scholarly journals Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

2020 ◽  
Author(s):  
Catherine Mattevi ◽  
Jonathan Garnier ◽  
Ugo Marchese ◽  
Jacques Ewald ◽  
Marine Gilabert ◽  
...  
Keyword(s):  
Ductal Adenocarcinoma ◽  
Ct Scanner ◽  
Resection Rate ◽  
Intention To Treat ◽  
Median Delay ◽  
Period 2 ◽  
Preoperative Ct ◽  
Spectral Computed Tomography ◽  
Weighted Magnetic Resonance Imaging ◽  
Mean Size

Abstract Purpose To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC). Methods From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000–March 2011) and period #2 (April 2011–August 2019). Results All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P <.01), and liver DW-MRI was significantly most prescribed during period #2 (14% vs 75%, P <.01). According to the intraoperative findings, the overall NRR was 24.5%, and remained stable over the two periods (24% vs 25%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, para-aortic lymph nodes invasion rate (0.4% vs 4.6%; P <0.001) significantly increased over the 2 periods. The mean size of the bigger extra pancreatic tumor significantly decrease (7.9mm vs 6.4mm ( P <.01), respectively) when the resection was not done. In multivariate analysis, CA 19-9<500U/mL ( P <.01), and liver DW-MRI prescription ( P <.01) favoured the resection. Conclusions Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement.

scholarly journals Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

2020 ◽  
Author(s):  
Catherine Mattevi ◽  
Jonathan Garnier ◽  
Ugo Marchese ◽  
Jacques Ewald ◽  
Marine Gilabert ◽  
...  
Keyword(s):  
Ductal Adenocarcinoma ◽  
Ct Scanner ◽  
Resection Rate ◽  
Intention To Treat ◽  
Median Delay ◽  
Period 2 ◽  
Preoperative Ct ◽  
Spectral Computed Tomography ◽  
Weighted Magnetic Resonance Imaging ◽  
Mean Size

Abstract Purpose: To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC).Methods: From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000–March 2011) and period #2 (April 2011–August 2019). Results: All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P<.01), and liver DW-MRI was significantly most prescribed during period #2 (14% vs 75%, P<.01). According to the intraoperative findings, the overall NRR was 24.5%, and remained stable over the two periods (24% vs 25%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, PALNs invasion rate (0.4% vs 4.6%; P<0.001) significantly increased over the 2 periods. The mean size of the bigger extra pancreatic tumor significantly decrease (7.9mm vs 6.4mm (P<.01), respectively) when the resection was not done. In multivariate analysis, CA 19-9<500U/mL (P<.01), and liver DW-MRI prescription (P<.01) favoured the resection. Conclusions: Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement.

scholarly journals Conversion Surgery for Advanced Pancreatic Cancer

2019 ◽  
Vol 8 (11) ◽  
pp. 1945
Author(s):  
Thomas Hank ◽  
Oliver Strobel
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Palliative Therapy ◽  
Advanced Pancreatic Cancer ◽  
Treatment Strategies ◽  
Ductal Adenocarcinoma ◽  
Conversion Surgery ◽  
Radiological Criteria ◽  
Intention To Treat ◽  
Conversion Rates

While primarily unresectable locally advanced pancreatic cancer (LAPC) used to be an indication for palliative therapy, a strategy of neoadjuvant therapy (NAT) and conversion surgery is being increasingly used after more effective chemotherapy regimens have become available for pancreatic ductal adenocarcinoma. While high-level evidence from prospective studies is still sparse, several large retrospective studies have recently reported their experience with NAT and conversion surgery for LAPC. This review aims to provide a current overview about different NAT regimens, conversion rates, survival outcomes and determinants of post-resection outcomes, as well as surgical strategies in the context of conversion surgery after NAT. FOLFIRINOX is the predominant regimen used and associated with the highest reported conversion rates. Conversion rates considerably vary between less than 5% and more than half of the study population with heterogeneous long-term outcomes, owing to a lack of intention-to-treat analyses in most studies and a high heterogeneity in resectability criteria, treatment strategies, and reporting among studies. Since radiological criteria of local resectability are no longer applicable after NAT, patients without progressive disease should undergo surgical exploration. Surgery after NAT has to be aimed at local radicality around the peripancreatic vessels and should be performed in expert centers. Future studies in this rapidly evolving field need to be prospective, analyze intention-to-treat populations, report stringent and objective inclusion criteria and criteria for resection. Innovative regimens for NAT in combination with a radical surgical approach hold high promise for patients with LAPC in the future.

