving / crucial issue!

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 25/09/2025

What is your anticoagulation practice 💉 after portal vein resection in pancreas surgery ?! 🧑‍🧑‍🧒‍🧒 1k pts / 90 days thrombosis 7% in Annals of Surgery 🔮 Predictors resection type / graft material 🩸 Therapeutic anticoagulation 📉 early thrombosis but 👎 at 90 days journals.lww.com/annalsofsurg...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 11/09/2025

It’s out!!! 🔥🔥🔥 The PREOPANC-2 is in @thelancet.com Neoadjuvant FOLFIRINOX 🤜🤛 Gemcitabine based chemoradiotherapy in resecatble / BR ⚖️ No difference in overall survival 😰 Serious adverse events 40% 👍 Both regimens may be considered www.thelancet.com/pdfs/journal...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 31/08/2025

Pancreas2000 is the official postgraduate course of the EPC @myueg.bsky.social Aimed at fostering the new generation of pancreatologists… almost 2 years with 5 in person meetings! #science #passion #education and #pancreas 🫵 Join us! Applications open in October

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 05/08/2025

⏰ Early onset of GI cancers ⛑️ a window for prompt diagnosis / therapy @bjsurgery.bsky.social ☝️Incidence in <50 y/o rising particularly in 🚺 🧬 Germline mutations but most sporadic 🚬 Modifiable factors smoke/alcohol/diet 🔬 Multidisciplinarity + research needed academic.oup.com/bjs/article/...

academic.oup.com

Early-onset gastrointestinal cancers: comprehensive review and future directions

The incidence of early-onset gastrointestinal cancers—commonly defined as being diagnosed in patients <50 years of age—is rising at an alarming rate glo

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 30/07/2025

Non-pancreatic neoplasms in and around the 🪷 ampulla of Vater: International Guidelines 🔬 Optimal pathology assessment 🤝 Multidisciplinary pathways leading to best treatment 🔜 Future research line have been defined in @myueg.bsky.social journal! onlinelibrary.wiley.com/doi/10.1002/ue…

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 26/07/2025

🟣🟣 Liver Transplantation For Colorectal Cancer Liver Metastases: does sex matter?! ♐️ Post LT recurrence liver > F; 🫁 only in M 🔮 Survival predicted by CEA, 👉 sided CRC, tumor size, 🧬 KRAS mutation 🔑 Selection criteria key factor www.jhep-reports.eu/article/S258... @jhepatology.bsky.social

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 21/07/2025

What to do when recurrent acute pancreatitis 🤕 is the only worrisome feature of a BD-IPMN 🍇?! Even more tricky in case of comorbidities like liver fibrosis … ⚖️ where do you set your threshold for surgery?! 🧐

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 09/07/2025

What is "Conversion surgery" 🐛➡️🦋 for upfront unresectable upper GI and HPB cancers ⁉️ 💉 Triggered by improvements in non surgical therapies 🧰 Many techniques included 🏆 Able to improve survival! 💡 All u need to know ⬇ comprehensive review in @bjsopen.bsky.social academic.oup.com/bjsopen/arti...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 01/07/2025

Is it possible to attend 4️⃣ LAPC cases simultaneously?! 🙈 only at University Hospital Heidelberg (UKHD) 🇩🇪!!! A unique team led by Christoph Michalski paving the way to treat pancreas cancer in a modern fashion, taking into account biology 🧬 and “extreme” surgery 🪡

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 27/06/2025

Out now in @sages.org journal! POPF 🐳 after distal pancreatectomy still a poorly understood complication 🙃 🌍 International validation of the fistula risk score 800 pts 🧯POPF predicted by BMI, NAT, robot approach 🤔 FRS insufficient discrimination 🧐 !!! link.springer.com/article/10.1...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 15/06/2025

🇯🇵 My keynote lecture at the 37th Japanese Society of HPB Surgery From 🔮 prediction to 🧯prevention of complications in pancreas surgery… a risk based approach to 🐳 POPF assessing POH 🧪 and PPAP! Thank you for having me, HPB conferences in Japan are simply impossible to beat 🤯

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 12/06/2025

My invited talk at @EAHPBA 2025 🇮🇪 was about IPMN 🍇 and related carcinoma A very slippery 🧽 topic!!! Indeed 2️⃣ different entities in 1️⃣… IPMN derived cancer follow distinct 🧬 pathways 🆚 conventional PDAC but are way less explored (NOT a single RCT) 👉 knowledge gap!

