scholarly journals Hyperthermic Intra-Abdominal Chemotherapy with Gemcitabine as an Adjuvant Locoregional Treatment After Radical Surgery in Pancreatic Cancer

2020 ◽  
pp. 1-3
Author(s):  
Esther Pilar García Santos ◽  
Esther Pilar García Santos ◽  
David Padilla-Valverde ◽  
Susana Sánchez-García ◽  
M. Carmen Manzanares-Campillo ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Adenocarcinoma ◽  
Adjuvant Treatment ◽  
Cytoreductive Surgery ◽  
Radical Surgery ◽  
Treatment Results ◽  
Locoregional Treatment ◽  
Number Of Patients ◽  
Term Evaluation

Purpose: The aim of our study is to present a series of patients in whom we have administered HIPEC therapy. Material and Methods: The treatment consists in performing cytoreductive surgery in patients diagnosed with potentially resectable pancreatic adenocarcinoma, together with the administration of HIPEC therapy with Gemcitabine. The dose of the drug is 120 mg/m2 for 30 minutes, followed by a conventional adjuvant treatment. Results: Five patients diagnosed with pancreatic adenocarcinoma have undergone surgery with a curative nature. There were no technical or hemodynamic complications during the procedure. Discussion: The use of HIPEC could achieve a decrease in the tumor progression of pancreatic cancer, improving the survival of the patient, and decreasing the recurrence of the disease. A larger number of patients will be necessary, as well as a long-term evaluation to assess the possible increase in survival in this group of patients.

Perioperative glucocorticoids are associated with improved long-term survival after pancreatic cancer surgery: A retrospective cohort study

2020 ◽  
Author(s):  
Yun-Xiao Zhang ◽  
Dong-Liang Mu ◽  
Ke-Min Jin ◽  
Xue-Ying Li ◽  
Dong-Xin Wang
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Radical Surgery ◽  
Radical Resection ◽  
Cancer Surgery ◽  
Term Survival ◽  
Long Term Survival

Abstract Background Perioperative anesthetic management may affect long-term outcome after cancer surgery. This study aimed to investigate the effect of perioperative glucocorticoids on long-term survival in patients after radical resection for pancreatic cancer.Methods In this retrospective cohort study, patients who underwent radical resection for pancreatic cancer from January 2005 to December 2016 were recruited. Baseline and perioperative data including use of glucocorticoids for prevention of postoperative nausea and vomiting were collected. Patients were followed up for tumor recurrence and survival. The primary outcome was the overall survival (OS); the secondary outcome was the recurrence-free survival (RFS). A multivariable Cox proportional hazard model was used to analyze the influence of perioperative glucocorticoid use on OS and RFS after correction for confounding factors.Results A total of 215 patients after radical surgery for pancreatic cancer were included in the study; of these, 112 received perioperative glucocorticoids and 103 did not. Patients were followed up for a median of 74.0 months (95% confidence interval [CI] 68.3-79.7). Both OS and RFS were significantly longer in patients with glucocorticoids than in those without (for OS: median 19.7 months [95% CI 12.3-36.2] vs. 13.9 months [8.0-23.9], P=0.001; for RFS: 12.0 months [6.0-28.0] vs. 6.9 months [4.2-17.0], P=0.002). After correction for confounding factors, perioperative glucocorticoids were significantly associated with prolonged OS (HR 0.692, 95% CI 0.499-0.959, P=0.027) and RFS (HR 0.634, 95% CI 0.459-0.878, P=0.006).Conclusions Perioperative use of low-dose glucocorticoids may improve long-term survival in patients undergoing radical surgery for pancreatic cancer.

scholarly journals Is there an oligometastatic state in pancreatic cancer? Practical clinical considerations raise the question

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190627
Author(s):  
Marta Scorsetti ◽  
Tiziana Comito ◽  
Davide Franceschini ◽  
Ciro Franzese ◽  
Maria Giuseppina Prete ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Local Treatment ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Free Survival ◽  
Number Of Patients ◽  
Clinical Considerations