scholarly journals Computed Tomography–Based Biomarker Outcomes in a Prospective Trial of Preoperative FOLFIRINOX and Chemoradiation for Borderline Resectable Pancreatic Cancer

2019 ◽  
pp. 1-15 ◽  
Author(s):  
Eugene J. Koay ◽  
Matthew H.G. Katz ◽  
Huamin Wang ◽  
Xuemei Wang ◽  
Laura Prakash ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Risk ◽  
Prospective Trial ◽  
Ductal Adenocarcinoma ◽  
Type I ◽  
Type Ii ◽  
Resection Rate ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Mesenteric Vessel

PURPOSE Effective preoperative regimens and biomarkers for pancreatic ductal adenocarcinoma (PDAC) are lacking. We prospectively evaluated fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX)-based treatment and imaging-based biomarkers for borderline resectable PDAC. METHODS Eligible patients had treatment-naïve, histology-confirmed PDAC and one or more high-risk features: mesenteric vessel involvement, CA 19-9 level of 500 mg/dL or greater, and indeterminate metastatic lesions. Patients received modified FOLFIRINOX and chemoradiation before anticipated pancreatectomy. Tumors were classified on baseline computed tomography as high delta (well-defined interface with parenchyma) or low delta (ill-defined interface). We designated computed tomography interface response after therapy as type I (remained or became well defined) or type II (became ill defined). The study had 80% power to differentiate a 60% from 40% resection rate (α = .10). Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and subgroups were compared using log-rank tests. RESULTS Thirty-three patients initiated therapy; 45% underwent pancreatectomy. The median OS was 24 months (95% CI, 16.2 to 29.6 months). For patients who did and did not undergo pancreatectomy, the median OS was 42 months (95% CI, 17.7 months to not estimable) and 14 months (95% CI, 9.0 to 24.8 months), respectively. Patients with high-delta tumors had lower 3-year PFS (4% v 40%) and 3-year OS rates (20% v 60%) than those with low-delta tumors (both P < .05). Patients with type II interface responses had lower 3-year PFS (0% v 29%) and 3-year OS rates (16% v 47%) than those with type I responses (both P < .001). CONCLUSION Preoperative FOLFIRINOX followed by chemoradiation for high-risk borderline resectable PDAC was associated with a resection rate of 45% and median OS of approximately 2 years. Our imaging-based biomarker validation indicates that personalized treatment may be achieved using these biomarkers at baseline and post-treatment.

Major arterial resection for stage 3 adenocarcinoma of the pancreas.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 362-362
Author(s):  
Benjamin Loveday ◽  
Koji Tomiyama ◽  
Nathan Zilbert ◽  
Amélie Tremblay St-Germain ◽  
Pablo Emilio Serrano Aybar ◽  
...  
Keyword(s):  
Overall Survival ◽  
Treatment Program ◽  
Oncologic Outcomes ◽  
Ductal Adenocarcinoma ◽  
R0 Resection ◽  
Negative Resection Margin ◽  
Surgical Exploration ◽  
Intention To Treat ◽  
Pancreas Resection ◽  
Adenocarcinoma Of The Pancreas

362 Background: Stage 3 pancreas ductal adenocarcinoma (PDAC) is defined by arterial involvement, and its resection remains controversial. The objective of this study was to evaluate clinical and oncologic outcomes for patients with stage 3 PDAC who entered a treatment program of neoadjuvant therapy (NAT) and pancreatic resection, with comparison between those who underwent arterial (AR) vs. standard resection (SR). Methods: This cohort study included patients from 2009-2016 in a single academic institution, with biopsy-proven potentially resectable stage 3 PDAC who entered a treatment program of NAT followed by surgical exploration if non-progressive disease on imaging. AR was performed if required to achieve R0 resection. Oncological outcomes were analyzed as intention to treat from diagnosis date. Results: Eighty-nine patients met inclusion criteria, of whom 87 (97.8%) received chemotherapy and 50 (56.2%) received radiotherapy. 46/89 (51.7%) underwent surgical exploration; 31 underwent pancreas resection (AR n = 20, SR n = 11), and 15 were found to have metastatic or unresectable disease. The AR group had a longer operative time (681 vs. 563 minutes, p = 0.0059) and more blood loss (1600 vs. 575 mL, p = 0.0004) compared with SR, with no difference between groups for blood transfusion, overall complications, pancreatic fistula, length of stay, reoperation, readmission or mortality. R0 rate was 100% for resected patients. Post-operative 90-day mortality was 1.1%. Median overall survival of resected patients was longer than in non-resected patients (25.9 vs. 14.8 months, p = 0.01), while AR had comparable overall survival to SR (19.7 vs. 28.4 months, p = 0.41). Conclusions: Patients with non-progressive stage 3 PDAC after NAT should be considered for pancreas resection. AR had comparable clinical and oncologic outcomes to SR. Resection may offer a survival advantage over non-surgical therapy alone, and AR should be considered if required to obtain a negative resection margin.

