Borderline resectable pancreatic cancer(BRPC)is a complex clinical entity with specific biological features.Criteria for resectability need to be assessed in combination with tumor anatomy and oncology.Neoadjuvant the...Borderline resectable pancreatic cancer(BRPC)is a complex clinical entity with specific biological features.Criteria for resectability need to be assessed in combination with tumor anatomy and oncology.Neoadjuvant therapy(NAT)for BRPC patients is associated with additional survival benefits.Research is currently focused on exploring the optimal NAT regimen and more reliable ways of assessing response to NAT.More attention to management standards during NAT,including biliary drainage and nutritional support,is needed.Surgery remains the cornerstone of BRPC treatment and multidisciplinary teams can help to evaluate whether patients are suitable for surgery and provide individualized management during the perioperative period,including NAT responsiveness and the selection of surgical timing.展开更多
Pancreatic cancer is the fourth leading cause of cancer death in the United States. While surgical resection remains the only curative option, more than 80% of patients present with unresectable disease. Unfortunately...Pancreatic cancer is the fourth leading cause of cancer death in the United States. While surgical resection remains the only curative option, more than 80% of patients present with unresectable disease. Unfortunately, even among those who undergo resection, the reported median survival is 15-23 mo, with a 5-year survival of approximately 20%. Disappointingly, over the past several decades, despite improvements in diagnostic imaging, surgical technique and chemotherapeutic options, only modest improvements in survival have been realized. Nevertheless, it remains clear that surgical resection is a prerequisite for achieving longterm survival and cure. There is now emerging consensus that a subgroup of patients, previously considered poor candidates for resection because of the relationship of their primary tumor to surrounding vasculature, may benefit from resection, particularly when preceded by neoadjuvant therapy. This stage of disease, termed borderline resectable pancreatic cancer, has become of increasing interest and is now the focus of a multiinstitutional clinical trial. Here we outline the history, progress, current treatment recommendations, and future directions for research in borderline resectable pancreatic cancer.展开更多
Borderline resectable(BR)pancreatic ductal adenocarcinoma(PDAC)is currently a well-recognized entity,characterized by some specific anatomic,biological and conditional features:It includes patients with a stage of dis...Borderline resectable(BR)pancreatic ductal adenocarcinoma(PDAC)is currently a well-recognized entity,characterized by some specific anatomic,biological and conditional features:It includes patients with a stage of disease intermediate between the resectable and the locally advanced ones.The term BR identifies a tumour with an aggressive biological behaviour,on which a neoadjuvant approach instead of an upfront surgery one should be preferred,in order to obtain a radical resection(R0)and to avoid an early recurrence after surgery.Even if during the last decades several studies on this topic have been published,some aspects of BR-PDAC still represent a matter of debate.The aim of this review is to critically analyse the available literature on this topic,particularly focusing on:The problem of the heterogeneity of definition of BR-PDAC adopted,leading to a misinterpretation of published data;its current management(neoadjuvant vs upfront surgery);which neoadjuvant regimen should be preferably adopted;the problem of radiological restaging and the determination of resectability after neoadjuvant therapy;the post-operative outcomes after surgery;and the role and efficacy of adjuvant treatment for resected patients that already underwent neoadjuvant therapy.展开更多
Pancreatic ductal adenocarcinoma(PDA) remains one of the most aggressive tumors with a low rate of survival. Surgery is the only curative treatment for PDA, although only 20% of patients are resectable at diagnosis. D...Pancreatic ductal adenocarcinoma(PDA) remains one of the most aggressive tumors with a low rate of survival. Surgery is the only curative treatment for PDA, although only 20% of patients are resectable at diagnosis. During the last decade there was an improvement in survival in patients affected by PDA, possibly explained by the advances in cancer therapy and by improve patient selection by pancreatic surgeons. It is necessary to select patients not only on the basis of surgical resectability, but also on the basis of the biological nature of the tumor. Specific preoperative criteria can be identified in order to select patients who will benefit from surgical resection. Duration of symptoms and level of carbohydrate antigen 19.9 in resectable disease should be considered to avoid R1 resection and early relapse. Radiological assessment can help surgeons to distinguish resectable disease from borderline resectable disease and locally advanced pancreatic cancer. Better patient selection can increase survival rate and neoadjuvant treatment can help surgeons select patients who will benefit from surgery.展开更多
Introduction: Surgical resection is the treatment of choice for pancreatic ductal adenocarcinoma (PDA). However, in case of venous tumor in-volvement, carcinomas are classified as borderline resectable and their prefe...Introduction: Surgical resection is the treatment of choice for pancreatic ductal adenocarcinoma (PDA). However, in case of venous tumor in-volvement, carcinomas are classified as borderline resectable and their preferential therapy remains controversial. The purpose of this study is to analyze the effectiveness of the surgical approach with simultaneous venous resection regarding perioperative outcome and long-term survival. Patients and methods: All patients that underwent pancreatoduodenectomy (PD) for PDA at our institution between 02/2002 and 12/2016 were analyzed retrospectively. A matched-pair analysis between patients that underwent PD with simultaneous venous resection (PDVR) and standard PD was performed to compare perioperative parameters, survival and factors relevant to long-term survival. Results: The study included 142 patients: 71 underwent PDVR and 71 underwent standard PD. Venous tumor infiltration could histopathologically be confirmed in 21 patients (29.58%). PDVR wasn’t associated with a higher rate of postoperative complications (56.34% for both groups), severe postoperative complications (28.17% vs. 23.94%) and mortality (5.63% vs. 9.86%) compared to standard PD. Median overall survival of both groups was 17 months (95% CI 10.89 - 23.11), without statistical significance between the two groups (PD 22 months, 95% CI 16.02 - 27.99 vs. PDVR 16 months, 95% CI 9.96 - 22.04, p = 0.087). Parameters associated with overall survival were his-topathologically proven venous tumor infiltration, the lymph node status and the necessity of postoperative blood transfusions. Conclusion: PDVR is justified, because peri- and post-operative morbidity and mortality, as well as long-term survival, are comparable to standard PD. Even in case of postoperatively histopathologically confirmed venous tumor infiltration, patients benefit over palliative treatment.展开更多
文摘Borderline resectable pancreatic cancer(BRPC)is a complex clinical entity with specific biological features.Criteria for resectability need to be assessed in combination with tumor anatomy and oncology.Neoadjuvant therapy(NAT)for BRPC patients is associated with additional survival benefits.Research is currently focused on exploring the optimal NAT regimen and more reliable ways of assessing response to NAT.More attention to management standards during NAT,including biliary drainage and nutritional support,is needed.Surgery remains the cornerstone of BRPC treatment and multidisciplinary teams can help to evaluate whether patients are suitable for surgery and provide individualized management during the perioperative period,including NAT responsiveness and the selection of surgical timing.
