“Conversion surgery” for locally advanced pancreatic cancer: A position paper by the study group at the joint meeting of the International Association of Pancreatology (IAP) &amp; Japan Pancreas Society (JPS) 2022

Oba, Atsushi; Chiaro, Marco Del; Fujii, Tsutomu; Okano, Keiichi; Stoop, Thomas F.; Wu, Yan‐Dong; Maekawa, Akio; Yoshida, Yuta; Hashimoto, Daisuke; Sugawara, Toshitaka; Inoue, Yosuke; Tanabe, Minoru; Sho, Masayuki; Sasaki, Takashi; Takahashi, Yu; Matsumoto, Ippei; Sasahira, Naoki; Nagakawa, Yuichi; Satoi, Sohei; Schulick, Richard D.; Yoon, Yoo Seok; He, Jin; Jang, Jin–Young; Wolfgang, Christopher L.; Hackert, Thilo; Besselink, Marc G.; Takaori, Kyoichi; Takeyama, Yoshifumi

doi:10.1016/j.pan.2023.06.005

Cited by 7 publications

(2 citation statements)

References 131 publications

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“…In the latter cases, undetected microscopic residual disease and aggressive cancer biology may lead to early clinical recurrence and death, rendering a morbid local resection futile. Thus, considering the tumor biology to determine surgical candidacy is becoming increasingly important [13,14]. Institutions such as the international consensus meetings and the MD Anderson Cancer Center have realized the importance of tumor biology and come up with alternative criteria for resectability that factor in both anatomic and biological parameters [15,16].…”

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confidence: 99%

Anatomical and Biological Considerations to Determine Resectability in Pancreatic Cancer

Rompen,

Habib,

Wolfgang

et al. 2024

Cancers

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Pancreatic ductal adenocarcinoma (PDAC) remains associated with poor outcomes with a 5-year survival of 12% across all stages of the disease. These poor outcomes are driven by a delay in diagnosis and an early propensity for systemic dissemination of the disease. Recently, aggressive surgical approaches involving complex vascular resections and reconstructions have become more common, thus allowing more locally advanced tumors to be resected. Unfortunately, however, even after the completion of surgery and systemic therapy, approximately 40% of patients experience early recurrence of disease. To determine resectability, many institutions utilize anatomical staging systems based on the presence and extent of vascular involvement of major abdominal vessels around the pancreas. However, these classification systems are based on anatomical considerations only and do not factor in the burden of systemic disease. By integrating the biological criteria, we possibly could avoid futile resections often associated with significant morbidity. Especially patients with anatomically resectable disease who have a heavy burden of radiologically undetected systemic disease most likely do not derive a survival benefit from resection. On the contrary, we could offer complex resections to those who have locally advanced or oligometastatic disease but have favorable systemic biology and are most likely to benefit from resection. This review summarizes the current literature on defining anatomical and biological resectability in patients with pancreatic cancer.

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Section: Introductionmentioning

confidence: 99%

Anatomical and Biological Considerations to Determine Resectability in Pancreatic Cancer

Rompen,

Habib,

Wolfgang

et al. 2024

Cancers

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“…However, there remains considerable variability in adherence to these guidelines ( 11 - 15 ). Determining surgical candidacy such that a patient derives maximal benefit from resection remains a challenge ( 16 ). This is primarily due to lack of reliable biomarkers to assess treatment response early on during induction therapy to guide treatment decision making.…”

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The value of CA19-9 dynamics in decision making for treatment of locally advanced pancreatic cancer

Rompen,

Habib,

Sereni

et al. 2024

Gland Surg

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Outcomes of patients with initially unresectable pancreatic cancer who underwent conversion surgery after FOLFIRINOX or gemcitabine plus nab‐paclitaxel chemotherapy: A multicenter retrospective cohort study (PC‐CURE‐1)

Okano,

Kawai,

Ueno

et al. 2024

J Hepato Biliary Pancreat

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BackgroundThe efficacy and safety of conversion surgery (CS) after FOLFIRINOX or gemcitabine plus nab‐paclitaxel (GnP) chemotherapy in patients with initially unresectable pancreatic cancer (PC) remains unclear.MethodsThis multicenter retrospective cohort study enrolled patients, between 2014 and 2018, with initially locally advanced or metastatic PC who were considered candidates for CS following FOLFIRINOX or GnP chemotherapy. They were classified into surgery (207 patients [194 resection and 13 exploratory laparotomy only]) and continued chemotherapy (10 patients, control) groups. The primary endpoint was overall survival (OS) from the day of diagnosis of potentially curative resection on imaging studies, with an expected hazard ratio (HR) of 0.7.ResultsOS in the surgery group was longer than that in the control group (HR, 0.47; 95% confidence interval [CI]: 0.24–0.93). The median OS was 34.4 (95% CI: 27.9–43.4) and 19.8 (95% CI: 14.9–31.1) months in the surgery and control groups, respectively. The Clavien‐Dindo grade ≥ IIIa postoperative complication and in‐hospital mortality rates were 19.6% and 0.5%, respectively. Multivariate analysis revealed that preoperative chemotherapy duration was not associated with OS.ConclusionsCS, following a favorable response to FOLFIRINOX or GnP chemotherapy, improved initially unresectable PC prognosis (specifically, OS), regardless of the chemotherapy duration.

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“Conversion surgery” for locally advanced pancreatic cancer: A position paper by the study group at the joint meeting of the International Association of Pancreatology (IAP) & Japan Pancreas Society (JPS) 2022

Cited by 7 publications

References 131 publications

Anatomical and Biological Considerations to Determine Resectability in Pancreatic Cancer

Anatomical and Biological Considerations to Determine Resectability in Pancreatic Cancer

The value of CA19-9 dynamics in decision making for treatment of locally advanced pancreatic cancer

Outcomes of patients with initially unresectable pancreatic cancer who underwent conversion surgery after FOLFIRINOX or gemcitabine plus nab‐paclitaxel chemotherapy: A multicenter retrospective cohort study (PC‐CURE‐1)

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