Resection of Recurrent Pancreatic Cancer: Who Can Benefit?

Background: Recurrence after resection of pancreatic cancer occurs in up to 80% of patients in the first 2 years after complete resection. While most patients are not eligible for surgical treatment due to disseminated disease, a certain group of patients can be evaluated for re-resection of local recurrence. This review summarizes the current literature on surgical treatment of recurrent pancreatic cancer and potential prognostic factors. Summary: Re-resection of recurrent pancreatic cancer provides a significant survival benefit to selected patients with acceptable procedure-related mortality. Median overall survival after re-resection of recurrent pancreatic cancer is up to 28 months. The most relevant clinical parameters associated with a prognostic benefit are young patient age (<65 years), time to initial resection (>10 months), and preoperative chemotherapy before re-resection. Molecular markers are currently under investigation and might help to improve patient selection in the future. Key Message: Re-resection of recurrent pancreatic cancer is safe and feasible in experienced hands. Selected patients benefit from surgical treatment, but future studies are needed to identify reliable prognostic markers predicting survival.

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Evolution of the Management of Resectable Pancreatic Cancer

Journal of Oncology Practice ◽

10.1200/jop.2016.015818 ◽

2016 ◽

Vol 12 (9) ◽

pp. 772-778 ◽

Cited By ~ 17

Author(s):

Susan Tsai ◽

Beth A. Erickson ◽

Kulwinder Dua ◽

Paul S. Ritch ◽

Parag Tolat ◽

...

Keyword(s):

Pancreatic Cancer ◽

Management Strategy ◽

Perioperative Management ◽

Metastatic Tumor ◽

Surgical Experience ◽

Resectable Pancreatic Cancer ◽

The Past ◽

Improve Patient Selection ◽

Tumor Dissemination ◽

Improve Patient

In pancreatic cancer, as with many other solid tumors, a commonly held surgical adage—a chance to cut is a chance to cure—has been promulgated throughout the years. Following such reasoning, surgical extirpation of a localized tumor would prevent tumor dissemination and metastatic tumor progression. However, decades of surgical experience have demonstrated that surgical resection alone provides a limited median survival benefit. Despite the optimization of surgical technique and perioperative management over the past three decades, little progress has been made to improve the limited survival of patients with localized pancreatic cancer who receive surgery. In this article, we discuss the rationale for a novel management strategy for patients with resectable pancreatic cancer, which may improve patient selection and the delivery of multimodality therapy.

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Impact of surgical treatment for recurrent pancreatic cancer after curative pancreatectomy

Pancreatology ◽

10.1016/j.pan.2016.06.359 ◽

2016 ◽

Vol 16 (4) ◽

pp. S100

Author(s):

Atsushi Miyamoto ◽

Naoki Hama ◽

Sakae Maeda ◽

Mamoru Uemura ◽

Kazuyoshi Yamamoto ◽

...

Keyword(s):

Pancreatic Cancer ◽

Surgical Treatment ◽

Recurrent Pancreatic Cancer

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Gflip/ox in the treatment of advanced pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15192 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15192-e15192

Author(s):

