Preoperative scoring system to predict early recurrence after surgery for resectable pancreatic cancer: a multi-center retrospective study

Abstract Background We designed a retrospective study to compare prognostic outcomes based on whether or not surgical resection was performed in elderly patients aged(≥75 years) with resectable pancreatic cancer. Methods We retrospectively analyzed 49 patients with resectable pancreatic cancer (surgery group, resection was performed for 38 cases; no surgery group, resection was not performed for 11 cases) diagnosed from January 2003 to December 2014 at the National Cancer Center, Korea. Results There was no significant difference in demographics between the two groups. The surgery group showed significantly better overall survival after diagnosis than the no surgery group (2-year survival rate, 40.7% vs. 0%; log-rank test, p = 0.015). Multivariate analysis revealed that not having undergone surgical resection [hazard ratio (HR) 2.412, P = 0.022] and a high Charlson comorbidity index (HR 5.252, P = 0.014) were independent prognostic factors for poor overall survival in elderly patients with early stage pancreatic cancer. Conclusions In the present study, surgical resection resulted in better prognosis than non-surgical resection for elderly patients with resectable pancreatic cancer. Except for patients with a high Charlson comorbidity index, an aggressive surgical approach seems to be beneficial for elderly patients with resectable pancreatic cancer.

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Surgery for elderly patients with resectable pancreatic cancer, a comparison with non-surgical treatments: a retrospective study

HPB ◽

10.1016/j.hpb.2019.10.2160 ◽

2019 ◽

Vol 21 ◽

pp. S426

Author(s):

Hyeong Min Park ◽

Sang-Jae Park ◽

Sung-Sik Han

Keyword(s):

Pancreatic Cancer ◽

Retrospective Study ◽

Elderly Patients ◽

Resectable Pancreatic Cancer ◽

Surgical Treatments

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Are We Sure that Adjuvant Chemotherapy is the Best Approach for Resectable Pancreatic Cancer? Are We in the Era of Neoadjuvant Treatment? A Review of Current Literature

Journal of Clinical Medicine ◽

10.3390/jcm8111922 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1922 ◽

Cited By ~ 3

Author(s):

Oneda ◽

Zaniboni

Keyword(s):

Pancreatic Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Performance Status ◽

Neoadjuvant Treatment ◽

Early Recurrence ◽

Current Treatment ◽

R0 Resection ◽

Resectable Pancreatic Cancer ◽

Advantages And Disadvantages

The outcome of pancreatic cancer is poor, with a 9% 5-year survival rate. Current treatment recommendations in the 10%–20% of patients who present with resectable disease support upfront resection followed by adjuvant therapy. Until now, only early complete surgical (R0) resection and adjuvant chemotherapy (AC) with either FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) or nab-paclitaxel plus gemcitabine have been shown to prolong the survival. However, up to 30% of patients do not receive adjuvant therapy because of the development of early recurrence, postoperative complications, comorbidities, and reduced performance status. The aims of neoadjuvant chemotherapy (NAC) are to identify rapidly progressing patients to avoid futile surgery, eliminate micrometastases, increase the feasibility of R0 resection, and ensure the completion of multimodal treatment. Neoadjuvant treatments are effective, but there is no consensus on their use in resectable pancreatic cancer (RPC) because of its lack of a survival benefit over adjuvant therapy. In this review, we analyze the advantages and disadvantages of the two therapeutic approaches in RPC. We need studies that compare the two approaches and can identify the appropriate sequence of adjuvant therapy after neoadjuvant treatment and surgery.

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