Pancreatic Adenocarcinoma, Version 2.2014

Abstract

The NCCN Guidelines for Pancreatic Adenocarcinoma discuss the diagnosis and management of adenocarcinomas of the exocrine pancreas and are intended to assist with clinical decision-making. These NCCN Guidelines Insights summarize major discussion points from the 2014 NCCN Pancreatic Adenocarcinoma Panel meeting. The panel discussion focused mainly on the management of borderline resectable and locally advanced disease. In particular, the panel discussed the definition of borderline resectable disease, role of neoadjuvant therapy in borderline disease, role of chemoradiation in locally advanced disease, and potential role of newer, more active chemotherapy regimens in both settings.

Oncologic and Perioperative Outcomes Following Selective Application of Laparoscopic Pancreaticoduodenectomy for Periampullary Malignancies

“…The primary criteria for proceeding directly to OPD was based upon National Comprehensive Cancer Network (NCCN) criteria 16 for borderline resectable disease: evidence of distortion, narrowing or occlusion of the superior mesenteric vein (SMV) or portal vein (PV), or abutment of the superior mesenteric artery (SMA) not exceeding 180 degrees of the circumference. The contraindications for LPD that were not related to the presence of a borderline resectable malignancy included morbid obesity as defined by a BMI ≥ 40, particularly unusual anatomy (i.e the duodenum and pancreatic head resided in the true pelvis), and previous surgery with prior operative notes that documented extensive adhesive disease (frozen abdomen).…”

Pancreatic cancer and SBRT: A new potential option?

“…They require non-surgical likelihood of attaining negative surgical margins. 5 Following staging by CT or MRI (and EUS/ERCP in some cases), liver function tests, and chest imaging, disease is classified as: (1) resectable; (2) borderline resectable (i.e., tumors that are involved with nearby structures so as to be neither clearly resectable nor clearly unresectable); (3) locally advanced unresectable (i.e., tumors that are involved with nearby structures to an extent that renders them unresectable despite the absence of evidence of metastatic disease); or (4) disseminated (i.e., distant metastases or metastases to lymph nodes beyond the field of resection). The distinction between borderline and locally advanced designations is based on the likelihood of attaining a margin negative (R0) resection; however, this may vary depending on surgical technique and institutional practices.…”

Extended Pancreatectomy: Does It Have a Role in the Contemporary Management of Pancreatic Adenocarcinoma?

“…For borderline resectable pancreatic cancer, there is an ongoing debate if these patients should undergo upfront resection in case of venous vessel involvement with a technical possibility for vascular reconstruction or if a neoadjuvant therapy should be indicated before resection [15,16] . The current ISGPS [12] and NCCN guidelines [13] do not support a neoadjuvant concept as there are no reliable studies available to date that show a superior outcome compared to upfront surgery. However, many centers perform this concept as a number of retrospective analyses suggest that the oncological outcome may be superior after pretreatment and consecutive resection, which provides the rationale for a large number of studies that are currently conducted and will contribute to this discussion in the near future [17][18][19] .…”

“…These consensus definitions are mainly based on the recommendations of the National Comprehensive Cancer Network (NCCN) [13] . In general, resectable pancreatic cancer is characterized by the absence of any vascular attachment (no distortion of the superior mesenteric vein or the portal vein and clearly preserved fat planes toward celiac trunk and the superior mesenteric artery in diagnostic imaging).…”