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.

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

Role of FDG PET/CT scan in preoperative pancreatic cancer staging.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 511-511
Author(s):  
Bhargavi Ghanta ◽  
Thavam C. Thambi-Pillai ◽  
Gary Timmerman ◽  
Christopher Fischer ◽  
Annie Nelson ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Preoperative Staging ◽  
False Negative ◽  
Number Of Patients ◽  
Pet Ct ◽  
Hepatic Metastatic Disease ◽  
Fdg Pet Ct

511 Background: Guidelines do not recommend routine FDG PET/CT (PET) as preoperative staging for pancreatic cancer, although many single center series have demonstrated that PET can lead to changes in management in a sizable minority of patients. We performed a retrospective analysis of patients undergoing PET for potentially resectable pancreatic adenocarcinoma at our institution to help define the utility of PET in this setting. Methods: We reviewed patients with pancreatic adenocarcinoma diagnosed at our center from June 2010 to May 2017 and included patients with pancreatic adenocarcinoma felt to be potentially resectable following standard staging studies [computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS)] who also underwent preoperative PET. Data collected and analyzed included: demographics, pre-PET staging, CA19-9 levels, PET results and surgical outcomes. Results: Forty eight patients with pancreatic adenocarcinoma felt to be surgically resectable underwent PET. PET changed management in 4/48 (8.3%) of these patients. In all 4 of these patients, hepatic metastatic disease was detected on PET and planned surgery was canceled; metastatic disease was confirmed by biopsy in 1 of these patients. 1/48 (2.1%) of patients had a false positive PET scan, where a focus of suspected metastatic disease on PET was biopsied and found to be benign, allowing the patient to proceed to surgery. 3/48 (6.3%) of patients had a false negative PET; 2 patients had hepatic metastatic disease and one had peritoneal disease discovered during surgery. Mean time from negative PET to surgery in these 3 patients was 31 days (range 21-45). Degree of CA19-9 elevation and primary tumor FDG avidity did not correlate with detection of metastatic disease on PET. Conclusions: PET changed management in a smaller number of patients in this cohort than in many previously reported series with a nearly equal number of patients with false negative PET results proceeding to unnecessary surgery. These results are consistent with the currently uncertain role of PET in preoperative staging for pancreatic cancer and further work must be undertaken to optimize presurgical staging in this population.

Analysis of preclinical and clinical data on the role of hyperthermia with gemcitabine and carboplatin on pancreatic adenocarcinoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14123-14123
Author(s):  
S. O. Peters ◽  
A. S. Stoltz ◽  
A. Bakshandeh ◽  
M. Vollmert ◽  
T. Wagner
Keyword(s):  
Cell Cycle ◽  
Pancreatic Cancer ◽  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Clinical Data ◽  
Whole Body ◽  
High Morbidity ◽  
Human Pancreas ◽  
Preclinical Data

14123 Background: Preclinical data show synergism of whole body hyperthermia (HT) of 41.8°C with gemcitabine (G) and carboplatin (CP) in lung head and neck tumor cell lines. Advanced pancreatic adenocarcinoma is an aggressive disease and is associated with high morbidity and a median survival of 8 to 12 months. The role of whole body HT with G and CP in the treatment of pancreatic cancer is unknown. Methods: We first show preclinical data to study the effects of combining HT of 37°, 39°, 41.8 and 43°C for 1 h with G and CP on the human pancreas carcinoma cell line DAN-G. We assessed proliferation ratios using crystal-violett assays and cell cycles by flow cytometry. We secondly analyzed the clinical outcome of 13 pts that received whole body HT of 41.8°C with G and CP for advanced pancreatic cancer on a compassionate-use basis at our institution between 2000 to 2004 was assessed for toxicity, response and overall survival. Results: Preclinical studies showed no effects of HT of 37, 39 and 41.8°C on DAN-G cell proliferation and cell cycle behaviour when used alone without cytostatic drugs. At 43°C cells decompose (in all experiments). Additional G and/or CP at concentrations of IC50 to HT of 37, 39, 41, 8°C did not alter the effects of the drugs alone. Cell cycle anaylsis showed that an increment of temperatures did not effect cycle phases. Analysis of the clinical data of patients whole body HT with G and CP showed partial remissions in 3 pts (23%) and no change situations in 5 pts (38%). Of 13 pts received only 2 cycles because of disease progression (n = 5) or because they refused to further treatment due to minor toxicities. 4 pts received all 4 therapy cycles initially planned. Overall survival was 11.4 months, one year survival for all patients was 38%. Generally the treatment was well tolerated. Grade 3–4 toxicities were thrombocytopenia in one patient and therapy induced anemia and neutropenia in another patient occurring after the forth cycle of treatment. Conclusions: Preclinical and clinical data show that HT plus G and CP is of no benefit in the treatment of pancreatic cancer. No significant financial relationships to disclose.

