Su1351 - Long-Term Outcomes after Pancreatectomy for Pancreatic Ductal Adenocarcinoma in Elderly Patients: Special Reference to Postoperative Adjuvant Chemotherapy

243 Background: The number of incidentally discovered asymptomatic pancreatic ductal adenocarcinoma (APDAC) has been increasing along with recent wide spread use of imaging studies in general practice. However, the clinical implication in early detection of asymptomatic pancreatic cancer remains yet to be determined. In this study, we reviewed our experience of patients with PDAC in high volume cancer center and compared the characteristics and long-term outcomes between those with APDAC and symptomatic PDAC (SPDAC). Methods: This retrospective study included 569 consecutive patients with PDAC initially treated in our institution from January 2007 to December 2012. Median follow-up period was 29 months for the survivors. Two hundred and fifty patients underwent surgical resection and 319 patients were deemed unresectable. The patient’s demographics, tumor locations, pathologic stages, and treatment type received, and the overall survival (OS) were compared between the patients with APDAC and those with SPDAC. Results: One hundred and sixty-three patients (29%) presented without any subjective symptoms. When compared with SPDAC, APDAC was associated with early stage (stage I, 6% vs. 1%, p<0.01). Among 163 patients with APDAC, 104 patients (64%) underwent surgical resection, while only 146 patients (36%) out of 406 SPDAC underwent resection ( p<0.01). The 5-year OS rate of the patients with APDAC was 18%, comparing with 7% for those with SPDAC ( p<0.01). Among the patients who underwent resection, the presence of symptoms did not affect the chance of incomplete resection (R1, 12% vs. 22% for patients with APDAC and SPDAC, respectively, p=0.06) and the 5-year OS rate (23% vs. 22%, p=0.09). However, the patients with SPDAC required complex operation (concomitant vascular resection and reconstruction 56% vs. 29% for those with APDAC, p<0.01). Conclusions: Asymptomatic PDAC is associated with better long-term outcomes than symptomatic PDAC due to early stage at presentation and higher chance of resectability. Our findings highlight the potential implication of screening program for early detection of PDAC for selected high-risk patient population.

Download Full-text

The predictors and patterns of the early recurrence of pancreatic ductal adenocarcinoma after pancreatectomy: the influence of pre- and post- operative adjuvant therapy

BMC Surgery ◽

10.1186/s12893-019-0644-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Hironobu Suto ◽

Keiichi Okano ◽

Minoru Oshima ◽

Yasuhisa Ando ◽

Shigeo Takahashi ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Local Recurrence ◽

Adjuvant Therapy ◽

Pancreatic Ductal Adenocarcinoma ◽

Preoperative Chemoradiotherapy ◽

Distant Recurrence ◽

Early Recurrence ◽

Ductal Adenocarcinoma ◽

Postoperative Adjuvant Chemotherapy ◽

Early Local Recurrence

Abstract Background The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma recurrence are unclear. This study attempted to identify the predictive factors for early pancreatic ductal adenocarcinoma recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. Methods One hundred and fifteen patients undergoing curative resection for pancreatic ductal adenocarcinoma between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did (n = 34) and did not (n = 81) experience a recurrence within 6 months postoperatively. Results Multivariate analyses demonstrated postoperative CA19–9 de-normalization, no postoperative adjuvant chemotherapy, and serosal invasion were independent risk factors for early recurrence (P < 0.001, P = 0.001, and P = 0.010, respectively). A subgroup analysis showed patients with (n = 51) and without (n = 64) preoperative chemoradiotherapy had different predictors. Although postoperative adjuvant chemotherapy was not a significant indicator in patients with preoperative chemoradiotherapy, CA19–9 de-normalization and no postoperative adjuvant chemotherapy were significant indicators in patients without preoperative chemotherapy. Preoperative chemotherapy strongly prevented early local recurrence while postoperative adjuvant chemotherapy prevented early distant recurrence. Conclusions CA19–9 de-normalization was an important predictor of early recurrence of pancreatic ductal adenocarcinoma. Although postoperative adjuvant chemotherapy was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative chemoradiotherapy could strongly prevent the early local recurrence of pancreatic ductal adenocarcinoma. These perioperative adjuvant therapies could have a complementary relationship.