scholarly journals The “K-Sign”—A Novel CT Finding Suggestive before the Appearance of Pancreatic Cancer

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4222
Author(s):  
Yuko Kobashi ◽  
Masateru Uchiyama ◽  
Junichi Matsui
Keyword(s):  
Pancreatic Cancer ◽  
Early Diagnosis ◽  
Early Stage ◽  
Patient Characteristics ◽  
Ct Imaging ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
Preoperative Ct ◽  
Invasive Ductal Adenocarcinoma ◽  
Ct Finding

Pancreatic invasive ductal adenocarcinoma (PDAC) has a poor prognosis, and the detection of PDAC during the early stage is thought to improve prognosis. In this study, we retrospectively investigated pancreatic morphological abnormalities that lead to the early diagnosis of PDAC with computed tomography (CT) imaging. In total, 41 out of 308 patients diagnosed with pancreatic cancer between 2011 and 2017 in our institution were enrolled. As a control group for the group with pancreatic cancer, 4277 patients without pancreato-biliary diseases were enrolled. We retrospectively reviewed and analyzed the clinical data including patient characteristics, the clinical course and preoperative CT imaging with pancreatic morphological features. Out of 41 patients, 24 patients (58.5%) showed local K-shaped constriction of the pancreatic parenchyma “K-sign” on preoperative CT images. Eight patients (19.5%) showed localized fatty change. Out of 4277 control patients, seven patients (0.16%) showed K-sign. “K-sign” may be used for the early diagnosis of PDAC by CT imaging.

scholarly journals Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial

2020 ◽  
Vol 38 (16) ◽  
pp. 1763-1773 ◽  
Author(s):  
Eva Versteijne ◽  
Mustafa Suker ◽  
Karin Groothuis ◽  
Janine M. Akkermans-Vogelaar ◽  
Marc G. Besselink ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Preoperative Chemoradiotherapy ◽  
Phase Iii ◽  
Resection Rate ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer ◽  
Intention To Treat ◽  
Immediate Surgery

PURPOSE Preoperative chemoradiotherapy may improve the radical resection rate for resectable or borderline resectable pancreatic cancer, but the overall benefit is unproven. PATIENTS AND METHODS In this randomized phase III trial in 16 centers, patients with resectable or borderline resectable pancreatic cancer were randomly assigned to receive preoperative chemoradiotherapy, which consisted of 3 courses of gemcitabine, the second combined with 15 × 2.4 Gy radiotherapy, followed by surgery and 4 courses of adjuvant gemcitabine or to immediate surgery and 6 courses of adjuvant gemcitabine. The primary end point was overall survival by intention to treat. RESULTS Between April 2013 and July 2017, 246 eligible patients were randomly assigned; 119 were assigned to preoperative chemoradiotherapy and 127 to immediate surgery. Median overall survival by intention to treat was 16.0 months with preoperative chemoradiotherapy and 14.3 months with immediate surgery (hazard ratio, 0.78; 95% CI, 0.58 to 1.05; P = .096). The resection rate was 61% and 72% ( P = .058). The R0 resection rate was 71% (51 of 72) in patients who received preoperative chemoradiotherapy and 40% (37 of 92) in patients assigned to immediate surgery ( P < .001). Preoperative chemoradiotherapy was associated with significantly better disease-free survival and locoregional failure-free interval as well as with significantly lower rates of pathologic lymph nodes, perineural invasion, and venous invasion. Survival analysis of patients who underwent tumor resection and started adjuvant chemotherapy showed improved survival with preoperative chemoradiotherapy (35.2 v 19.8 months; P = .029). The proportion of patients who suffered serious adverse events was 52% versus 41% ( P = .096). CONCLUSION Preoperative chemoradiotherapy for resectable or borderline resectable pancreatic cancer did not show a significant overall survival benefit. Although the outcomes of the secondary end points and predefined subgroup analyses suggest an advantage of the neoadjuvant approach, additional evidence is required.

