Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations

Huang, Lei; Jansen, Lina; Balavarca, Yesilda; Molina‐Montes, Esther; Babaei, Mohammad; Geest, L. van der; Lemmens, Valery; Eycken, Liesbet Van; Schutter, Harlinde De; Johannesen, Tom B.; Fristrup, Claus Wilki; Mortensen, Michael Bau; Primic-Žakelj, Maja; Zadnik, Vesna; Becker, Nikolaus; Hackert, Thilo; Mägi, Margit; Cassetti, Tiziana; Sassatelli, Romano; Grützmann, Robert; Merkel, Susanne; Gonçalves, Ana Filipa; Bento, Maria José; Hegyi, Péter; Lakatos, Gábor; Szentesi, Andrea; Moreau, Michel; Velde, Tony van de; Broeks, Annegien; Sant, Milena; Minicozzi, Pamela; Mazzaferro, Vincenzo; Real, Francisco X.; Carrato, Alfredo; Molero, Xavier; Besselink, Marc G.; Malats, Núria; Büchler, Markus W.; Schrotz‐King, Petra; Brenner, Hermann

doi:10.1136/gutjnl-2017-314828

Cited by 177 publications

(139 citation statements)

References 47 publications

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“…The resection rate in our study was 17.2%, which is comparable to the rate in the Netherlands (17.9%) and higher than that in Norway (13%) [23]. The overall resection rate of PC in Denmark increased from 12.0%-17.6% from 2011-2012 to 2013-2014 [23]. Four centers in Denmark perform PC resections, with an annual volume of 13-82 patients.…”

Section: Discussionsupporting

confidence: 63%

“…In this nationwide, population-based study, 623 patients underwent curative intent resection for ductal adenocarcinoma of the pancreas between 2011 and 2016. The resection rate in our study was 17.2%, which is comparable to the rate in the Netherlands (17.9%) and higher than that in Norway (13%) [23]. The overall resection rate of PC in Denmark increased from 12.0%-17.6% from 2011-2012 to 2013-2014 [23].…”

Section: Discussionsupporting

confidence: 59%

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The effect of postoperative gemcitabine on overall survival in patients with resected pancreatic cancer: A nationwide population-based Danish register study

Rasmussen¹,

Ladekarl²,

Pfeiffer

et al. 2019

Acta Oncologica

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Background: Adjuvant chemotherapy following curative resection is the standard treatment for pancreatic adenocarcinoma (PC). Randomized clinical trials using gemcitabine have shown a median overall survival (mOS) of 2 years and a 5-year survival rate of 15-20%. However, the effect of gemcitabine outside these trials is less clear. We examined the effect of postoperative gemcitabine on survival in an unselected cohort of patients receiving curative resection for PC in Denmark during a five-year period. Material and methods: From 1 May 2011 to 30 April 2016, 731 patients treated with curative resection were identified in the Danish Pancreatic Cancer Database (DPCD). Thirty patients died within 10 weeks postoperatively; 78 received other regimens or preoperative chemotherapy and were excluded. Of the remaining 623 patients, the chemotherapy (CT) group (n ¼ 409, 66%) received gemcitabine within 10 weeks after resection, whereas the non-chemotherapy (NCT) group (n ¼ 214, 34%) did not receive CT within 10 weeks. Results: CT patients were slightly younger than NCT patients but did not otherwise differ in baseline characteristics. The CT group showed a mOS of 24 months (95% CI; 21-27) and a 5-year survival rate of 22% (95% CI; 17-27); the NCT group had a mOS of 22 months (95% CI; 16-26, p ¼ .27) and a 5-year survival rate of 26% (95% CI; 19-34, p ¼ .66). Most patients (415/623) had lymph node metastases. Of these patients, those in the CT group (n ¼ 280) had significantly longer mOS [20 months (95% CI; 18-24)] than those in the NCT group (n ¼ 135) [14 months (95% CI; 11-17)]. Conclusions: In this national Danish cohort of PC patients undergoing resection between 2011 and 2016, the survival after postoperative gemcitabine was similar to that reported in previous clinical trials. However, the survival advantage of postoperative gemcitabine was limited to patients with lymph node metastases.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionsupporting

confidence: 59%

The effect of postoperative gemcitabine on overall survival in patients with resected pancreatic cancer: A nationwide population-based Danish register study

Rasmussen¹,

Ladekarl²,

Pfeiffer

et al. 2019

Acta Oncologica

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“…Although the TNM staging system is not directly translatable to widely used resectability criteria, 5 the low resection rate in this study, compared with that previously reported, 20 is noteworthy and could be explained by the inclusion of patients C 70 years of age. In addition, some patients may have anatomically resectable disease, yet have unfavorable biological (high CA19.9) and conditional (poor functional status) factors.…”

Section: Discussioncontrasting

confidence: 57%

Treatment and Survival of Elderly Patients with Stage I–II Pancreatic Cancer: A Report of the EURECCA Pancreas Consortium

Groen

Douwes

Eycken³

et al. 2020

Ann Surg Oncol

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Background. Elderly patients with pancreatic cancer are underrepresented in clinical trials, resulting in a lack of evidence. Objective. The aim of this study was to compare treatment and overall survival (OS) of patients aged C 70 years with stage I-II pancreatic cancer in the EURECCA Pancreas Consortium.Methods. This was an observational cohort study of the Belgian (BE), Dutch (NL), and Norwegian (NOR) cancer registries. The primary outcome was OS, while secondary outcomes were resection, 90-day mortality after resection, and (neo)adjuvant and palliative chemotherapy.Previous communication This work was presented as a 'poster in the spotlight' at the 39th

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“…Approximately 50% of patients with PDAC are classified as having clinically localized disease, with locally advanced disease diagnosed in about 35% [8]. Therefore, those classified as having resectable disease account for fewer than 20% of patients with newly diagnosed PDAC [9]. When PDAC is suspected based on blood pancreatic enzyme levels, tumor markers, and ultrasonography, contrast-enhanced multidetector row computed tomography (MDCT) is useful for defining the diagnosis and resectability because of its excellent resolution, widespread availability, and cost.…”

Section: Definition Of R/br and Diagnostic Modalitiesmentioning

confidence: 99%

The past, present, and future status of multimodality treatment for resectable/borderline resectable pancreatic ductal adenocarcinoma

et al. 2020

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A multimodal approach to treating pancreatic ductal adenocarcinoma (PDAC) is now widely accepted. Improvements in radiological assessment have enabled us to define resectability in detail. Multimodality treatment is essential for patients, especially for those with PDAC in the borderline resectable (BR) stage. Even for disease in a resectable (R) stage, adjuvant and neoadjuvant therapies have demonstrated beneficial outcomes in several trials and analyses. Thus, there is growing interest in optimization of the perioperative therapeutic strategy. We discuss the transition of resectability criteria and the global standard of adjuvant and neoadjuvant treatments for patients with R/BR-PDAC.

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Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations

Abstract: Rates of PaC resection remain low in Europe and USA with great international variations. Further studies are warranted to explore reasons for these variations.

Cited by 177 publications

References 47 publications

The effect of postoperative gemcitabine on overall survival in patients with resected pancreatic cancer: A nationwide population-based Danish register study

The effect of postoperative gemcitabine on overall survival in patients with resected pancreatic cancer: A nationwide population-based Danish register study

Treatment and Survival of Elderly Patients with Stage I–II Pancreatic Cancer: A Report of the EURECCA Pancreas Consortium

The past, present, and future status of multimodality treatment for resectable/borderline resectable pancreatic ductal adenocarcinoma

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