Improved Long-Term Outcomes After Resection of Pancreatic Adenocarcinoma: A Comparison Between Two Time Periods

Serrano, Pablo E.; Cleary, Sean P.; Dhani, Neesha C.; Kim, Peter T. W.; Greig, Paul D.; Leung, Kenneth; Moulton, Carol‐Anne; Gallinger, Steven; Wei, Alice C.

doi:10.1245/s10434-014-4196-2

Cited by 54 publications

(47 citation statements)

References 34 publications

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“…As expected, the overall R0 resection rates reported in our review (70–77 %) are slightly lower, as reported by two recent studies (84–92 %) on borderline resectable disease 24,25. Surgical outcomes post-resection seem comparable with outcomes in upfront resectable patients, although still based on immature data 26–28…”

Section: Discussionsupporting

confidence: 83%

Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer

et al. 2016

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BackgroundFOLFIRINOX prolongs survival in patients with metastatic pancreatic cancer and may also benefit patients with locally advanced pancreatic cancer (LAPC). Furthermore, it may downstage a proportion of LAPC into (borderline) resectable disease, however data are lacking. This review assessed outcomes after FOLFIRINOX-based therapy in LAPC.MethodsThe PubMed, EMBASE and Cochrane library databases were systematically searched for studies published to 31 August 2015. Primary outcome was the (R0) resection rate.ResultsFourteen studies involving 365 patients with LAPC were included; three studies administered a modified FOLFIRINOX regimen. Of all patients, 57 % (n = 208) received radiotherapy. The pooled resection rate was 28 % (n = 103, 77 % R0), with a perioperative mortality of 3 % (n = 2), and median overall survival ranged from 8.9 to 25.0 months. Survival data after resection were scarce, with only one study reporting a median overall survival of 24.9 months in 28 patients. A complete pathologic response was found in 6 of 85 (7 %) resected specimens. Dose reductions were described in up to 65 % of patients, grade 3–4 toxicity occurred in 23 % (n = 51) of patients, and 2 % (n = 5) had to discontinue treatment. Data of patients treated solely with FOLFIRINOX, without additional radiotherapy, were available from 292 patients: resection rate was 12 % (n = 29, 70 % R0), with 15.7 months median overall survival and 19 % (n = 34) grade 3–4 toxicity.ConclusionsOutcomes after FOLFIRINOX-based therapy in patients with LAPC seem very promising but further prospective studies are needed, especially with regard to survival after resection.

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Section: Discussionsupporting

confidence: 83%

Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer

et al. 2016

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“…1 Surgical resection is the only curative treatment option for pancreatic cancer patients with a 5-year survival of 20–25 %. 2,3 While the mortality associated with pancreatic resection has dramatically decreased over the last several decades, morbidity remains a problem. 4–6 Specifically, up to 20–40 % of patients will experience some type of complication following pancreatic resection.…”

Section: Introductionmentioning

confidence: 99%

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Amini

Spolverato

Gupta

et al. 2015

Journal of Gastrointestinal Surgery

210

219

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Background While sarcopenia is typically defined using total psoas area (TPA), characterizing sarcopenia using only a single axial cross-sectional image may be inadequate. We sought to evaluate total psoas volume (TPV) as a new tool to define sarcopenia and compare patient outcomes relative to TPA and TPV. Method Sarcopenia was assessed in 763 patients who underwent pancreatectomy for pancreatic adenocarcinoma between 1996 and 2014. It was defined as the TPA and TPV in the lowest sex-specific quartile. The impact of sarcopenia defined by TPA and TPV on overall morbidity and mortality was assessed using multivariable analysis. Result Median TPA and TPV were both lower in women versus men (both P<0.001). TPA identified 192 (25.1 %) patients as sarcopenic, while TPV identified 152 patients (19.9 %). Three hundred sixty-nine (48.4 %) patients experienced a postoperative complication. While TPA-sarcopenia was not associated with higher risk of postoperative complications (OR 1.06; P=0.72), sarcopenia defined by TPV was associated with morbidity (OR 1.79; P=0.002). On multivariable analysis, TPV-sarcopenia remained independently associated with an increased risk of postoperative complications (OR 1.69; P=0.006), as well as long-term survival (HR 1.46; P=0.006). Conclusion The use of TPV to define sarcopenia was associated with both short- and long-term outcomes following resection of pancreatic cancer. Assessment of the entire volume of the psoas muscle (TPV) may be a better means to define sarcopenia rather than a single axial image.

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“…Those findings imply medical practice variation attributable to institution-specific practice patterns, both in terms of patients receiving adjuvant treatment compared with obs, and in terms of patients receiving ctx compared with crt. Indeed, a recent analysis of pcc treatment at a single Ontario institution noted the prevailing historical practice of not referring patients for adjuvant radiation, possibly relating to the publication of evidence supporting the role of ctx alone during the study period 5,22,24,25 . Such referral patterns and institutional biases might partly underlie the observed geographic variation in rates and types of adjuvant treatment administered.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Adjuvant Treatment for Pancreatic Adenocarcinoma at the Population Level

et al. 2016

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Improved Long-Term Outcomes After Resection of Pancreatic Adenocarcinoma: A Comparison Between Two Time Periods

Cited by 54 publications

References 34 publications

Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer

Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Predictors of Adjuvant Treatment for Pancreatic Adenocarcinoma at the Population Level

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