scholarly journals 229 - Surgical and Patient-Centered Outcomes after Pancreatic Resection in High-Risk Individuals for Pancreatic Cancer: A 20-Year Prospective Cancer of the Pancreas Screening (CAPS) Cohort Study

2018 ◽  
Vol 154 (6) ◽  
pp. S-1263-S-1264
Author(s):  
Tossapol Kerdsirichairat ◽  
Marcia I. Canto ◽  
Madeline Ford ◽  
Michael G. Goggins ◽  
Amanda Blackford ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
High Risk ◽  
Pancreatic Resection ◽  
Patient Centered ◽  
Cancer Of The Pancreas

Cancer of the Pancreas: Clinical Outcome in 76 Cases

1986 ◽  
Vol 72 (6) ◽  
pp. 601-607 ◽  
Author(s):  
Vittorio Pugliese ◽  
Sebastiano Saccomanno ◽  
Luigina Bonelli ◽  
Daniela Barone ◽  
Massimo Conio ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Clinical Outcome ◽  
Clinical Presentation ◽  
High Sensitivity ◽  
Radical Resection ◽  
Final Diagnosis ◽  
Diagnostic Techniques ◽  
Tissue Diagnosis ◽  
Cancer Of The Pancreas

A final diagnosis of pancreatic cancer was established in 76 consecutive patients during 4 years. The clinical outcome was evaluated retrospectively, as well as clinical presentation and its impact on the rate of resectability. Even though the diagnostic techniques showed a high sensitivity, only 18.4% of patients had a radical resection performed. In 77.6% of the cases a tissue diagnosis had been obtained. However, in only 1/5 of them was the tissue proof obtained preoperatively. This review confirms that the survival of patients with pancreatic cancer is poor, with slight advantages in the few resectable cases. Therefore, an earlier diagnosis should be attempted in high-risk symptomatic patients, selected by means of nonaggressive tests and evaluated by means of more accurate diagnostic techniques, when suitable.

Predictors of Neoplastic Progression in High-Risk Individuals Undergoing Surveillance for Pancreatic Cancer: Lessons from the First 16 Years of the Cancer of the Pancreas Screening (CAPS) Program

2017 ◽  
Vol 152 (5) ◽  
pp. S274 ◽  
Author(s):  
Jose Alejandro N. Almario ◽  
Marcia I. Canto ◽  
Anne Marie Lennon ◽  
Eun J. Shin ◽  
Christopher L. Wolfgang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Neoplastic Progression ◽  
Cancer Of The Pancreas

scholarly journals Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer

2019 ◽  
Vol 24 (5) ◽  
pp. 1101-1110 ◽  
Author(s):  
Marcia Irene Canto ◽  
Tossapol Kerdsirichairat ◽  
Charles J. Yeo ◽  
Ralph H. Hruban ◽  
Eun Ji Shin ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Surgical Outcomes ◽  
Pancreatic Resection

scholarly journals Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium

Gut ◽  
2019 ◽  
Vol 69 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Michael Goggins ◽  
Kasper Alexander Overbeek ◽  
Randall Brand ◽  
Sapna Syngal ◽  
Marco Del Chiaro ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Multidisciplinary Teams ◽  
Familial Pancreatic Cancer ◽  
High Grade ◽  
Degree Relative ◽  
Delphi Approach ◽  
Cancer Of The Pancreas ◽  
Increased Risk ◽  
Consensus Statements

Background and aimThe International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals).MethodsA modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed.ResultsConsensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions.ConclusionsPancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.

Predicting early mortality in resectable pancreatic adenocarcinoma: A cohort study.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 414-414
Author(s):  
Davendra Sohal ◽  
Shiva Shrotriya ◽  
Katherine Glass ◽  
Robert James Pelley ◽  
Michael J. McNamara ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
High Risk ◽  
Pancreatic Adenocarcinoma ◽  
Cleveland Clinic ◽  
Pancreatic Head ◽  
Early Mortality ◽  
Prognostic Variables ◽  
High Risk Patients ◽  
Risk Patients

414 Background: Overall survival after pancreatic cancer resection remains poor. A subgroup of patients die early (<6 months) and understanding factors associated with early mortality may help identify high-risk patients. The Khorana Score, including baseline hemoglobin, leukocyte and platelet counts, and body mass index [Khorana et al, Blood, 2008], has been shown to be associated with early mortality in solid tumors [Ay et al; Kuderer et al]. We evaluated the role of this score and other prognostic variables in predicting early mortality following resection. Methods: We conducted a cohort study of consecutive patients who underwent surgical resection for pancreatic cancer from January 2006 through June 2013 and were followed at the Cleveland Clinic. Baseline (diagnosis +/- 30 days) parameters were used to define patients as high-risk (Score >=3). Statistically significant univariable associations and a priori prognostic variables were tested in multivariable models; adjusted hazard ratios (HR) are presented. Results: The study population comprised 334 patients. Median age was 67 years; 50% were female; 86% were Caucasian. Pancreatic head was the primary site for 73%; 67% were T3 and 63% were N1 tumors. Median Khorana score was 2; 152 patients (47%) were high-risk. Adjunctive treatment included chemotherapy (70%) and radiation (40%). Post-operative (30-day) mortality was 0.9%. Six-month mortality for the entire cohort was 9.4%, with significantly higher rates for high-risk patients (13.4% vs. 5.6%, p=0.02). In univariable analyses, Khorana score, low hemoglobin, and elevated blood urea nitrogen (BUN) were associated with early mortality; T- and N-stage, as well as margin status (R0/R1), were not. In multivariable analyses (n=326), Khorana score (HR high-risk = 2.31, p=0.039) and elevated BUN (HR = 4.34, p<0.001) were associated with early mortality. Conclusions: Patients at high risk for early mortality after resection of pancreatic adenocarcinoma can be identified using simple baseline patient-related clinical and laboratory parameters rather than tumor characteristics. Future studies could evaluate the benefit of pre-operative interventions targeting patients at high risk for early mortality.

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