scholarly journals Efficacy And Safety Of EUS-Guided Multimode Ablation Compared With Conventional Chemotherapy In Unresectable Pancreatic Cancer Patients

2021 ◽  
Author(s):  
Xixian Ruan ◽  
Zinan Zhang ◽  
Xiuyan Long ◽  
Ning Fang ◽  
Xiaoyu Yu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Tumor Size ◽  
Ductal Adenocarcinoma ◽  
Unresectable Pancreatic Cancer ◽  
Efficacy And Safety ◽  
Conventional Chemotherapy ◽  
Significant Difference ◽  
Group A ◽  
Mean Size ◽  
Group B

Abstract Background & Aims: To compare the feasibility and safety between multimode endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and conventional chemotherapy in unresectable pancreatic ductal adenocarcinoma (PDAC).Methods: All the pathologically confirmed unresectable PDAC located in the head of the pancreas patients who underwent multimode EUS-RFA or conventional chemotherapy were retrospectively enrolled from June 2018 and April 2019. Patients who underwent multimode EUS-RFA (Group A) was performed through HybridTherm probe(HTP). Patients in Group B accepted nab-Paclitaxel plus Gemcitabine or S-1 plus Gemcitabine. The comparison between efficacy and safety of multimode EUS-RFA and conventional chemotherapy were analyzed by T test and MannWhitney test. A multivariate analysis was performed for each prognostic factor using the Cox proportional hazards model.Results: A total of 10 unresectable PDAC patients were retrospectively enrolled in Group A (mean size 9.46±5.94 cm3, range 2.00-21.09 cm3) and 9 patients in Group B (mean size 14.02±5.81cm3, range 4.60–24.62 cm3). The tumor size was significantly reduced before and after undergoing multimode EUS-RFA (P = 0.005), with an average tumor volume reduction of 38.1%.The tumor size was not significantly changed in Group B (P = 0.452). Statistically significant difference was observed in tumor size between Group A and Group B after treatment (P = 0.033). All patients died because of the progress of the tumor. The median lifetime from Group A&B was 9 months ranged 3-18 months VS 7 months ranged 1-7 months (P = 0.001). Overall no severe adverse events occurred in both groups.Conclusion: EUS-guided multimode ablation has the more feasibility in the treatment of unresectable pancreatic cancer than conventional chemotherapy. In this article, the limited data seems to show the trend of tumor shrinkage, pain relief, lifetime prolongation. Further studies are needed, such as expanding the sample size of patients and comparing the feasibility and safety among all the treatment.

scholarly journals Paranasal sinus mucoceles, therapeutic solution through external surgical approach

2020 ◽  
Vol 10 (40) ◽  
pp. 137-141
Author(s):  
Bogdan Mihail Cobzeanu ◽  
Dragos Octavian Palade ◽  
Gianina Bandol ◽  
Patricia Sonia Vonica ◽  
Florentina Severin ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Paranasal Sinuses ◽  
Clinical Symptoms ◽  
External Approach ◽  
Ct Scanner ◽  
Complete Excision ◽  
Cystic Tumors ◽  
Preoperative Ct ◽  
Sinus Ostium ◽  
Histopathological Result

AbstractMucoceles are benign, expansive, cystic tumors, affecting especially the adult, with development in the paranasal sinuses. Clinical symptoms are not specific. These are rare conditions that originate within the sinusal mucosa, favoured by the obstruction of the sinus ostium. Due to the inflammation and the expansive character of the tumor, with the erosion of the bony walls, combined forms can develop, with the involvement of two or more sinuses, most frequently with fronto-ethmoidal localization.The authors carry out a clinical retrospective study on 25 cases of mucoceles of the paranasal sinuses, diagnosed and treated in the ENT Clinic of the “Sfantul Spiridon” Emergency Clinical Hospital Iasi, during 2015-2019. The authors insist on aspects related to clinical and radiological diagnosis (CT scanner), as well as surgical treatment by external approach.The postoperative evolution is generally simple, with full recovery, without complications or recurrences.The diagnosis of the mucoceles of the paranasal sinuses consists in radiologic techniques by preoperative CT scan examination, intraoperative macroscopic aspect and histopathological result.Surgical approach with complete excision of the tumor and creating a new sinusal drainage path prevents the occurrence of recurrences.

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