Objectives: To evaluate the role of stereotactic body radiotherapy (SBRT) as a local ablative treatment (LAT) in oligometastatic pancreatic cancer. Methods: Patients affected by histologically confirmed stage IV pancreatic adenocarcinoma were included in this analysis. Endpoints are local control (LC), progression-free survival (PFS), and overall survival (OS). Results: From 2013 to 2017, a total of 41 patients were treated with SBRT on 64 metastases. Most common sites of disease were lung (29.3%) and liver (56.1%). LC at 1 and 2 years were 88.9% (95% CI 73.2–98.6) and 73.9% (95% CI 50–87.5), respectively. Median LC was 39.9 months (95% CI 23.3—not reached). PFS rates at 1 and 2 years were 21.9% (95% CI 10.8–35.4) and 10.9% (95% CI 3.4–23.4), respectively. Median PFS was 5.4 months (95%CI 3.1–11.3). OS rates at 1 and 2 years were 79.9% (95% CI 63.7–89.4) and 46.7% (95% CI 29.6–62.2). Median OS was 23 months (95%CI 14.1–31.8). Conclusions: Our results, although based on a retrospective analysis of a small number of patients, show that patients with oligometastatic pancreatic cancer may benefit from local treatment with SBRT. Larger studies are warranted to confirm these results. Advances in knowledge: Selected patients affected by oligometastatic pancreatic adenocarcinoma can benefit from local ablative approaches, like SBRT

scholarly journals Current State of Vascular Resections in Pancreatic Cancer Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Thilo Hackert ◽  
Lutz Schneider ◽  
Markus W. Büchler
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Treatment ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Treatment Strategies ◽  
Western World ◽  
Term Survival ◽  
Long Term Survival ◽  
Current State

Pancreatic cancer (PDAC) is the fourth leading cause of cancer-related mortality in the Western world and, even in 2014, a therapeutic challenge. The only chance for long-term survival is radical surgical resection followed by adjuvant chemotherapy which can be performed in about 20% of all PDAC patients by the time of diagnosis. As pancreatic surgery has significantly changed during the past years, extended operations, including vascular resections, have become more frequently performed in specialized centres and the border of resectability has been pushed forward to achieve a potentially curative approach in the respective patients in combination with neoadjuvant and adjuvant treatment strategies. In contrast to adjuvant treatment which has to be regarded as a cornerstone to achieve long-term survival after resection, neoadjuvant treatment strategies for locally advanced findings are currently under debate. This overview summarizes the possibilities and evidence of vascular, namely, venous and arterial, resections in PDAC surgery.

scholarly journals Is Cytoreductive Surgery Possible in Cervical Cancer Peritoneal Carcinomatosis?

2021 ◽  
Vol 15 ◽  
pp. 117955492110653
Author(s):  
Ozgul Duzgun ◽  
Murat Kalin
Keyword(s):  
Cervical Cancer ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Early Period ◽  
Long Term Results ◽  
Large Sample Size ◽  
Number Of Patients

Background: The number of cases of cervical cancer with recurrence and peritoneal carcinomatosis is limited. In our study, we aimed to present the results of cytoreductive surgery hyperthermic intraperitoneal chemotherapy treatment and its 3-year early period results in patients with peritoneal metastases due to cervical cancer. Methods: Data of 306 patients who had undergone cytoreductive surgery hyperthermic intraperitoneal chemotherapy between May 2016 and 2021 because of intra-abdominal metastases were collected prospectively and evaluated retrospectively. Ten cases who had undergone cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy due to cervical peritoneal carcinomatosis were included in this study. Results: Average time of operation was 5 (range = 3-6) hours, mean average of peritoneal carcinomatosis index score was 12.3 (range = 7-36), and mean average of completeness of cytoreduction score was 1 in 2 patients and 0 in 8 patients. No mortality was recorded in 30 days postoperatively. Four patients relapsed and died because of pneumonia, coronavirus disease, pulmonary embolism, and terminal illness. These patients died at 2, 5, 6, and 12 months, respectively. Six patients are still alive and early period tumor relapse has not been reported during their follow-ups. Conclusions: This study has a limited number of patients and the results are early period results. The follow-up of patients were not long term. Therefore, it is hard to say that cytoreductive surgery hyperthermic intraperitoneal chemotherapy could be of any benefit looking at the results. Long-term results should be waited. Also, multicentered randomized cohort study with large sample size is required to evaluate this invasive procedure.

