Clinical efficacy of adjuvant surgery following systemic treatments in patients with initially unresectable pancreatic cancer: Results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 255-255
Author(s):  
Satoshi Hirano ◽  
Sohei Satoi ◽  
Hiroki Yamaue ◽  
Kentaro Kato ◽  
Shinichiro Takahashi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Surgical Resection ◽  
Initial Treatment ◽  
Multimodal Treatment ◽  
Control Group ◽  
Unresectable Pancreatic Cancer ◽  
Adjuvant Surgery ◽  
Surgery Group ◽  
Systemic Treatments

255 Background: Medical oncologists or pancreatic surgeons have identified candidates for surgical resection in patients with initially unresectable pancreatic cancer who favorably responded to multimodal treatment. Additional surgical resection during multimodal treatment, is called “adjuvant surgery”. A multicenter survey was conducted to explore the clinical efficacy of adjuvant surgery for initially unresectable pancreatic cancer with a long-term favorable response to systemic treatments. Methods: Clinical data, including the primary endpoint of overall survival were retrospectively compared between 58 initially unresectable pancreatic cancer patients that underwent adjuvant surgery with a favorable response to non-surgical cancer treatments over 6 months after the initial treatment (adjuvant surgery group) and 101 patients who did not undergo adjuvant surgery (control group). Results: The median observation periods were 51 months (20-122) in the control group, and 54 months (26-125) in the adjuvant surgery group, respectively. The actuarial survival rate at 1, 3, and 5 years after initial treatment in adjuvant surgery group (95, 53, and 34%) was significantly better than that in control group (88, 18, and 10%, p<0.0001). The propensity score analysis to provide adjustment of significant differences in the clinical backgrounds between the two groups revealed that adjuvant surgery was a significant independent prognostic variable with an adjusted hazard ratio (95% confidential interval) of 0.569 (0.36-0.89). Subgroup analysis according to the time from initial treatment to surgical resection showed a significant favorable difference in the overall survival in patients who underwent adjuvant surgery over 240 days after the initial treatment. Conclusions: The adjuvant surgery can occupy an important position in the multimodal therapy for patients with initially unresectable pancreatic cancer. The overall survival rate from the initial treatment is extremely high, especially in patients who received systemic treatments for more than 240 days.

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

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hyeong Min Park ◽  
Sang-Jae Park ◽  
Sung-Sik Han ◽  
Seoung Hoon Kim
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Surgical Resection ◽  
Charlson Comorbidity Index ◽  
Resectable Pancreatic Cancer ◽  
Surgery Group ◽  
Comorbidity Index ◽  
High Charlson Comorbidity Index

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.

scholarly journals Role of Radiofrequency Ablation in the Management of Unresectable Pancreatic Cancer

2021 ◽  
Vol 7 ◽  
Author(s):  
Muhammad Nadeem Yousaf ◽  
Hamid Ehsan ◽  
Ahmad Muneeb ◽  
Ahsan Wahab ◽  
Muhammad K. Sana ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiofrequency Ablation ◽  
Surgical Resection ◽  
Retrospective Studies ◽  
Advanced Disease ◽  
Protein Denaturation ◽  
Solid Organ ◽  
Unresectable Pancreatic Cancer ◽  
The Past

Pancreatic cancer is one of the most aggressive malignancies of the digestive tract and carries a poor prognosis. The majority of patients have advanced disease at the time of diagnosis. Surgical resection offers the only curative treatment, but only a small proportion of patients can undergo surgical resection. Radiofrequency ablation (RFA) is a well-known modality in the management of solid organ tumors, however, its utility in the management of pancreatic cancer is under investigation. Since the past decade, there is increasing use of RFA as it provides a feasible palliation treatment in the management of unresectable pancreatic cancer. RFA causes tumor cytoreduction through multiple mechanisms such as coagulative necrosis, protein denaturation, and activation of anticancer immunity. The safety profile of RFA is controversial because of the high risk for complications, however, small prospective and retrospective studies have shown promising results in its applicability for palliative management of unresectable pancreatic malignancies. In this review, we discuss different approaches of RFA, their indications, technical accessibility, safety, and major complications in the management of unresectable pancreatic cancer.

