Clinical usefulness of conversion surgery for unresectable pancreatic cancer diagnosed on multidetector computed tomography imaging: Results from a multicenter observational cohort study by the Hokkaido Pancreatic Cancer Study Group (HOPS UR‐01)

Abstract

Background and Aim Effective multidisciplinary approaches for unresectable pancreatic cancer (UR‐PC) that include modern chemotherapeutic regimens and subsequent conversion surgery (CS) are being developed. The aim of this study was to evaluate outcomes of patients clinically diagnosed with UR‐PC, focusing on the efficacy of CS. Methods Patients ineligible for two multicenter phase II studies conducted by the Hokkaido Pancreatic Cancer Study Group (HOPS) were recruited. Sequential treatment regimens, conversion to radical surgery, and overall survival (OS) were analyzed by multidetector computed tomography (MDCT)‐based UR factors. Univariate and multivariate analyses were performed to identify predictors of OS. Results Sixty‐six of 247 intended recruits for HOPS studies from October 2013 to April 2016 were included. Unresectability was due to locally advanced (LA) disease and metastasis (M) in 42 and 24 patients, respectively. Induction therapy began with chemotherapy (CT) and chemoradiotherapy (CRT) in 44 and 17 patients, respectively, of whom 23 received modern CT regimens. Radical surgery was completed in 12 (LA, 10; M, two) with a median treatment interval of 10.3 months (range, 2‐32). Eleven patients (91.6%) achieved pathological R0 resection. Median OS was significantly longer in patients who underwent CS than those who did not (44.1 vs 14.5 months, P < 0.0001). CS was an independent predictor of OS (hazard ratio, 0.078; 95% confident interval, 0.017‐0.348; P = 0.001). Conclusion Conversion surgery after a favorable response to sequential treatment might prolong survival in patients with UR‐PC. Precise diagnosis on MDCT followed by sequential multimodal anticancer treatment is essential.

Clinical Benefits of Conversion Surgery for Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Institution, Retrospective Analysis

“…The reports on conversion surgery for locally advanced pancreatic cancer have been increasing since the 2010s [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. According to the recent NCCN guidelines (version 1.2021) [ 4 ], surgical resection of locally advanced cancer is a subsequent therapy option for patients with good performance status and no disease progression after first-line therapy.…”

“…This surgical strategy is called “conversion surgery”. Therefore, several reports about conversion surgery have been published in selected patients with initially UR-PDAC, and the prognostic effect of conversion surgery has been reported [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. However, it is unclear whether conversion surgery with a high treatment effect is truly advantageous in patients with UR-PDAC.…”

Clinical Benefits of Conversion Surgery for Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Institution, Retrospective Analysis

“…This surgical strategy is called "conversion surgery". Therefore, several reports about conversion surgery have been published in selected patients with initially UR-PDAC, and the prognostic effect of conversion surgery has been reported [12][13][14][15][16][17][18][19][20][21][22].…”

Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery

“…Although the prognosis of patients who are initially diagnosed with unresectable LAPC remains to be poor, there are some cases of LAPC that have been successfully treated with conversion surgery after systemic chemotherapy or chemoradiotherapy, resulting in long-term survival [ 11 – 13 ].…”