CT diagnosis of recurrence after pancreatic cancer: Is there a pattern?

Heye, Tobias; Zausig, N.; Klauß, Miriam; Singer, Reinhard; Werner, Jens; Richter, G. M.; Kauczor, Hans‐Ulrich; Grenacher, Lars

doi:10.3748/wjg.v17.i9.1126

Cited by 51 publications

(22 citation statements)

References 27 publications

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“…A significant proportion of these isolated local recurrences may originate from regional lymph node metastases. In a radiological study of computed tomography scans performed for surveillance in 99 patients after pancreatic cancer resection, 17% of patients developed isolated local recurrence, including six patients with isolated lymph node recurrences and 11 patients with lymph node and additional perivascular recurrences . In a study on re‐resection for isolated local recurrence of pancreatic cancer, 41 (72%) of 57 patients with isolated local recurrence proven histologically upon surgical exploration, underwent successful re‐resection associated with a median survival of 26 months after re‐resection .…”

Section: Extent Of Lymphadenectomy and Outcome In Pancreatic Cancermentioning

confidence: 99%

Local radicality and survival outcome of pancreatic cancer surgery

Niesen

Hank

Büchler

et al. 2019

Annals of Gastroent Surgery

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Pancreatic cancer remains a therapeutic challenge. Surgical resection in combination with systemic chemotherapy is the only option promising long‐term survival and potential cure. However, only about 20% of patients are diagnosed with tumors that are still in a resectable stage. Even after potentially curative resection and modern regimens for adjuvant chemotherapy, the majority of patients develop local and systemic recurrence resulting in median overall survival times of 28‐54 months. The predominance of systemic recurrence and its impact on survival may lead to the assumption that surgical radicality and local control play only minor roles in the treatment of pancreatic cancer. This review provides an overview of the recent literature on surgical radicality and survival outcome in pancreatic cancer. The current evidence on the extent of lymphadenectomy, the prognostic impact of the extent of lymph node involvement, and the impact of the resection margin status on postresection survival are reviewed. Data from recent studies performed in the context of modern surgery and adjuvant therapy provide good evidence of a considerable impact of local radicality on survival after pancreatic cancer surgery. Surgical techniques that have been developed to refine oncological resections and to increase local control as well as resectability are highlighted. These techniques include artery‐first approaches, level‐3 dissection with removal of the periarterial nerve plexus, the triangle operation, and extended resections. Local radicality and quality of surgical resection remain among the most important parameters that determine the chances for survival in patients with non‐metastatic pancreatic cancer.

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Section: Extent Of Lymphadenectomy and Outcome In Pancreatic Cancermentioning

confidence: 99%

Local radicality and survival outcome of pancreatic cancer surgery

Niesen

Hank

Büchler

et al. 2019

Annals of Gastroent Surgery

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“…Local recurrence was defined as radiological evidence of intra-abdominal soft tissue in the resection area or along adjacent cardinal visceral vessels that (i) increased in size over time or (ii) had concomitant raised CA 19-9. 30 Biopsy to confirm recurrence was not routinely performed.…”

Section: Postoperative Management and Surveillancementioning

confidence: 99%

Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery

Kleive

Berstad

Verbeke

et al. 2016

HPB

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“…In pancreatic cancer, the celiac artery (CA) and superior mesenteric artery (SMA) are very important blood vessels to decide the indication for surgery. Some studies have shown that most recurrences were in regions around the CA and SMA, 14,15 and it is considered important in RT planning for LAPC to judge whether to include the CA and SMA lymph node regions. However, because the incidence of CA or SMA involvement in LAPC is high, the gross target volume (GTV) would include those lymph node regions in many patients.…”

Section: Introductionmentioning

confidence: 99%

How Much Was the Elective Lymph Node Region Covered in Involved-Field Radiation Therapy for Locally Advanced Pancreatic Cancer? Evaluation of Overlap Between Gross Target Volume and Celiac Artery–Superior Mesenteric Artery Lymph Node Regions

Umezawa

Ito

Wakita

et al. 2020

Advances in Radiation Oncology

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Purpose: The purpose of this study was to investigate the overlaps between gross target volume (GTV) and the celiac artery (CA) and superior mesenteric artery (SMA) lymph node regions and to examine the dose incidentally irradiated to the CA and SMA lymph node regions by involved-field radiation therapy (IFRT) for locally advanced pancreatic cancer (LAPC). Methods and Materials: Fifty-nine patients who had LAPC without distant metastasis were included. They received IFRT at 50.4 Gy in 28 fractions with 3-dimensional conformal radiation therapy. We calculated the percentages of overlap of GTV in the CA and SMA lymph node regions and examined what cases tend to have an overlap. We also investigated the dose metrics of CA and SMA lymph node regions by IFRT and the frequency of CA or SMA lymph node metastasis after IFRT. Results: The median GTV volume was 52.2 mL. Median overlap percentages in the CA and SMA lymph node regions were 39.2% and 28.6%, respectively. There was a significant correlation between GTV volume and SMA overlap percentage (P < .001). Although the SMA overlap percentage was higher in the pancreas head (P Z .028), the CA overlap percentage was higher in the pancreas body or tail (P Z .002). Median mean dose, D95, and minimum dose in the CA lymph node region were 50.1 Gy, 48.7 Gy, and 45.9 Gy, respectively, and those in the SMA lymph node region 49.9 Gy, 47.3 Gy, and 39.2 Gy, respectively. CA lymph node metastases after IFRT were detected in 4 patients (6.8%).

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CT diagnosis of recurrence after pancreatic cancer: Is there a pattern?

Abstract: Specific changes of local and lymph node recurrence can be found in the course of the cardinal peripancreatic vessels. The superior mesenteric artery is the leading structure for recurrence.

Cited by 51 publications

References 27 publications

Local radicality and survival outcome of pancreatic cancer surgery

Local radicality and survival outcome of pancreatic cancer surgery

Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery

How Much Was the Elective Lymph Node Region Covered in Involved-Field Radiation Therapy for Locally Advanced Pancreatic Cancer? Evaluation of Overlap Between Gross Target Volume and Celiac Artery–Superior Mesenteric Artery Lymph Node Regions

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