Commentary: Periadventitial dissection of the superior mesenteric artery at pancreatoduodenectomy for locally advanced pancreatic cancer

Surgery ◽  
2021 ◽  
Author(s):  
Matthew H.G. Katz
Keyword(s):  
Pancreatic Cancer ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Locally Advanced Pancreatic Cancer

Effect of venous involvement on survival in locally advanced pancreatic cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 153-153
Author(s):  
Kelly C. Hewitt ◽  
Jesse L Madden ◽  
Joslin C Christensen ◽  
Sean J. Mulvihill ◽  
Courtney L. Scaife
Keyword(s):  
Pancreatic Cancer ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Stage Ii ◽  
Locally Advanced Pancreatic Cancer ◽  
Vascular Involvement ◽  
Venous Involvement ◽  
Ajcc Staging

153 Background: Locally advanced pancreatic cancer is defined as tumor that extends beyond the pancreas into surrounding structures. Borderline resectable disease usually includes a description of superior mesenteric vein (SMV) or portal vein (PV) involvement, while the AJCC staging no longer includes venous involvement in the staging system. We reviewed our institutional cancer database to determine if venous involvement affects overall survival and should be included in pancreatic ductal adenocarcinoma (PDA) staging. Methods: A retrospective review was performed of all patients with stage II or III PDA identified through our institutional prospective Clinical Cancer Research Database, between 2007-2012. Patients with superior mesenteric artery (SMA) or celiac artery and/or venous (SMV or PV) involvement were compared to those without. Vascular involvement was defined as either vessel encasement or abutment on endoscopic ultrasound or CT imaging. Survival analysis was performed using the Kaplan-Meier method with log-rank test for comparison of survival curves. Results: A total of 194 patients were identified as having stage II or stage III pancreatic adenocarcinoma, with 85 having evidence of vascular involvement. In our patient population we found that in patients with stage IIA and IIB disease PV or SMV involvement did not portend statistically worse survival (median survival 14 months v 15 months p=0.63). In stage III patients survival was actually longer in patients with PV or SMV involvement, but this was not statistically significant (median survival 13 months v 7.9 months p=.066). When comparing those with PV or SMV involvement versus those with celiac axis or superior mesenteric artery (SMA) involvement in all patients with locally advanced pancreatic cancer (stage II or III), those with celiac or SMA involvement did significantly worse (mean survival 14 months v. 7.9 months p<0.001). Conclusions: Venous involvement does not portend a worse survival in patients with stage II and III pancreatic cancer. The addition of venous involvement to the current AJCC staging scheme would not provide additional survival information.

A Critical Overview of Systematic Reviews of Chemotherapy for Advanced and Locally Advanced Pancreatic Cancer using both AMSTAR2 and ROBIS as Quality Assessment Tools

2020 ◽  
Vol 15 ◽  
Author(s):  
Amit Dang ◽  
Surendar Chidirala ◽  
Prashanth Veeranki ◽  
BN Vallish
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Systematic Reviews ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Risk Of Bias ◽  
Low Risk ◽  
Locally Advanced Pancreatic Cancer ◽  
Grade 3 ◽  
Critical Overview

Background: We performed a critical overview of published systematic reviews (SRs) of chemotherapy for advanced and locally advanced pancreatic cancer, and evaluated their quality using AMSTAR2 and ROBIS tools. Materials and Methods: PubMed and Cochrane Central Library were searched for SRs on 13th June 2020. SRs with metaanalysis which included only randomized controlled trials and that had assessed chemotherapy as one of the treatment arms were included. The outcome measures, which were looked into, were progression-free survival (PFS), overall survival (OS), and adverse events (AEs) of grade 3 or above. Two reviewers independently assessed all the SRs with both ROBIS and AMSTAR2. Results: Out of the 1,879 identified records, 26 SRs were included for the overview. Most SRs had concluded that gemcitabine-based combination regimes, prolonged OS and PFS, but increased the incidence of grade 3-4 toxicities, when compared to gemcitabine monotherapy, but survival benefits were not consistent when gemcitabine was combined with molecular targeted agents. As per ROBIS, 24/26 SRs had high risk of bias, with only 1/26 SR having low risk of bias. As per AMSTAR2, 25/26 SRs had critically low, and 1/26 SR had low, confidence in the results. The study which scored ‘low’ risk of bias in ROBIS scored ‘low confidence in results’ in AMSTAR2. The inter-rater reliability for scoring the overall confidence in the SRs with AMSTAR2 and the overall domain in ROBIS was substantial; ROBIS: kappa=0.785, SEM=0.207, p<0.001; AMSTAR2: kappa=0.649, SEM=0.323, p<0.001. Conclusion: Gemcitabine-based combination regimens can prolong OS and PFS but also worsen AEs when compared to gemcitabine monotherapy. The included SRs have an overall low methodological quality and high risk of bias as per AMSTAR2 and ROBIS respectively.

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