文摘Pancreatic cancer is the fourth leading cause of cancer death in the United States. While surgical resection remains the only curative option, more than 80% of patients present with unresectable disease. Unfortunately, even among those who undergo resection, the reported median survival is 15-23 mo, with a 5-year survival of approximately 20%. Disappointingly, over the past several decades, despite improvements in diagnostic imaging, surgical technique and chemotherapeutic options, only modest improvements in survival have been realized. Nevertheless, it remains clear that surgical resection is a prerequisite for achieving longterm survival and cure. There is now emerging consensus that a subgroup of patients, previously considered poor candidates for resection because of the relationship of their primary tumor to surrounding vasculature, may benefit from resection, particularly when preceded by neoadjuvant therapy. This stage of disease, termed borderline resectable pancreatic cancer, has become of increasing interest and is now the focus of a multiinstitutional clinical trial. Here we outline the history, progress, current treatment recommendations, and future directions for research in borderline resectable pancreatic cancer.
文摘Borderline resectable(BR)pancreatic ductal adenocarcinoma(PDAC)is currently a well-recognized entity,characterized by some specific anatomic,biological and conditional features:It includes patients with a stage of disease intermediate between the resectable and the locally advanced ones.The term BR identifies a tumour with an aggressive biological behaviour,on which a neoadjuvant approach instead of an upfront surgery one should be preferred,in order to obtain a radical resection(R0)and to avoid an early recurrence after surgery.Even if during the last decades several studies on this topic have been published,some aspects of BR-PDAC still represent a matter of debate.The aim of this review is to critically analyse the available literature on this topic,particularly focusing on:The problem of the heterogeneity of definition of BR-PDAC adopted,leading to a misinterpretation of published data;its current management(neoadjuvant vs upfront surgery);which neoadjuvant regimen should be preferably adopted;the problem of radiological restaging and the determination of resectability after neoadjuvant therapy;the post-operative outcomes after surgery;and the role and efficacy of adjuvant treatment for resected patients that already underwent neoadjuvant therapy.
文摘Pancreatic ductal adenocarcinoma(PDA) remains one of the most aggressive tumors with a low rate of survival. Surgery is the only curative treatment for PDA, although only 20% of patients are resectable at diagnosis. During the last decade there was an improvement in survival in patients affected by PDA, possibly explained by the advances in cancer therapy and by improve patient selection by pancreatic surgeons. It is necessary to select patients not only on the basis of surgical resectability, but also on the basis of the biological nature of the tumor. Specific preoperative criteria can be identified in order to select patients who will benefit from surgical resection. Duration of symptoms and level of carbohydrate antigen 19.9 in resectable disease should be considered to avoid R1 resection and early relapse. Radiological assessment can help surgeons to distinguish resectable disease from borderline resectable disease and locally advanced pancreatic cancer. Better patient selection can increase survival rate and neoadjuvant treatment can help surgeons select patients who will benefit from surgery.
文摘Introduction: Surgical resection is the treatment of choice for pancreatic ductal adenocarcinoma (PDA). However, in case of venous tumor in-volvement, carcinomas are classified as borderline resectable and their preferential therapy remains controversial. The purpose of this study is to analyze the effectiveness of the surgical approach with simultaneous venous resection regarding perioperative outcome and long-term survival. Patients and methods: All patients that underwent pancreatoduodenectomy (PD) for PDA at our institution between 02/2002 and 12/2016 were analyzed retrospectively. A matched-pair analysis between patients that underwent PD with simultaneous venous resection (PDVR) and standard PD was performed to compare perioperative parameters, survival and factors relevant to long-term survival. Results: The study included 142 patients: 71 underwent PDVR and 71 underwent standard PD. Venous tumor infiltration could histopathologically be confirmed in 21 patients (29.58%). PDVR wasn’t associated with a higher rate of postoperative complications (56.34% for both groups), severe postoperative complications (28.17% vs. 23.94%) and mortality (5.63% vs. 9.86%) compared to standard PD. Median overall survival of both groups was 17 months (95% CI 10.89 - 23.11), without statistical significance between the two groups (PD 22 months, 95% CI 16.02 - 27.99 vs. PDVR 16 months, 95% CI 9.96 - 22.04, p = 0.087). Parameters associated with overall survival were his-topathologically proven venous tumor infiltration, the lymph node status and the necessity of postoperative blood transfusions. Conclusion: PDVR is justified, because peri- and post-operative morbidity and mortality, as well as long-term survival, are comparable to standard PD. Even in case of postoperatively histopathologically confirmed venous tumor infiltration, patients benefit over palliative treatment.