Value of pre-existent bacterial colonization in patients with advanced/relapsed ovarian neoplasms undergoing cytoreductive surgery: a multicenter observational study (BONSAI)

2020 ◽  
Vol 30 (10) ◽  
pp. 1562-1568
Author(s):  
Christina Fotopoulou ◽  
Natasha Rinne ◽  
Valentina Ghirardi ◽  
Paulea Cunnea ◽  
Anastasis Drosou ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Risk Factor ◽  
Cytoreductive Surgery ◽  
Pathogenic Bacteria ◽  
Bacterial Colonization ◽  
Surgical Morbidity ◽  
Intravenous Access ◽  
Systemic Treatments ◽  
Number Of Patients

ObjectiveAs an increasing number of patients with advanced/relapsed ovarian cancer need extensive cytoreductive procedures, there is an increasing number of complex cases collected in accredited tertiary cancer centers. With nosocomial infections and bacterial colonizations being a significant challenge in these patient cohorts, we aimed to evaluate the risk such infections pose to surgical outcome.MethodsProspective assessment of pathological bacterial colonization (vaginal, umbilical/groin, intraperitoneal, urine, oral/nose cavity) in patients who underwent open cytoreductive surgery for advanced/relapsed ovarian cancer in two large European tertiary referral centers for gynecologic malignancies. We recruited patients at initial diagnosis with International Federation of Gynecology and Obstetrics (FIGO) stage III and IV ovarian cancer and patients undergoing surgery for relapse. Swabs or cultures were taken from the following sites: vagina, groin and/or umbilicus, urine, intraperitoneal, mouth and/or nose. Only evidence of pathogenic bacteria was considered positive for bacterial colonization.ResultsA total of 172 primary advanced (70.9%) or relapsed (29.1%) ovarian cancer patients were included; 63.4% of them had received chemotherapy±additional targeted agents (16.3%) by the time of cytoreduction. 39.5% of the patients had a long-term vascular access line in situ. A bowel resection was performed in 44.8% and a splenectomy in 16.3% of the patients. Predefined surgical morbidity and mortality were 22.3% and 0%, respectively. Forty-one patients (23.8%) screened positive for pathogenic bacterial colonization with the presence of long-term intravenous access as the only independent risk factor identified (OR 2.34; 95% CI 1.05 to 5.34; p=0.04). Type of systemic treatments, previous bowel resections, previous hospitalizations, and patient demographics did not appear to significantly impact the risk of bacterial colonization. Furthermore, pathogenic bacterial colonization was shown to have no significant effect on peri-operative infection-related complications such as abscesses, wound infection, pneumonia, relaparotomy, or anastomotic leak.ConclusionsA total of 24% of patients undergoing cytoreductive surgery for ovarian cancer were confirmed positive for pathogenic bacterial colonization. The presence of long-term intravenous access was identified as the only significant risk factor for that, however the presence of pathogenic bacterial colonization per se did not seem to adversely affect outcome of cytoreductive effort or increase perioperative infection related complications.

A Long-term Evaluation of Treatment Results of Pregnant Patients Following a Liver Transplant

2020 ◽  
Vol 52 (8) ◽  
pp. 2512-2516
Author(s):  
Monika Pendraszewska ◽  
Brygida Krucińska ◽  
Joanna Pazik ◽  
Zoulikha Jabiry-Zieniewicz ◽  
Janusz Wyzgał
Keyword(s):  
Liver Transplant ◽  
Treatment Results ◽  
Term Evaluation

scholarly journals Surgery for Recurrent Pancreatic Cancer: Is It Effective?

Cancers ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 991 ◽  
Author(s):  
Lucia Moletta ◽  
Simone Serafini ◽  
Michele Valmasoni ◽  
Elisa Sefora Pierobon ◽  
Alberto Ponzoni ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Adenocarcinoma ◽  
Surgical Procedures ◽  
Extensive Literature ◽  
Disease Free Interval ◽  
Number Of Patients ◽  
Recurrent Pancreatic Cancer ◽  
Primary Neoplasm ◽  
Meta Analyses

Despite improvements to surgical procedures and novel combinations of drugs for adjuvant and neoadjuvant therapies for pancreatic adenocarcinoma, the recurrence rate after radical surgery is still high. Little is known about the role of surgery in the treatment of isolated recurrences of pancreatic cancer. The aim of this study was to review the current literature dealing with surgery for recurrent pancreatic cancer in order to examine its feasibility and effectiveness. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 14 articles dealing with re-resections for recurrent pancreatic adenocarcinoma were analyzed, focusing on the characteristics of the primary neoplasm and its recurrence, the surgical procedures used, and patient outcomes. Data were retrieved on a total of 301 patients. The interval between surgery for primary pancreatic cancer and the detection of a recurrence ranged from 2 to 120 months. The recurrence was local or regional in 230 patients, and distant in 71. The median overall survival was 68.9 months (range 3–152) after resection of the primary tumor, and 26.0 months (range 0–112) after surgery for recurrent disease. The disease-free interval after the resection of recurrences was 14.2 months (range 4–29). Although data analysis was performed on a heterogeneous and limited number of patients, some of these may benefit from surgery for isolated recurrence of pancreatic adenocarcinoma. Further studies are needed to identify these cases.

