A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer

Imamura, Masayuki; Doi, Ryuichiro; Imaizumi, Tsutomu; Funakoshi, Akihiro; Wakasugi, Hideyuki; Sunamura, Makoto; Ogata, Yoshiro; Hishinuma, Shoichi; Asano, Tomohiko; Aikou, Takashi; Hosotani, Ryo; Maetani, Shunzo

doi:10.1016/j.surg.2004.04.030

Cited by 116 publications

(63 citation statements)

References 27 publications

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“…1,4,5 Current scenario in such a tricky situation is a difficult proposition as outcome with other alternative therapies are not acceptable in terms of survival and quality of life. [6][7][8] Some recent reports show improved survival with Gemcitabine as a first line of therapy. 9 In the present series males are the sufferers of pancreatic cancer, out of 62 patients, 48 (77.41%) males, 14 patients (22.59%) females, age group was 33 to 65 years with mean age between 45 to 55 years.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 When surgical resection was compared with radio chemotherapy for resectable pancreatic cancer, patients in operative group done fairly well with median survival of 17 months versus 11 months in chemoradiation group. 6,7 Few studies report improvements especially with regard to quality of life, are primarily due to use of gemcitabine as first line chemotherapy. 8 Standardized surgical treatment for head of pancreas cancer, duodenal cancer, distal cholangiocarcinoma, periampullary cancer was Whipple's or it's pylorus preserving modification.…”

Section: Introductionmentioning

confidence: 99%

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Audit of 62 cases of pancreatic resections for pancreatic cancer

Nichkaode¹,

Bhukte²,

Bandhe³

2017

Int Surg J

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Background: Varieties of pancreatic pathologies, needs resection of pancreatic tissue. Adenocarcinoma of the pancreatic duct is the most common malignancy presenting with early metastasis and seen as resistant to alternative treatment regimens currently available. Management and handling of such tumors is a complex and challenging task for a surgeon. Surgical resection offers an improved prognosis, with a median survival after resection of 14-20 months and up to 25% 5-year survival rates. Present study is aimed at presenting data of 62 pancreatic resections for various malignant pancreatic lesions.Methods: This is an ongoing longitudinal study which started in 2009 at teaching institute in central India. Though we had 109 patients for pancreatic resection, only 62 patients were considered suitable for the study. All patients after admission were thoroughly investigated and then considered for surgery. 48 patients were male and 14 patients were female. Age group was ranging from 33 to 65 years with mean age between 45 to 55 years. Spectrum of various malignancies and different types of pancreatic resections were done and results are presented here.Results: Pancreatic adenocarcinoma is an aggressive malignancy responds to surgical treatment better than other alternative modalities. In the present series out of 62 patients 27 patients with pancreatic head cancer, 22 patients with periampullary cancer, 2 patients with duodenal cancer, 6 patients with distal cholangio carcinoma, 1 patient with mucinous cystadenocarcinoma. 4 patients with body and tail of pancreas cancer. Average age 38 to 65 years, 47 males and 15 females. Commonest procedure was Whipple’s operation, and distal pancreatectomy. Survival in present series was 18 -24 months and 5-year survival was 12 % that is seen mainly with Periampullary cancer.Conclusions: Surgery is the only chance of cure or long-term survival in pancreatic cancer. Chemo radiation as a primary therapy is ineffective. But some reports suggest the improved quality of life with palliative chemotherapy. Biology of the disease is the king and dictates the survival, the type of surgical procedure had no impact on survival, nor on morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Audit of 62 cases of pancreatic resections for pancreatic cancer

Nichkaode¹,

Bhukte²,

Bandhe³

2017

Int Surg J

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“…Imamura et al [14] randomized 42 patients with tumor invasion of the serosal or retroperitoneal pancreatic surfaces or with extension into the intrapancreatic portal vein without complete obstruction to resection without adjuvant chemoradiotherapy (n ϭ 20) or radiochemotherapy with or without digestive/biliary bypass (n ϭ 22). Therapy consisted of 5,040 cGy in 28 fractions with continuous 5-fluorouracil (5-FU) at 200 mg/m 2 per day during radiotherapy followed by weekly 5-FU at 500 mg/ m 2 .…”

Section: Rationale For Resectionmentioning

confidence: 99%

Extended Resection for Pancreatic Adenocarcinoma

et al. 2007

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LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the evidence in favor of and against the role of surgical resection in the management of pancreatic adenocarcinoma.2. Explain how the components of an extended pancreatectomy, including total pancreatectomy, extended lymph node dissection, and major intestinal arterial resection, do not improve survival above what is provided after pancreaticoduodenectomy and are associated with substantial morbidity.3. Discuss how portal/mesenteric vein resection to achieve negative resection margins does not add to the morbidity of pancreaticoduodenectomy, does not worsen survival after resection, and is most often performed because of tumor location.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTAdenocarcinoma of the pancreas presents a number of therapeutic challenges. Given the poor long-term outcomes after pancreaticoduodenectomy (PD), many surgeons have sought to improve survival via a radical or "extended" pancreatectomy which may include (a) total pancreatectomy (TP), (b) extended lymph node dissection (ELND), and (c) portal/mesenteric vascular resections. These themes of "extended" resection are addressed in this review. TP should not be performed for most cases of adenocarcinoma of the pancreatic head because of the nominal incidence of lymph node involvement along the body and tail of the pancreas, the scarcity of multicentric disease, and the better management of pancreatic leaks after PD. Most studies show no difference in long-term survival and demonstrate greater postoperative morbidity after TP than after PD. Performing ELND in addition to PD is not worthwhile because most studies do not demonstrate any long-term benefits from ELND and the circumferential dissection around the mesenteric vessels required to harvest distant lymph nodes increases postoperative morbidity. Major arterial resection increases postoperative morbidity after PD and worsens long-term survival as the need for arterial resection to achieve negative resection margins indicates more aggressive disease. In contrast, portal and/or mesenteric venous resection does not increase the morbidity after PD or impact long-term survival as venous resection is often performed because of tumor location and not extent of disease. The disappointing experience with extended resections underscores the need for better adjuvant systemic strategies and the interdisciplinary care of patients with pancreatic adenocarcinoma.

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“…Finding an effective therapeutic approach for pancreatic cancer remains challenging. A Japanese randomized trial compared surgery with chemoradiotherapy for locally resectable invasive pancreatic cancer, and its findings suggested that surgery remains the only potentially curative treatment (3), and subsequently, only if there is a negative surgical margin (4). There has been much debate as to whether the use of preoperative chemoradiotherapy can help achieve a clear margin and hence prolong survival (5).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of intensity-modulated radiotherapy combined with gemcitabine and S-1 for patients with pancreatic cancer

Kennoki

Nakayama

Nagakawa

et al. 2015

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to establish whether intensity-modulated radiotherapy (IMRT) with concurrent gemcitabine and S-1 is a feasible treatment option for patients with locally advanced pancreatic ductal adenocarcinoma. Patients with pancreatic ductal adenocarcinoma were prospectively enrolled. An IMRT dose of 50.4 Gy in 28 fractions with concurrent gemcitabine at a dose of 600 mg/m 2 and S-1 at a dose of 60 mg were administrated. Adverse events and associated dosimetric factors were assessed. Between

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A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer

Cited by 116 publications

References 27 publications

Audit of 62 cases of pancreatic resections for pancreatic cancer

Audit of 62 cases of pancreatic resections for pancreatic cancer

Extended Resection for Pancreatic Adenocarcinoma

Feasibility of intensity-modulated radiotherapy combined with gemcitabine and S-1 for patients with pancreatic cancer

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