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 11/06/2025

Super excited to meet this fantastic Pancreas star ⭐️ at the EAHPBA congress right from the @myueg.bsky.social presidency!!! Thank you @maloehr.bsky.social United for the pancreas, always!

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 11/06/2025

🔵 The European-African Hepato-Pancreato-Biliary Association (E-AHPBA) mentorship program is ready to take off 🛫 again! So excited to serve as a mentor also for the second edition after a previous successful journey

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 02/06/2025

IPMN 🍇 without HRS and long term risk of cancer development @bmj.com 🇯🇵 2.5k pts > 5 years surveillance 🫧 IPMN size and growth predict cancer within 5 years 🤏 MPD diameter at 5 years predicts cancer after 5 years gut.bmj.com/content/74/6...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 01/06/2025

🚨 From @ascocancer.bsky.social 2025 👉 Preop chemo with PAXG 🆚 mFOLFIRINOX for extending event-free survival (EFS) in resectable or BR PDAC (phase 3 CASSANDRA trial) 🆙 PAXG 3-year EFS 31% vs. 13% P = .003 🫸 Immature analysis for survival but.. future practice changing?! 🧐 @ascopost.bsky.social

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 27/05/2025

Postop ⬆️ amylasemia and acute pancreatitis 🧪 systematic review and meta analysis 🐳 POH predicts POPF ⚡️ PPAP causes POPF, DGE, PPH and mortality 👉 Check amylase early and get ready to mitigate 🧯postop complications! #HPBSky #SurgSky www.sciencedirect.com/science/arti...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 25/05/2025

✂️ Arterial resection and divestment 🔟 year comparative study in @bjsopen.bsky.social 🇯🇵 Analysis of 200 PDAC + artery 👗 Divestment (120 cases) most used in first 5 years 🎖️Last 5 years ⬆️ Neoadjuvant chemo + resection ⬇️ complications 👍 academic.oup.com/bjsopen/arti...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 24/05/2025

Out now in @bjsopen.bsky.social Anatomically resectable 🆚 biologically borderline PDAC 🩻 886 pts with identical imaging appearance 🪡 With upfront surgery 🧪 Biologically BR had worse DSS (54 vs. 27 months) ✌️different entities ✌️different approaches academic.oup.com/bjsopen/arti...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 19/05/2025

🚨 FOLFIRINOX vs. GEM Nab Paclitaxel for LAPC @ascocancer.bsky.social 💉 171 pts median PFS 9 months better in FOLFIRINOX group 🎯 FOLFIRINOX improves PFS significantly compared with gemcitabine and is well tolerated in LAPC ascopubs.org/doi/10.1200/...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 10/05/2025

🔙 to New York University 2️⃣2️⃣ years after med school! 🟣 Such a honor to be hosted by the amazing team led by Christopher Wolfgang to learn his techniques for locally advanced pancreas cancer, including arterial and venous resection

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Reposted by Giovanni Marchegiani, MD PhD

PANC-PALS Consortium @pancpals.bsky.social · 09/05/2025

What a pleasure to host University of Padova PANC-PALS local PI, @gio-marchegiani.bsky.social, at our HQ this week! 💜 Great discussions followed by a drink by the East River 😎 #PANCPALS @ammaraj.bsky.social

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 05/05/2025

🔥 Great discussion at the in person meeting of the GLOBAL GUIDELINES FOR CYSTIC TUMORS OF THE PANCREAS expected to be released 🔜 stay tuned! @letswinpc.org #HPBSky

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 05/05/2025

With @riccardopellegrini.bsky.social at the 2️⃣0️⃣2️⃣5️⃣ Pancreas Club in San Diego 🇺🇸

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 02/05/2025

✨ Although his primacy was subsequently challenged by a student, it is now known that Johann Georg Wirsüng 🇩🇪 the prosector of Padova University 🇮🇹 discovered the human pancreatic duct in 1642 during the dissection of an executed murderer…

