Downstaging in Stage IV Pancreatic Cancer: A New Population Eligible for Surgery?

Frigerio, Isabella; Regi, Paolo; Giardino, Alessandro; Scopelliti, F.; Girelli, R.; Bassi, Claudio; Gobbo, Stefano; Martini, Paolo Tinazzi; Capelli, Paola; D’Onofrio, Mirko; Malleo, Giuseppe; Maggino, Laura; Viviani, Elena; Butturini, Giovanni

doi:10.1245/s10434-017-5885-4

Cited by 94 publications

(132 citation statements)

References 20 publications

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“…A common feature of both the Heidelberg study and the European registry is that only a minority of patients underwent neoadjuvant therapy before LM resection was performed. By contrast, three other reports showed much longer survival rates when all of the analyzed patients received neoadjuvant therapy prior to undergoing resection [42][43][44]. This observation is certainly explained by the selection effect of neoadjuvant treatment, which is exemplarily shown in the study by Crippa et al [42].…”

Section: K Main Topicmentioning

confidence: 83%

“…Although only 11 patients eventually underwent metastasectomy in this collective, survival was impressively high when multiagent chemotherapy was used, the number of resected metastases did not exceed five lesions, and CA 19-9 levels showed a reduction of >50% during neoadjuvant therapy. Interestingly, in one study from Verona, patients with hepatic metastases had exploration laparotomy after preoperative chemotherapy and underwent isolated primary tumor resection only in cases with complete intraoperatively vanished liver lesions, and therefore did never receive hepatectomy [43]. Still, the resulting median OS in these 24 patients was 13 months after pancreatic resection and 56 months after the initial diagnosis of metastases.…”

Section: K Main Topicmentioning

confidence: 99%

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Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

et al. 2019

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Background Pancreatic cancer (PC) remains a disease characterized by an extremely poor prognosis, which is often limited by advanced tumor stage at diagnosis. As surgery remains the only option for long-term survival, indications for resection to achieve a complete tumor removal have been extended in recent years, including locally advanced as well as metastatic disease. Methods Here, we provide a literature overview of modern multimodal treatment concepts of metastatic PC focused on surgery and local interventions including neoadjuvant concepts, stratification of patients, prognostic parameters, and oncological outcomes. Results The current literature lacks level I evidence studies on surgery in stage IV PC. The available observational studies show that resection for liver metastasis has been increasingly performed in recent years, outcomes improve after neoadjuvant therapy, and certain prognostic parameters can identify patients who benefit from this approach. In addition, interventional or radio-oncological liver-directed therapies have been evaluated showing the possibility of some disease control. Resection of pulmonary metastases is rarely performed, although this patient subgroup may have a more favorable prognosis than patients with Willem Niesen and Florian Primavesi contributed equally to the manuscript.

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Section: K Main Topicmentioning

confidence: 83%

Section: K Main Topicmentioning

confidence: 99%

Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

et al. 2019

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“…11 Increasing evidence has suggested that neoadjuvant chemotherapy may improve outcomes in pancreatic cancer. [15][16][17][18][19][20][21] To receive full doses of neoadjuvant chemotherapy, patients with obstructive jaundice may undergo preoperative ERCP. However, in this analysis, patients who did not receive a preoperative ERCP appeared more likely to receive neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14] More recent studies have suggested that patients may have improved outcomes with neoadjuvant therapy before resection. [15][16][17][18][19][20][21] Therefore, more pancreatic cancer patients may receive preoperative ERCP, particularly those with borderline resectable tumors.…”

mentioning

confidence: 99%

Preoperative Endoscopic Retrograde Cholangiopancreatography Is Not Associated With Increased Pancreatic Cancer Mortality

Rustgi¹,

Amin

Yang

et al. 2019

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS:Endoscopic retrograde cholangiopancreatography (ERCP) before surgery for pancreatic cancer has been associated with infectious complications after surgery. Little is known about the effects of preoperative ERCP on the survival of patients with pancreatic cancer. We investigated whether ERCP before surgery affects overall survival, after controlling for confounding factors. METHODS:We used Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims data to identify patients older than 65 years with cancer localized to the head of the pancreas, from 2000 through 2011. We used inverse propensity-weighted Cox proportional hazard models to assess the effects of ERCP on the survival of patients who underwent surgery for pancreatic cancer. RESULTS:Among 16,670 patients with cancer of the head of the pancreas, 2890 (17.3%) underwent surgical resection; 1864 (64.5%) of these patients received preoperative ERCP. After we adjusted for confounders, we found that patients who received preoperative ERCP did not have an increased risk of death compared with patients who underwent resection alone (hazard ratio, 1.02; 95% CI, 0.96-1.08). CONCLUSIONS:Patients with pancreatic cancer who underwent ERCP before surgery did not have an increased risk of death compared with patients who proceeded directly to surgery. Studies are needed to identify subsets of patients who may benefit from this procedure.

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“…It is rational to include our case clinical course within the PDAC phenotype identified by Frigerio et al, in which the complete response obtained on liver metastases to a first line cytoreduction, might predict a favorable clinical outcome with a median overall survival (OS) of 56 months for 24 out of 535 subjects (4,5%) bridged to surgery. The regimen employed was either FOLFIRINOX (66%) or gemcitabine-based therapy (34%) [15], leading to 88% of R0 resection and to 17% of patients gaining a complete pathological response. The mortality rate was 0%.…”

Section: Discussionmentioning

confidence: 99%

Complete Response of Synchronous Liver Metastasis in a Pancreatic Ductal Adenocarcinoma: Could Surgery Represent a Therapeutic Option?

Argentiero¹,

Brunetti²,

Calabrese³

et al. 2019

Preprint

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Metastatic pancreatic ductal adenocarcinoma pancreatic (PDAC) is characterized by poor prognosis and short survival. Today, the use of new polytherapeutic regimens increases clinical outcome of these patients opening new clinical scenario. A crucial issue related to the actual improvement achieved with these new regimens is represented by the occasional possibility to observe a radiological complete response of metastatic lesions in patients with synchronous primary tumor. What could be the best therapeutic management of these patients? Could surgery represent an indication? Herein we reported a case of a patient with a PDAC of the head with multiple liver metastasis, who underwent first line chemotherapy with mFOLFIRINOX. After 10 cycles, he achieved a complete radiological response of liver metastases and a partial response of pancreatic lesion. A, duodenocephalopancreasectomy was performed. Due to liver a lung metastases after 8 months from surgery, a second line therapy was started with a disease free survival and overall survival of 8 months and 45 months, respectively. Improvement in the molecular characterization of PDAC could help in the selection of patients suitable for multimodal treatments.

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Downstaging in Stage IV Pancreatic Cancer: A New Population Eligible for Surgery?

Abstract: Patients with mPDAC who were fully responsive to nCT may be cautiously considered for surgery, with potential benefit in survival compared with palliative chemotherapy alone. This is supported by results of our retrospective study, which is the largest ever reported.

Cited by 94 publications

References 20 publications

Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

Surgical and local therapeutic concepts of oligometastatic pancreatic cancer in the era of effective chemotherapy

Preoperative Endoscopic Retrograde Cholangiopancreatography Is Not Associated With Increased Pancreatic Cancer Mortality

Complete Response of Synchronous Liver Metastasis in a Pancreatic Ductal Adenocarcinoma: Could Surgery Represent a Therapeutic Option?

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