Conversion surgery only for highly selected patients with unresectable pancreatic cancer: a satisfactory outcome in exchange for a lower resection rate

Natsume, Seiji; Shimizu, Yasuhiro; Senda, Yoshiki; Hijioka, Susumu; Matsuo, Keitaro; Ito, Seiji; Kono, Koji; T, Abe; Hara, Kazuo

doi:10.1007/s00595-019-01776-y

Cited by 12 publications

(38 citation statements)

References 24 publications

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“…Four of five articles that identified predictors of resectability showed that decreased CA19‐9 level was a predictor . Eight of 11 articles identifying predictors of OS also showed decreased CA19‐9 level as a prognostic factor for OS . All three articles reporting prognostic factors for DFS showed that CA19‐9 response was a prognostic factor .…”

Section: Discussionmentioning

confidence: 96%

“…In the present review, the surgical indication for conversion surgery remains unclear, and it differed in each institution. One institution had strict criteria, as follows: tumor shrinkage to R/BR status, decreased levels of tumor marker, maintenance of performance status, and a long interval between initial treatment and surgical resection . Strict criteria may lead to lower resectability but longer OS as a result of patient selection.…”

Section: Discussionmentioning

confidence: 99%

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Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Satoi

Yamamoto

Yamaki

et al. 2019

Annals of Gastroent Surgery

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Aim of this review is to propose an acceptable surgical indication for conversion surgery in patients with initially unresectable (UR) pancreatic ductal adenocarcinoma (PDAC) by considering desirable outcomes, including resectability, overall survival (OS), and disease-free survival (DFS). A comprehensive literature search of PubMed was conducted through July 15, 2019. Eligible studies were those reporting on patients with UR-PDAC who underwent surgery. We excluded case reports with fewer than 10 patients, insufficient descriptions of survival data, and palliative surgery.When patients with UR-PDAC with no progression after chemo(radiation) therapy were offered surgical exploration, resectability and median survival time (MST) of those who underwent conversion surgery ranged from 20% to 69% (median, 52%) and from 19.5 to 33 months (median, 21.9 months), respectively. When conversion surgery was carried out in patients with expected margin-negative resection or with clinical response by Response Evaluation Criteria In Solid Tumors (RECIST), resectability and MST ranged from 18% to 27% (median, 20%) and from 21 to 35.3 months (median, 30 months), respectively. Among patients who underwent conversion surgery based on clinical response and decreased CA19-9 level after multimodal treatment, resectability and MST ranged from 2% to 24% (median, 4.1%) and from 24.1 to 64 months (median, 36 months), respectively. Decreased CA19-9 level was a predictor of resectability, OS and DFS by multivariate analysis. In conclusion, decision-making for conversion surgery based on clinical response and decreased CA19-9 level after multimodal treatment may be appropriate. With regard to desirable outcomes of OS and DFS, conversion surgery may provide improved survival for patients with initial UR-PDAC. K E Y W O R D Sconversion surgery, overall survival, resectability, surgical indication, unresectable pancreatic ductal adenocarcinoma | 7 SATOI eT Al.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Satoi

Yamamoto

Yamaki

et al. 2019

Annals of Gastroent Surgery

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“…Conversion surgery represents a new therapeutic strategy which may improve short- and long-term outcomes of patients with UR-PDAC. Several articles have reported the utility of CS in such patients, as well as the positive effects on prognosis [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. In the present study, the rate of CS among patients with UR-LA and UR-M was similar to that reported previously [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several articles have reported the utility of CS in such patients, as well as the positive effects on prognosis [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. In the present study, the rate of CS among patients with UR-LA and UR-M was similar to that reported previously [ 25 ]. We found the long-term prognosis; one-, three-, and five-year OS rates from initial treatment; and MST were significantly better among patients with long PR/SD who did not undergo CS, although there were no significant differences in survival with relation to UR-LA or UR-M.…”

Section: Discussionmentioning

confidence: 99%

Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma

Yanagimoto

Satoi

Yamamoto

et al. 2020

Cancers

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Background: Traditionally, the treatment options for unresectable locally advanced (UR-LA) and metastatic (UR-M) pancreatic ductal adenocarcinoma (PDAC) are palliative chemotherapy or chemoradiotherapy. The benefits of surgery for such patients remains unknown. The present study investigated clinical outcomes of patients undergoing conversion surgery (CS) after chemo(radiation)therapy for initially UR-PDAC. Methods: We recruited patients with UR-PDAC who underwent chemo(radiation)therapy for initially UR-PDAC between April 2006 and September 2017. We analyzed resectability of CS, predictive parameters for overall survival, and early recurrence (within six months). Results: A total of 468 patients (108 with UR-LA and 360 with UR-M PDAC) were enrolled in this study, of whom, 17 (15.7%) with UR-LA and 15 (4.2%) with UR-M underwent CS. The median survival time (MST) and five-year survival of patients who underwent CS was 37.2 months and 34%, respectively; significantly better than non-resected patients (nine months and 1%, respectively, p < 0.0001). MST did not differ according to UR-LA or UR-M (50.5 vs. 29.0 months, respectively, p = 0.53). Early recurrence after CS occurred in eight patients (18.8%). Lymph node metastasis, positive washing cytology, large tumor size (>35 mm), and lack of postoperative adjuvant chemotherapy were statistically significant predictive factors for early recurrence. Moreover, the site of pancreatic lesion and administration of postoperative adjuvant chemotherapy were statistically significant prognostic factors for overall survival in the patients undergoing CS. Conclusion: Conversion surgery offers benefits in terms of increase survival for initially UR-PDAC for patients who responded favorably to chemo(radiation)therapy when combined with postoperative adjuvant chemotherapy.

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“…The median resection rate was 28.6% (range, 8%-69%), the negative margin resection rate was 78.3% (range, 35%-100%), and the MST was 12-96 months for LA-PDAC. 26,29,37,[174][175][176][177][178][179][180][181][182][183][184][185][186][187][188][189][190][191][192][193] The median resection rate was 14.3% (range, 2%-43%), the margin-negative resection rate was 88% (range, 51%-91.3%), and the MST was 21.9-56 months, even in advanced PDAC with distant metastases. 34,[194][195][196][197][198] Accordingly, even in UR-LA and UR-M PDACs, good prognosis was feasible when resection was performed, and MST was equivalent to that of R-PDAC.…”

Section: Conversion Surgery For Initially Unresectable Pdacmentioning

confidence: 98%

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

Ishido

Hakamada

Kimura

et al. 2020

Annals of Gastroent Surgery

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Pancreatic ductal adenocarcinoma (PDAC) is highly malignant. While cancers in other organs have shown clear improvements in 5‐year survival, the 5‐year survival rate of pancreatic cancer is approximately 10%. Early relapse and metastasis are not uncommon, making it difficult to achieve an acceptable prognosis even after complete surgical resection of the pancreas. Studies have been performed on various treatments to improve the prognosis of PDAC, and multidisciplinary approaches including non‐surgical treatments have led to gradual improvement. In the present literature review, we have described the significance of anatomical and biological resectability criteria, the concept of R0 resection in surgical treatment, the feasibility of minimally invasive surgery, the remarkable development of perioperative chemotherapy, the effectiveness of conversion surgery for unresectable PDAC, and ongoing challenges in PDAC treatment. We also provide an essential update on these subjects by focusing on recent trends and topics.

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Conversion surgery only for highly selected patients with unresectable pancreatic cancer: a satisfactory outcome in exchange for a lower resection rate

Cited by 12 publications

References 24 publications

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

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