Download Full-text

Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma

Cancers ◽

10.3390/cancers12061428 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1428

Author(s):

Hiroaki Yanagimoto ◽

Sohei Satoi ◽

Tomohisa Yamamoto ◽

So Yamaki ◽

Satoshi Hirooka ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Adjuvant Chemotherapy ◽

Pancreatic Ductal Adenocarcinoma ◽

Locally Advanced ◽

Early Recurrence ◽

Ductal Adenocarcinoma ◽

Conversion Surgery ◽

Postoperative Adjuvant Chemotherapy ◽

Large Tumor

Background: Traditionally, the treatment options for unresectable locally advanced (UR-LA) and metastatic (UR-M) pancreatic ductal adenocarcinoma (PDAC) are palliative chemotherapy or chemoradiotherapy. The benefits of surgery for such patients remains unknown. The present study investigated clinical outcomes of patients undergoing conversion surgery (CS) after chemo(radiation)therapy for initially UR-PDAC. Methods: We recruited patients with UR-PDAC who underwent chemo(radiation)therapy for initially UR-PDAC between April 2006 and September 2017. We analyzed resectability of CS, predictive parameters for overall survival, and early recurrence (within six months). Results: A total of 468 patients (108 with UR-LA and 360 with UR-M PDAC) were enrolled in this study, of whom, 17 (15.7%) with UR-LA and 15 (4.2%) with UR-M underwent CS. The median survival time (MST) and five-year survival of patients who underwent CS was 37.2 months and 34%, respectively; significantly better than non-resected patients (nine months and 1%, respectively, p < 0.0001). MST did not differ according to UR-LA or UR-M (50.5 vs. 29.0 months, respectively, p = 0.53). Early recurrence after CS occurred in eight patients (18.8%). Lymph node metastasis, positive washing cytology, large tumor size (>35 mm), and lack of postoperative adjuvant chemotherapy were statistically significant predictive factors for early recurrence. Moreover, the site of pancreatic lesion and administration of postoperative adjuvant chemotherapy were statistically significant prognostic factors for overall survival in the patients undergoing CS. Conclusion: Conversion surgery offers benefits in terms of increase survival for initially UR-PDAC for patients who responded favorably to chemo(radiation)therapy when combined with postoperative adjuvant chemotherapy.

Download Full-text

Impact of surgical margin status on long-term outcomes after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Pancreatology ◽

10.1016/j.pan.2017.08.055 ◽

2017 ◽

Vol 17 (5) ◽

pp. S14

Author(s):

N. Pelàez ◽

L. Secanella ◽

M. Alberich ◽

J. Busquets ◽

T. Serrano ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Surgical Margin ◽

Margin Status ◽

Ductal Adenocarcinoma ◽

Long Term Outcomes

Download Full-text

Long-term outcomes following en bloc resection for pancreatic ductal adenocarcinoma of the head with portomesenteric venous invasion

Asian Journal of Surgery ◽

10.1016/j.asjsur.2020.07.021 ◽

2021 ◽

Vol 44 (1) ◽

pp. 313-320

Author(s):

Sunjong Han ◽

Dong Wook Choi ◽

Seong Ho Choi ◽

Jin Seok Heo ◽

In Woong Han ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Venous Invasion ◽

En Bloc Resection ◽

Bloc Resection ◽

Ductal Adenocarcinoma ◽

Long Term Outcomes ◽

En Bloc

Download Full-text

The predictors and patterns of the early recurrence of pancreatic ductal adenocarcinoma after pancreatectomy: the influence of pre- and post- operative adjuvant therapy

10.21203/rs.2.11858/v3 ◽

2019 ◽

Author(s):

Hironobu Suto ◽

Keiichi Okano ◽

Minoru Oshima ◽

Yasuhisa Ando ◽

Shigeo Takahashi ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Local Recurrence ◽

Adjuvant Therapy ◽

Pancreatic Ductal Adenocarcinoma ◽

Preoperative Chemoradiotherapy ◽

Distant Recurrence ◽

Early Recurrence ◽

Ductal Adenocarcinoma ◽

Postoperative Adjuvant Chemotherapy ◽

Early Local Recurrence

Abstract Background The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma recurrence are unclear. This study attempted to identify the predictive factors for early pancreatic ductal adenocarcinoma recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. Methods One hundred and fifteen patients undergoing curative resection for pancreatic ductal adenocarcinoma between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did (n=34) and did not (n=81) experience a recurrence within 6 months postoperatively. Results Multivariate analyses demonstrated postoperative CA19-9 de-normalization, no postoperative adjuvant chemotherapy, and serosal invasion were independent risk factors for early recurrence (P<0.001, P=0.001, and P=0.010, respectively). A subgroup analysis showed patients with (n=51) and without (n=64) preoperative chemoradiotherapy had different predictors. Although postoperative adjuvant chemotherapy was not a significant indicator in patients with preoperative chemoradiotherapy, CA19-9 de-normalization and no postoperative adjuvant chemotherapy were significant indicators in patients without preoperative chemotherapy. Preoperative chemotherapy strongly prevented early local recurrence while postoperative adjuvant chemotherapy prevented early distant recurrence. Conclusions CA19-9 de-normalization was an important predictor of early recurrence of pancreatic ductal adenocarcinoma. Although postoperative adjuvant chemotherapy was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative chemoradiotherapy could strongly prevent the early local recurrence of pancreatic ductal adenocarcinoma. These perioperative adjuvant therapies could have a complementary relationship.

Download Full-text