Long-term survivorship in pancreatic adenocarcinoma.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 175-175 ◽  
Author(s):  
M. A. Gubens ◽  
P. L. Kunz ◽  
G. A. Fisher ◽  
J. M. Ford ◽  
D. Lichtensztajn ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Adenocarcinoma ◽  
Multivariate Logistic Regression Model ◽  
Academic Hospital ◽  
Term Survival ◽  
Long Term Survival ◽  
Stage Disease ◽  
Long Term Survivors

175 Background: Pancreatic cancer is one of the most lethal malignancies, with an estimated 5-year survival rate of 6%, often due to advanced stage at diagnosis. However, there is a small population of patients, even with metastatic disease, who survive 3 years and beyond. Methods: Cases of pancreatic adenocarcinoma diagnosed from 1998 to 2005 were identified in the California Cancer Registry. A multivariate logistic regression model was constructed to predict the outcome of 3+ year survival according to demographic, disease and treatment variables defined a priori: age, gender, race/ethnicity, socioeconomic status (SES), histology, stage, treatment within 4 months of diagnosis (surgery, chemotherapy, and/or radiation), prior cancer history, and treatment at an academic hospital. Results: Among 54,475 cases of pancreatic cancer with ≥3 years of follow-up data available, median survival was 3.5 months. 2,855 patients (5.2%) survived at least 3 years, of whom 19% had remote stage disease at diagnosis. On multivariate analysis, advanced age was associated with decreased odds of long-term survival (p<0.01). By race, Asian/Pacific Islanders (odds ratio (OR) 1.76, p<0.01), Hispanics (OR 1.29, p=0.01) and non-Hispanic blacks (OR 1.24, p=0.14) were more likely to be long-term survivors than non-Hispanic whites. There was a gradient toward increased long- term survival for patients with higher SES (OR 1.49 for highest vs. lowest quintile, p<0.01). Mucinous tumors were associated with higher long-term survival than other adenocarcinomas (OR 2.21, p<0.01). Localized (OR 6.82) and regional stage disease (OR 2.61) showed more long-term survival than remote stage disease, both p<0.01. Surgery (OR 8.20, p<0.01), chemotherapy (OR 1.44, p<0.01), and radiation therapy (OR 1.25, p=0.02) increased the odds of long-term survival, as did treatment at an academic hospital (OR 1.54, p<0.01). Conclusions: In a well- characterized population-based registry with rigorous follow-up, we were able to identify a cohort of long-term survivors of pancreatic adenocarcinoma as well as factors associated with their exceptional survival. Planned future work with this cohort includes case-control studies making use of tumor and germline specimens, as well as survivorship research. No significant financial relationships to disclose.

scholarly journals Arrowroot as a treatment for diarrhoea in irritable bowel syndrome patients: a pilot study

2000 ◽  
Vol 37 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Caroline COOKE ◽  
Irene CARR ◽  
Keith ABRAMS ◽  
John MAYBERRY
Keyword(s):  
Irritable Bowel Syndrome ◽  
Abdominal Pain ◽  
Pilot Study ◽  
Term Effect ◽  
Treatment Results ◽  
Long Term Effect ◽  
Number Of Patients ◽  
Bowel Action ◽  
Irritable Bowel

Objectives - Arrowroot is an old-fashioned remedy for diarrhoea, but no clinical studies have been done to evaluate its effectiveness. The aim of this pilot study was to assess its efficacy as a treatment for diarrhoea in 11 patients, all of whom had irritable bowel syndrome with diarrhoea as a feature. Methods - The patients were interviewed and a questionnaire completed on entry into the trial. They then took 10 mL arrowroot powder three times a day for one month and discontinued the treatment for the subsequent month. Questionnaires were completed after one month on treatment and at the end of the trial after one month off treatment. Results - Arrowroot reduced diarrhoea and had a long-term effect on constipation. It also eased abdominal pain. Conclusion - Arrowroot is an effective treatment for diarrhoea. Its action could be explained by several theories which relate to an increase in faecal bulk and thus a more efficient bowel action. The number of patients was small, and further studies are needed to substantiate preliminary results.

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