Combined multiagent chemotherapy and radiotherapy is associated with prolonged overall survival in patients with non-operatively managed stage II-III pancreatic adenocarcinoma

Sugumar, Kavin; Hue, Jonathan J.; Hardacre, Jeffrey M.; Ammori, John B.; Rothermel, Luke D.; Dorth, Jennifer A.; Saltzman, Joel; Mohamed, Amr; Selfridge, J. Eva; Bajor, David J.; Winter, Jordan M.; Ocuin, Lee M.

doi:10.1016/j.hpb.2021.08.938

Cited by 2 publications

(2 citation statements)

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“…About 10–30% of patients with cancer stage III have a non-metastatic phenotype for a long time, especially during chemotherapy [ 3 , 4 , 5 , 6 ]. Effective systemic control of non-metastatic PDAC [ 7 ] combined with R0-resection [ 8 , 9 , 10 , 11 , 12 ] significantly increases survival in this patient cohort.…”

Section: Introductionmentioning

confidence: 99%

“…Both surgeries are anatomically based on collateral arterial supply to the pancreatic head, liver, and stomach through the inferior pancreaticoduodenal artery and pancreaticoduodenal arcade after resectioning the celiac axis and common hepatic artery [ 19 ]. Over the last ten years, various studies demonstrated the oncological effectiveness of this procedure with acceptable morbidity and mortality compared to, for example, survival after chemotherapy alone [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 20 , 21 , 22 ]. Despite widespread DP CAR for the treatment of pancreatic cancer, liver and stomach ischemia is a specific complication of this procedure [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic, Surgical and Oncological Outcomes of 40 Distal Pancreatectomies with Celiac and Left Gastric Arteries Resection (DP CAR) without Arterial Reconstructions and Preoperative Embolization

Егоров

Kim²,

Kharazov

et al. 2022

Cancers

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DPCAR’s short- and long-term outcomes are highly diverse, while the causes and prevention of ischemic complications are unclear. To assess oncological, surgical, and hemodynamic outcomes of 40 consecutive DPCARs for pancreatic (n37) and gastric tumors (n3) (2009–2021), retrospective analyses of mortality, morbidity, survival, and hemodynamic consequences after DPCAR were undertaken using case history data, IOUS, and pre- and postoperative CT measurements. In postoperative complications (42.5%), the pancreatic fistula was the most frequent event (27%), 90-day mortality was 7.5. With 27 months median follow-up, median overall (OS) and progression-free survival (PFS) for PDAC were 29 and 18 months, respectively; with 1-, 3-, and 5-years, the OS were 90, 60, and 28%, with an R0-resection rate of 92.5%. Liver and gastric ischemia developed in 0 and 5 (12.5%) cases. Comparison of clinical and vascular geometry data revealed fast adaptation of collateral circulation, insignificant changes in proper hepatic artery diameter, and high risk of ischemic gastropathy if the preoperative diameter of pancreaticoduodenal artery was <2 mm. DP CAR can be performed with acceptable morbidity and survival. OS and RFS in this super-selective cohort were compared to those for resectable cancer. The changes in the postoperative arterial geometry could explain the causes of ischemic complications and determine directions for their prevention.

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