Laparoscopic staging and surgical treatment of pancreatic cancer

Muniraj, Thiruvengadam; Barve, Pranav

doi:10.4103/1947-2714.106183

Cited by 23 publications

(9 citation statements)

References 63 publications

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“…Vast majority of the patients with PDAC present at advanced stage of disease at the time of diagnosis and only 20% of patients are considered candidates for surgery. 1 Among patients with PDAC who underwent surgery with or without adjuvant therapy, the 5-year survival rate is approximately 15–20% and the median overall survival ranges from 11 to 23.6 months. 2–6 The high mortality in these patients results from a high propensity for early recurrence and metastasis, which has been reported in up to 80% of patients after surgery, and tumor resistance to conventional chemotherapeutic agents and radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Proposed Tumor Regression Grading Scheme for Pancreatic Ductal Adenocarcinoma After Neoadjuvant Therapy as a Prognostic Indicator for Survival

Lee¹,

Katz

Liu³

et al. 2016

American Journal of Surgical Pathology

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Neoadjuvant therapy has been increasingly used to treat patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC). Although the College of American Pathologists (CAP) grading scheme for tumor response in post-therapy specimens has been used, its clinical significance has not been validated. Previously, we proposed a three-tier histologic tumor regression grading (HTRG) scheme (HTRG 0, no viable tumor; HTRG 1, < 5% viable tumor cells; HTRG 2, ≥5 % viable tumor cells) and showed that the three-tier HTRG scheme correlated with prognosis. In this study, we sought to validate our proposed HTRG scheme in a new cohort of 167 consecutive PDAC patients who completed neoadjuvant therapy and pancreaticoduodenectomy. We found that patients with HTRG 0 or 1 were associated with a lower frequency of lymph node metastasis (p=0.004) and recurrence (p=0.01), lower ypT (p <0.001) and AJCC stage (p <0.001), longer disease free survival (DFS, p=0.004) and overall survival (OS, p=0.02) than those with HTRG 2. However, there was no difference in either DFS or OS between the groups with CAP grade 2 and those with CAP grade 3 (p >0.05). In multivariate analysis, HTRG grade 0 or 1 was an independent prognostic factor for better DFS (p =0.03), but not OS. Therefore we validated the proposed HTRG scheme from our previous study. The proposed HTRG scheme is simple and easy to apply in practice by pathologists and might be used as a successful surrogate for longer DFS in patients with potentially resectable PDAC who completed neoadjuvant therapy and surgery.

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Section: Introductionmentioning

confidence: 99%

Validation of a Proposed Tumor Regression Grading Scheme for Pancreatic Ductal Adenocarcinoma After Neoadjuvant Therapy as a Prognostic Indicator for Survival

Lee¹,

Katz

Liu³

et al. 2016

American Journal of Surgical Pathology

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“…Besides, we reviewed two articles that proposed to use laparoscopic surgery in combination with laparotomic surgery [37,38]. One article regarded the PC staging by using laparoscopy [39]. Below the results are shown.…”

Section: Resultsmentioning

confidence: 98%

“…At last we reviewed the efficacy of laparoscopy to stage the PC, as showed by Thiruvengadam's work [39], that demonstrates "Although computed tomography (CT) scan remains the best modality to stage the tumor for resectability, laparoscopy and laparoscopic ultrasound offers its own advantages".…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic pancreatectomy: Did the indications change? A review from literature

Sperlongano

Esposito

et al. 2015

International Journal of Surgery

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Pancreatic Cancer (PC) is the fourth cause of death for tumors in Western countries. Symptoms are not specific, and can vary according to the tumor size and place. Diagnostic workup includes CA 19-9, CT and MRI. Surgery is the only treatment for PC, associated to radio-chemo therapy. Laparoscopic approaches are actually used for PC treatment in few specialized centers, and could be an alternative to laparotomic surgery. The aim of our study is to evaluate the efficacy of laparoscopy for PC treatment compared to laparotomy. We reviewed 19 articles in literature to assess the feasibility and efficacy of Laparoscopic Distal Pancreatectomy (LDP) and Laparoscopic Pancreaticoduodenectomy (LPD). The results have shown that LDP is nowadays a safe technique, and the outcomes are comparable to laparotomic surgery. Regarding to LPD instead, results are controversial and the data are still not sufficient to consider this technique as a valid alternative to laparotomic surgery.

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“…Tumours that have not embraced the portal and superior mesenteric veins and not attacked the celiac or superior mesenteric artery roots are defined as unresectable. Also, local advancement and the presence of distant metastases are contraindications for this procedure [ 23 ]. Since the majority of tumours form in the head of the pancreas, pancreaticoduodenectomy (Whipple procedure) is a common strategy in pancreatic cancer treatment.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Adjuvant, neoadjuvant, and experimental regimens in overcoming pancreatic ductal adenocarcinoma

Wysocka

Kulbacka

Saczko

2016

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Pancreatic cancer is one of the most aggressive and deadly malignancies. Despite better understanding of its biology and pathogenesis, contemporary treatment regimens are still insufficient. Along with the introduction of new treatment agents and combination therapy, the response rates are increasing, but these scores do not go with overall survival, and results are frequently conflicting. Therefore, contemporary medicine faces the challenge of expanding the knowledge base and practice on all grounds – pathology, factor risk, diagnosis, and finally surgical and palliative treatment of this disease. This paper provides a review of current adjuvant and neoadjuvant regimens and the role of experimental therapies in pancreatic ductal adenocarcinoma.

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Laparoscopic staging and surgical treatment of pancreatic cancer

Cited by 23 publications

References 63 publications

Validation of a Proposed Tumor Regression Grading Scheme for Pancreatic Ductal Adenocarcinoma After Neoadjuvant Therapy as a Prognostic Indicator for Survival

Validation of a Proposed Tumor Regression Grading Scheme for Pancreatic Ductal Adenocarcinoma After Neoadjuvant Therapy as a Prognostic Indicator for Survival

Laparoscopic pancreatectomy: Did the indications change? A review from literature

Adjuvant, neoadjuvant, and experimental regimens in overcoming pancreatic ductal adenocarcinoma

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