scholarly journals The Prognostic Value of Low Muscle Mass in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (14) ◽  
pp. 3033
Author(s):  
Elisa Sefora Pierobon ◽  
Lucia Moletta ◽  
Sandra Zampieri ◽  
Roberta Sartori ◽  
Alessandra Rosalba Brazzale ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Muscle Mass ◽  
Meta Analysis ◽  
Analysis Data ◽  
Oncologic Outcomes ◽  
Extensive Literature ◽  
Cancer Types ◽  
Muscle Mass Loss ◽  
Meta Analyses ◽  
The Impact

Low muscle mass is associated with reduced survival in patients with different cancer types. The interest in preoperative sarcopenia and pancreatic cancer has risen in the last decade as muscle mass loss seems to be associated with poorer survival, higher postoperative morbidity, and mortality. The aim of the present study was to review the literature to compare the impact of low muscle mass on the outcomes of patients undergoing surgery for pancreatic adenocarcinoma. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 10 articles were analyzed in detail and included in the meta-analysis. Data were retrieved on 2811 patients undergoing surgery for pancreatic cancer. Meta-analysis identified that patients with low muscle mass demonstrated a significantly reduced OS when compared to patients without alterations of the muscle mass (ROM 0.86; 95% CI: 0.81–0.91, p < 0.001), resulting in a 14% loss for the former. Meta-analysis failed to identify an increase in the postoperative complications and length of stay of patients with low muscle mass. Our analysis confirms the role of low muscle mass in influencing oncologic outcomes in pancreatic cancer. Its role on surgical outcomes remains to be established.

scholarly journals The Role of MRI Pancreatic Protocol in Assessing Response to Neoadjuvant Therapy for Patients With Borderline Resectable Pancreatic Cancer

2022 ◽  
Vol 11 ◽  
Author(s):  
Nervana Hussien ◽  
Rasha S. Hussien ◽  
Darine Helmy Amin Saad ◽  
Mohamed El Kassas ◽  
Walid F. Elkhatib ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Therapy ◽  
Operative Procedure ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer ◽  
Number Of Patients ◽  
Magnetic Resonance Imaging Mri ◽  
Post Therapy

BackgroundBorderline Resectable Pancreatic Cancer (BRPC) remains a unique entity that is difficult to categorize due to variance in definitions and the small number of patients. The ultimate goal is to achieve a free resection (R0) after a favorable response to neoadjuvant therapy that is somewhat difficult to assess by current radiological parameters.AimTo evaluate the role of Magnetic Resonance Imaging (MRI) pancreatic protocol, including Diffusion-Weighted Imaging (DWI), in patients with BRPC receiving neoadjuvant therapy, and further compare it to RECIST criteria and outcome.MethodsHistologically confirmed BRPC patients were prospectively included. DWI-MRI was performed pre- and post-therapy. Clinical characteristics with ensuing operability were recorded and correlated to radiological RECIST/apparent diffusion coefficient (ADC) change, preoperative therapy administrated, surgical resection status, and survival.ResultsOut of 30 BRPC cases, only 11 (36.7%) ultimately underwent pancreaticoduodenectomy. Attaining a stationary or stable disease via ADC/RECIST was achieved in the majority of cases (60%/53.3% respectively). Of the 12 patients (40%) who achieved a regression by ADC, 11 underwent surgery with an R0 status. These surgical cases showed variable RECIST responses (PR=5, SD=4, PD=3). Responders by ADC to neoadjuvant therapy were significantly associated to presenting with abdominal pain (p =0.07), a decline in post-therapy CA19-9 (p&lt;0.001), going through surgery (p&lt;0.001), and even achieving better survival (p&lt;0.001 vs. 0.66).ConclusionDWI-MRI ADC picked up patients most likely to undergo a successful operative procedure better than traditional RECIST criteria. An algorithm incorporating novel radiological advances with CA19-9 deserves further assessment in future studies.