Yashar Hirshaut ◽

Daniel Khalil ◽

Rachel V. Kramer ◽

Daniel Helfgott

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Dose Adjustment ◽

Median Overall Survival ◽

Advanced Pancreatic Cancer ◽

Sensory Neuropathy ◽

Phase 3 ◽

Recurrent Pancreatic Cancer ◽

M 12 ◽

Age Range

e15192 Background: GFLIP and GLIP/Ox (Bruckner et al. ASCO, 2008) are effective in the treatment of pancreatic cancer (Bruckner, et.al. ASCO, 2008). A similar regimen FOLFIRINOX proved successful in a Phase 3 trial (Conroy, T. et al. NEJM, 2011). However, these regimens are not widely used because of concerns about efficacy and/ or toxicity. Our experience suggests that with dose adjustment when necessary, GFLIP/Ox is both effective and well tolerated. Methods: This is a retrospective review of 24 patients (12 M, 12 F) with unresectable or recurrent pancreatic cancer. The drugs/doses used were leucovorin 300mg, gemcitabine 500mg/M2, irinotecan 80mg/M2, fluorouracil (FU) 400mg/M2 bolus, FU 600mg/M2 46 hr. infusion, oxaliplatin 35 mg/M2, bevacizumab 10mg/M2 +/- cetuximab 400mg/2 given q2 wks. Doses were reduced up to 50% for pts. >70 yrs. Results: 24 pts treated, 11 with cetuximab. Age range 44-87 yrs, mean 68.8 yrs. Response (RR) 38%, Disease Control (DC) 79%. PFS (19 pts) median 264 days (d). Median OS 382 d. Overall survival <70 yrs median 814 d. >70 yrs 304 d. With cetuximab (CTX) DC 91%, OS 512 d, without CTX DC 69%, OS 249 days. Side effects were fatigue, sensory neuropathy, anemia, neutropenia, generally grade 1-2. There was one case of grade 4 thrombocytopenia. There were no deaths attributable to chemotherapy. Conclusions: The median OS of this regimen is 12.7 mo. vs. 6.8 mo. for gemcitabine and 11.1 mo. for FOLFIRINOX. The RR of 38% compares favorably to the 31% RR for FOLFIRINOX. Taken together with the 27 month median overall survival among those under 70 (11 pts) makes GFLIP/Ox a regimen worth further study for this disease.

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RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS AND THE RISK OF CANCER AFTER SURGICAL TREATMENT

Problems in oncology ◽

10.37469/0507-3758-2018-64-2-228-233 ◽

2018 ◽

Vol 64 (2) ◽

pp. 228-233

Author(s):

Vladimir Lubyanskiy ◽

Vasiliy Seroshtanov ◽

Ye. Semenova

Keyword(s):

Pancreatic Cancer ◽

Chronic Pancreatitis ◽

Surgical Treatment ◽

Fibrous Tissue ◽

Pancreatic Head ◽

Head Region ◽

Intestinal Anastomoses ◽

Resection Of The Pancreas ◽

Risk Of Cancer

The aim: To analyze results of surgical treatment of patients with chronic pancreatitis (CP) and to assess the causes of pancreatic cancer after surgical treatment. Materials and methods: 137 patients had duodenum-preserving resections of the pancreas. Results: In the histological examination of the pancreas it was established that the growth of fibrous tissue was registered in patients with CP., which in 19 (13.8%) almost completely replaced the acinar tissue. In the long term after the operation from 6 months to 2 years in 8 patients (5.8%) pancreatic cancer was detected. Possible causes of tumor origin were analyzed, the value of preservation of ductal hypertension, which affects the state of the duct’s epithelium, was established. The most commonly used for treatment of chronic pancreatitis the Frey surgery removed pancreatic hypertension but in two patients during the operation an insufficient volume of the pancreatic head was reconstructed. In the case of the abandonment of a large array of fibrous tissue, local hypertension was retained in the region of the ductal structures of the head, which led to the transformation of the duct epithelium. An essential factor in the problem of the preservation of pancreatic hypertension were the stenosis of pancreatic intestinal anastomoses, they arose in the long term in 4 operated patients. With stenosis of anastomosis after duodenum-preserving resection both the hypertension factor and the regeneration factor could be realized, which under certain circumstances might be significant. Conclusion: After resection of the pancreas for CP cancer was diagnosed in 5.8% of patients. The main method of preventing the risk of cancer was performing the Frey surgery for CP eliminating pancreatic hypertension in the head region of the pancreas. Diagnosis of stenosis in the late period after resection of the pancreas was an important element in the prevention of recurrence of cancer since a timely reconstructive operation could improve the drainage of duct structures.

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