Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trial

Abstract

BackgroundOne critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer.MethodsPretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared.ResultsOne hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P < 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p < 0.05).ConclusionExcellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors.Trial registrationEudraCT:2009-014476-21 (2013-02-22) and NCT01827553 (2013-04-09).

Current Status of Circulating Tumor DNA Liquid Biopsy in Pancreatic Cancer

“…The decision to pursue or forgo surgical resection and curative intent therapy is a critical branch point in all treatment algorithms. Multidisciplinary tumor boards stratify patients into surgically resectable, borderline resectable, or unresectable subgroups based on the presence of distal disease and/or local tumor advancement [ 14 ]. Following treatment with either neoadjuvant chemotherapy, upfront surgery, or palliative intent systemic therapy, patients undergo serial evaluation with imaging and CA 19-9 analysis for surveillance in a curative setting or to ascertain response to therapies in a palliative setting [ 8 , 15 , 16 , 17 ].…”

Association between non-traumatic vertebral fractures and adjacent discs degeneration: a cross-sectional study and literature review

“…The post hoc test was performed to assess the probability values for each combination of independent category levels by using a Bonferroni correction to control for type I error in ation [16,17]. Signi cance was determined by Chi-square test with post-hoc analysis by cellwise adjusted residual analysis in two-way contingency tables according to Garcia-Perez [16][17][18]. Post-hoc testing was performed with adjusted standardized residual analysis with an eight-fold…”

Von der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie konsentierte Operationsindikationen beim duktalen Pankreasadenokarzinom

“…Gefäßinfiltration sowie der Ausschluss von Fernmetastasen immer noch problematisch. Das tatsächliche Ausmaß der Erkrankung wird auch heutzutage in bis zu 30 % der Fälle präoperativ falsch eingeschätzt [13]. Dies bedeutet, dass die präoperativ gestellte Indikation zu einer Pankreaskopfresektion sich intraoperativ rasch zu einer kompletten Pankreatektomie oder zu einer Doppelbypassoperation ändern kann.…”

“…[11,12]. Deswegen ist es äußerst wichtig, dass die Beurteilung des Lokalbefundes bei Borderline-und irresektablen Tumoren sowie bei Prüfung einer möglichen sekundärer Resektabilität möglichst immer durch einen erfahrenen Pankreaschirurgen am Pankreaszentrum erfolgt [13]. Die biologische Definition eines BR-PDAC (Borderline Resectable Pancreatic Ductal Adenocarcinoma) basiert auf dem dringenden, aber nicht bewiesenen Verdacht auf extrapankreatische Metastasen.…”