scholarly journals How pancreatic adenocarcinoma might cause diabetes? The role of TGF- β

2021 ◽  
pp. 05-10
Author(s):  
Hanan F. Aly
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Pancreatic Adenocarcinoma ◽  
De Novo ◽  
Ductal Adenocarcinoma ◽  
Preneoplastic Lesions ◽  
Β Cells ◽  
Selective Depletion ◽  
New Onset

Pancreatic ductal adenocarcinoma (PDAC) is a deadly sickness that stays incurable due to past due diagnosis, which renders any healing intervention challenging. Most PDAC sufferers expand de novo diabetes, which exacerbates their morbidity and mortality. How PDAC triggers diabetes continues to be unfolding. Using a mouse version of KrasG12D-pushed PDAC, which faithfully recapitulates the development of the human sickness, we determined a large and selective depletion of β-cells, taking place very early on the degrees of preneoplastic lesions. Mechanistically, it turned into observed that accelerated TGF beta (TGF-β) signaling throughout PDAC development induced erosion of β-mobileular mass thru apoptosis. Suppressing TGF-β signaling, both pharmacologically thru TGF-β immunoneutralization or genetically thru deletion of Smad4 or TGF-β kind II receptor (TβRII), afforded size able safety in opposition to PDAC-pushed β-mobileular depletion. From a translational perspective, each activation of TGF-β signaling and depletion of β-cells often arise in human PDAC, imparting a mechanistic cause of the pathogenesis of diabetes in PDAC sufferers, and similarly implicating new- onset diabetes as a capability early prognostic marker for PDAC. In this mini review we try to analyze the principle relationships between pancreatic cancer and diabetes and vice versa in addition to the implication of TGF-β signaling as a likely goal for attenuating diabetes in pancreatic most cancers patients.

scholarly journals The role of surgeons during the COVID-19 pandemic: The experience of the Surgery Clinic of the Clinical Hospital Center 'Zemun'

2021 ◽  
Vol 2 (3) ◽  
pp. 228-235
Author(s):  
Dragoš Stojanović ◽  
Nebojša Mitrović ◽  
Dejan Stevanović ◽  
Damir Jašarović ◽  
Srđan Milina ◽  
...  
Keyword(s):  
Healthcare System ◽  
Surgical Procedures ◽  
Vascular Diseases ◽  
Hospital Treatment ◽  
Clinical Hospital ◽  
Number Of Patients ◽  
Study Results ◽  
The Republic ◽  
Hospital Center

Introduction: In December 2019, the existence of a new type of disease, caused by SARS coronavirus 2 (SARS-CoV-2), was discovered in the city of Wuhan, the Republic of China. The disease itself is characterized by a large number of patients with moderate and severe clinical presentation, who require hospital treatment. The organization of the healthcare system of Serbia, during the aforementioned pandemic, has required the engagement of all doctors, regardless of their specialty, in the treatment of patients with COVID-19. Surgeons of all branches, from the Surgery Clinic of the Clinical Hospital Center Zemun, were directly engaged in the treatment of both primary manifestations of the virus and the numerous surgical complications arising in the wake of this disease, but also in the treatment of primary acute surgical diseases in COVID-19-positive patients. Aim: The aim of this paper is to present the functioning of the Surgery Clinic of CHC Zemun, in the conditions of the COVID-19 pandemic, as well as to present the types and results of surgical procedures performed in patients with the COVID-19 infection. Methods: This study was conceived as a retrospective study and was conducted in the period between February 2020 and April 2021, in patients who had undergone emergency surgery and in whom the COVID-19 infection had previously been verified. A total of 232 patients surgically treated at the level of the entire Surgery Clinic of the CHC Zemun participated in the study. Results: Chest drainage, due to the development of pneumothorax, accounted for a quarter of all surgical procedures performed, while, in 53.85% of cases, surgical treatment was undertaken due to acute abdomen of various etiology, and in 21.15% of cases, due to vascular diseases. Conclusion: The COVID-19 pandemic is, in itself, a major challenge for the entire healthcare system. The role of the surgeon is significant, both in organization and in direct treatment, which is additionally complicated by the uniqueness of the entire situation and the severity of the disease itself. In addition to their involvement in the treatment of the COVID-19 infection itself, surgeons were, in a large number of cases, engaged in their primary activity in health care, i.e., in the treatment of surgical diseases and complications of COVID-19, performing demanding surgical procedures in very difficult and unique conditions.