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 21/04/2025

We warmly welcome dr. Aya Maekawa from Tokyo University Hospital 🇯🇵 for her fellowship at @hpdsurgery.bsky.social !!! Great to have you in our team! #HPBSky #SurgSky

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 16/04/2025

Neoadjuvant chemo 🤜🤛 surgery for Resectable PDAC 🇯🇵 RCT 💉 Gemcitabine + S1 median OS 37 months vs. 26 💡 Is neoadjuvant chemo extending survival over upfront surgery?! 🤔 What are your thoughts?! 💭 journals.lww.com/annalsofsurg... #HPBSky #Surgsky

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 13/04/2025

🟢 Since 2012 i never miss a single postgraduate course of the European Digestive Surgery @myueg.bsky.social 🎓 The concept is simple: brining a top notch faculty every year to a different country so local trainees can take advantage! 🔜 🇲🇰 “You can never be overdressed or over educated” 📚

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 11/04/2025

☢️ Is there a role for ablative radiation therapy for technically resectable pancreas cancer?! 🇺🇸 25 pts T1-T2 with comorbidities (❌surgery) 👍 2-year local progression 20% overall survival 43% 😱 Very provocative read in @jama.com Oncology jamanetwork.com/journals/jam...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 10/04/2025

A key 🔑 moment during a liver transplant !!! 🦂 The portal vein is unclamped first, allowing blood to flow into the liver 🚿 The liver is the flushed to remove any remaining of solutions #HPBSky

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 05/04/2025

🔵 Pancreas2000 is the young talent group of the European Pancreas Club @myueg.bsky.social and is aimed at shaping the nextgen of pancreas experts 🙏 I feel very privileged to coordinate this program, our future is in good hands! 💙

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 28/03/2025

👁️ Bordeline observable IPMNs 👁️ our new editorial in @bmj.com GUT ⚖️ Reappraisal of the actual benefit of extended surveillance between cancer risk🫸 🫷discontinuation 🧬 "Less invasive" biomarkers are expected to exclude from FU harmless cyst since first observation 🟠 gut.bmj.com/content/earl...

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 21/03/2025

Can we personalize 📐 surveillance of IPMN?! 🇮🇹 🇺🇸 🇩🇪 🇰🇷 🇳🇱 🇬🇧 🇸🇬 🇪🇸 analysis of 2k IPMN developing WF/HRS 👴 Age and 🫧 cyst size impact the timing of surveillance 🦘 First prudential control always 6 months… then 🦘🦘 2 years if no WF/HRS journals.lww.com/annalsofsurg... #HPBSky #SurgSky

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 19/03/2025

Are we reducing the 🏋️‍♀️ burden of pancreas cancer by surveilling mucinous cystic neoplasms?! 🫧 🧐 Maybe we are not there yet ... And... Do you apply different policies for IPMN and MCN!? 🍇 Enjoy a 🆓 dowload at this link (expires in 30 days!) authors.elsevier.com/a/1kn5Y5P-Xy... #HPBSky #SurgSky

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 19/03/2025

Is there a role for 🫸compressing🫷 the pancreas before transection in left pancreatectomy?! 🇯🇵 RCT pre compression vs. no 🐳 POPF 12% ❌ no difference between groups 🫵 How do you transect the pancreas ?! 🤔 Do you ruotine drain a LP?1 academic.oup.com/bjs/article/... Out in @bjsurgery.bsky.social

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 19/03/2025

Thank you @augishealth.bsky.social Roux group 🇬🇧 for having me in Liverpool! 🟣 A vibrant gathering of young HPB surgeons and a solid support to @pancreaticcanuk.bsky.social !!!

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Giovanni Marchegiani, MD PhD @gio-marchegiani.bsky.social · 16/03/2025

Delayed Gastric Emptying 🤢 is an issue after robotic 🤖 PD 2️⃣1️⃣ % overall DGE rate 📹 assessment of technical skills ⬇️ DGE rates (after 35 procedures) 🤔 How do you perform GJ after a robotic PD ?! How do you prevent DGE?! 🫵 journals.lww.com/annalsofsurg... @marcbesselink.bsky.social #HPBSky

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