Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05)

Motoi, Fuyuhiko; Kosuge, Tomoo; Ueno, Hideki; Yamaue, Hiroki; Satoi, Sohei; Sho, Masayuki; Honda, Goro; Matsumoto, Ippei; Wada, Keita; Furuse, Junji; Matsuyama, Yutaka; Unno, Michiaki

doi:10.1093/jjco/hyy190

Cited by 368 publications

(239 citation statements)

References 14 publications

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“…After 85% of events needed, the interim analysis showed superior R0 resection rate (63 vs. 31%, p < 0.001) and superior DFS (10 vs. 8 months, p = 0.02) in the neoadjuvant group, but a difference in OS could not be demonstrated (17 vs. 14 months, HR = 0.74, p = 0.07). To allow for comparison with adjuvant trials, a subgroup analysis was performed of patients who received at least one cycle of adjuvant chemotherapy, showing a median (54). This study also showed superior survival following neoadjuvant treatment, with a median OS of 37 vs. 27 months (HR = 0.72, 95% CI: 0.55-0.94, p = 0.015).…”

Section: Published Neoadjuvant Trials-regimens Other Than Folfirinox mentioning

confidence: 95%

Neoadjuvant Treatment in Patients With Resectable and Borderline Resectable Pancreatic Cancer

et al. 2020

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Section: Published Neoadjuvant Trials-regimens Other Than Folfirinox mentioning

confidence: 95%

Neoadjuvant Treatment in Patients With Resectable and Borderline Resectable Pancreatic Cancer

et al. 2020

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“…Neoadjuvant chemoradiotherapy (NACRT) and chemotherapy (NAC) are accepted as new treatment strategies for borderline resectable (BR) PC due to improved margin negative resection rate and median overall survival 6 7 8 9 10 . Recently, neoadjuvant therapy is becoming a new trend even in resectable (R) PC 11 12 .…”

Section: Introductionmentioning

confidence: 99%

Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer

et al. 2020

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Background and study aims Self-expandable metallic stents (SEMS) are now widely used even for patients with borderline resectable (BR) pancreatic cancer (PC), as neoadjuvant therapy has become common. Therefore, we conducted this study to evaluate safety of SEMS placement in the population including BR PC and to explore risk factors for recurrent biliary obstruction (RBO), pancreatitis, and cholecystitis. Patients and methods We retrospectively investigated consecutive patients with PC who received initial SEMS between January 2015 and March 2019. We compared time to RBO (TRBO), causes of RBO, and stent-related adverse events (AEs) according to resectability status. Univariate and multivariate analyses were performed to explore risk factors for TRBO, pancreatitis, and cholecystitis. Results A total of 135 patients were included (BR 31 and unresectable [UR] 104). Stent-related AEs occurred in 39 patients: pancreatitis 14 (mild/moderate/severe 1/6/7), cholecystitis 12, and non-occluding cholangitis 13. TRBO, causes of RBO, and stent-related AEs were not significantly different according to resectability status. Overall rate of RBO was higher in UR PC due to the longer follow-up period. Sharp common bile duct (CBD) angulation was an independent risk factor for short duration of TRBO. High pancreatic volume index and SEMS of high axial force were independent risk factors for pancreatitis, whereas tumor involvement to orifice of cystic duct was the only risk factor for cholecystitis. Conclusions We demonstrated that SEMS can be safely deployed even in patients with BR PC. Sharp CBD angulation and high pancreatic volume index were identified as novel risk factors for RBO and pancreatitis, respectively, after SEMS placement.

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“…Although current guidelines recommend upfront resection for pancreatic cancers not meeting the criteria to be classified either "borderline resectable" or "locally advanced" 35 , neoadjuvant treatments may also be beneficial in patients with immediately resectable tumors 36,37 . No evidence is currently available on the impact of the new neoadjuvant treatments on both the feasibility and safety of minimally invasive pancreatic resections.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

Napoli

Kauffmann

Menonna

et al. 2020

JoVE

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This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the spleno-mesenteric junction, for cancer of the body-tail of the pancreas. The patient is placed supine with the legs parted and a pneumoperitoneum is established and maintained at 10 mmHg. To use the surgical system, four 8 mm ports and one 12 mm port are required. The optic port is placed at the umbilicus. The other ports are placed, on either side, along the pararectal line and the anterior axillary line at the level of the umbilical line. The assistant port (12 mm) is placed along the right pararectal line. Dissection begins by detaching the gastrocolic ligament, thus opening the lesser sac, and by a wide mobilization of the splenic flexure of the colon. The superior mesenteric vein is identified along the inferior border of the pancreas. Lymph node number 8a is removed to permit clear visualization of the common hepatic artery. A tunnel is then created behind the neck of the pancreas. To permit safe resection and reconstruction of the spleno-mesenteric junction, further preemptive dissection is required before dividing the pancreatic neck to bring in clear view all relevant vascular pedicles. Next, the splenic artery is ligated and divided, and the pancreatic neck is divided, with selective ligature of the pancreatic duct. After vein resection and reconstruction, dissection proceeds to complete the clearance of peripancreatic arteries that are peeled off from all lympho-neural tissues. Both celiac ganglia are removed en-bloc with the specimen. The Gerota fascia covering the upper pole of the left kidney is also removed en-bloc with the specimen. Division of short gastric vessels and splenectomy complete the procedure. A drain is left near the pancreatic stump. The round ligament of the liver is mobilized to protect the vessels. Video Link The video component of this article can be found at https://www.jove.com/video/60370/ 12 , the complexity of this procedure and the high rate of margin negative resection reported after robotic procedures 13 suggest that robotic assistance could be rewarding in this operation. We herein describe the technique for robotic assisted RAMPS, that was developed in a center with experience in thousands of robotic procedures and in over 350 robotic pancreatic resections. Protocol The procedure described herein was conducted in compliance with the guidelines set out by the Ethics Committee of Pisa University Hospital for robotic operations, including regulations on research activity.

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Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05)

Cited by 368 publications

References 14 publications

Neoadjuvant Treatment in Patients With Resectable and Borderline Resectable Pancreatic Cancer

Neoadjuvant Treatment in Patients With Resectable and Borderline Resectable Pancreatic Cancer

Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

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