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.

scholarly journals Autophagy in Pancreatic Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Daniel Grasso ◽  
Maria Noé Garcia ◽  
Juan L. Iovanna
Keyword(s):  
Pancreatic Cancer ◽  
Life Expectancy ◽  
Effective Treatment ◽  
Pancreatic Adenocarcinoma ◽  
Published Data ◽  
Cytoplasmic Component ◽  
Cellular Pathways ◽  
Cellular Components

Pancreatic adenocarcinoma (PDAC) is a devastating disease with an extremely poor life expectancy and no effective treatment. Autophagy is a process of degradation of cytoplasmic component capable of recycling cellular components or eliminate specific targets. The presence of autophagy in PDAC has been demonstrated. However, the implicated cellular pathways are not fully understood and, more importantly, the role of autophagy in PDAC is matter of intensive debate. This review summarizes recently published data in an attempt to clarify the importance of autophagy in this disease and try to reconcile apparently contradictory results.

scholarly journals Prognostic Role of Carbohydrate Antigen 19 to 9 in Predicting Survival of Patients With Pancreatic Cancer: A Meta-Analysis

2021 ◽  
Vol 20 ◽  
pp. 153303382110430
Author(s):  
Yong-Ming Kang ◽  
Hao Wang ◽  
Ran Li ◽  
Gu Pan
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Median Survival ◽  
Meta Analysis ◽  
Carbohydrate Antigen ◽  
Prognostic Role ◽  
Eligibility Criteria ◽  
Before And After ◽  
Meta Analyses

This study evaluates the prognostic role of carbohydrate antigen 19 to 9 (CA19-9) in predicting survival of pancreatic cancer patients. Literature search was conducted in electronic databases (Google Scholar, Ovid, PubMed, and Science Direct) and study selection was based on precise eligibility criteria. Random-effects meta-analyses were performed to achieve overall estimates of median survival and hazard ratios (HRs) of survival with cutoff defined lower and higher CA19-9 levels before and after surgery or chemotherapy (CT)/radiotherapy (RT) and the changes in CA19-9 levels after any treatment. A total of 41 studies (6519 patients; 42% females; age 63.3 years [95% confidence interval [CI]: 62.2, 64.4]) were included. A pooled HR of 1.79 with a narrow 95% CI (1.58, 2.01) showed that higher CA19-9 levels or less decrease in CA19-9 levels after treatment predicted shorter survival. Median survival in patients with lower and higher preoperative CA19-9 levels was 23.2 months [95% CI: 17.2, 29.2] and 14.0 months [95% CI: 10.9, 17.2], respectively, whereas median survival with lower and higher postoperative CA19-9 levels was 25.0 months [95% CI: 21.9, 28.0] and 13.0 months [95% CI: 10.9, 15.0] respectively. Median survival with lower and higher pre-CT/RT CA19-9 levels was 11.9 months [95% CI: 10.2, 13.6] and 7.7 months [95% CI: 6.2, 9.2], respectively, whereas median survival with lower and higher post-CT/RT CA19-9 levels was 15.1 months [95% CI: 13.2, 17.0] and 10.7 months [95% CI: 7.3, 14.0] respectively. A decrease in CA19-9 levels after treatment was also associated with longer survival. Thus, both pretreatment and posttreatment CA19-9 levels or their changes after treatment have good prognostic value in determining the survival of pancreatic cancer patients.

Sign in / Sign up

Export Citation Format

Share Document