scholarly journals Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

2017 ◽  
Vol 8 (5) ◽  
pp. 766-777 ◽  
Author(s):  
Michael J. Dohopolski ◽  
Scott M. Glaser ◽  
John A. Vargo ◽  
Goundappa K. Balasubramani ◽  
Sushil Beriwal
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Stereotactic Body Radiotherapy ◽  
Locally Advanced ◽  
Patterns Of Care ◽  
Unresectable Pancreatic Cancer

Treatment at high-volume facilities and academic centers in relation to overall survival in patients with locally advanced pancreatic cancer: A National Cancer Database analysis

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 392-392
Author(s):  
John David ◽  
Sungjin Kim ◽  
Erik Anderson ◽  
Arman Torossian ◽  
Simon Lo ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
High Volume ◽  
Locally Advanced Pancreatic Cancer ◽  
Median Income ◽  
National Cancer Database ◽  
Improved Outcomes

392 Background: Numerous studies have shown that treatment at a high volume facility (HVF) for patients (pts) with pancreatic cancer is associated with improved outcomes, particularly with pancreatectomy. In fact, a recent study showed that pts undergoing a pancreatectomy at an academic center (AC) is independently associated with improved outcomes. However, the role of chemotherapy (CT) and radiation (RT) in the treatment of locally advanced pancreatic cancer (LAPC) at HVF and AC, to our knowledge, has not been studied. Herein, we investigate the benefit of treatment at HVF and AC compared to low volume facilities (LVF) and non-academic centers (NAC) with CT or chemoradiation (CRT) in pts with LAPC. Methods: The National Cancer Database (NCDB) was utilized to identify LAPC patients treated at all facility types. All patients were treated with CT or CRT. Univariate (UVA) and multivariate (MVA) Cox regression were performed to identify the impact of HVF and AC on overall survival (OS) when compared to LVF and NAC, respectively. HVF was defined as the top 5% of facilities by number of pts treated. Results: From 2004 – 2014, a total of 10139 pts were identified. The median age was 66 years (range 22-90) with median follow up of 48.8 months (46-52.1 months); 49.9% were male and 50.1% female. All pts had clinical stage 3/T4 disease irrespective of nodal metastases. Of these, 4779 pts were treated at an AC and 5260 were treated at a NAC and 588 were treated at HVF and 9551 were treated at LVF. On UVA, age, high median income, high education level, comorbidities, and recent year of diagnosis were associated with improved OS. ACs were associated with improved OS when compared to non-AC (HR 0.92 95% CI 0.88 – 0.96, p = 0.004), as were HVF when compared to LVH (HR 0.84 95% CI 0.76 – 0.92, p < 0.001). Odds ratio for undergoing surgical resection at HVF and AC was 1.68 and 1.37 (p < 0.001), respectively, when compared to LVF and NAC. Conclusions: The treatment of LAPC patients with CT or CRT at an AC led to significantly improved rate of surgical resection and OS. In the absence of prospective data, these results support the referral of pts with LAPC to HVF and/or AC for evaluation and treatment.

Role of adjuvant surgery in initially unresectable pancreatic cancer after long-term chemotherapy or chemoradiation therapy: survival benefit?

2014 ◽  
Vol 21 (9) ◽  
pp. 695-702 ◽  
Author(s):  
Singh Sapam Opendro ◽  
Sohei Satoi ◽  
Hiroaki Yanagimoto ◽  
Tomohisa Yamamoto ◽  
Hideyoshi Toyokawa ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Benefit ◽  
Chemoradiation Therapy ◽  
Unresectable Pancreatic Cancer ◽  
Adjuvant Surgery

Chemotherapy as initial treatment of locally advanced unresectable pancreatic cancer: a valid option?

2007 ◽  
Vol 31 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Jean-Baptiste Bachet ◽  
Emmanuel Mitry ◽  
Céline Lepère ◽  
Gilles Declety ◽  
Jean-Nicolas Vaillant ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Initial Treatment ◽  
Locally Advanced ◽  
Unresectable Pancreatic Cancer
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