Modified Appleby Procedure for Pancreatic Adenocarcinoma: Does Improved Neoadjuvant Therapy Warrant Such an Aggressive Approach?

Peters, Niek A.; Javed, Ammar A.; Cameron, John L.; Makary, Martin A.; Hirose, Kenzo; Pawlik, Timothy M.; He, Jin; Wolfgang, Christopher L.; Weiss, Matthew J.

doi:10.1245/s10434-016-5303-3

Cited by 55 publications

(42 citation statements)

References 41 publications

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“…Recent studies have underlined this approach in the context of the presently available efficient chemotherapy regimens . A US study matched seventeen patients undergoing DP‐CAR after neoadjuvant therapy, mostly performed by Folfirinox chemotherapy in a 3:1 ratio with 51 patients undergoing DP alone.…”

Section: Neoadjuvant Therapy In Borderline Resectable Pancreatic Cancermentioning

confidence: 99%

Surgery for Pancreatic Cancer after neoadjuvant treatment

Hackert

2018

Annals of Gastroent Surgery

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Pancreatic ductal adenocarcinoma (PDAC) remains to be a therapeutic challenge as only 15%‐20% of all patients present with resectable tumor stages by the time of diagnosis. In the remaining patients, either local tumor extension or systemic spread are obstacles for a surgical therapy as the only chance for long‐term survival. With regard to local tumor extension, PDAC has been classified as resectable, borderline‐resectable (BR) or locally advanced (LA). While there is currently no evidence for neoadjuvant therapy in resectable PDAC, this issue remains controversial in BR‐PDAC. In the case of venous tumor involvement, guidelines mostly recommend upfront resection, when technically possible; whereas arterial involvement is regarded as an indication for chemotherapy or chemoradiotherapy first. Furthermore, in locally advanced PDAC, neoadjuvant treatment approaches have recently resulted in high rates of secondary resection, thus allowing “conversion” surgery in an otherwise palliative treatment situation. The present review gives an overview on the current literature of treatment concepts in these situations and additionally focuses of evaluation of resectability after neoadjuvant therapy as well as technical aspects in this specific situation.

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Section: Neoadjuvant Therapy In Borderline Resectable Pancreatic Cancermentioning

confidence: 99%

Surgery for Pancreatic Cancer after neoadjuvant treatment

Hackert

2018

Annals of Gastroent Surgery

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“…Previous studies have shown that DP-CAR can be performed safely by experienced teams at high-volume pancreatic surgery centers. 8 , 14 , 18 , 35 Most importantly, DP-CAR offers a survival benefit to a selected group of patients with otherwise unresectable pancreatic cancer. 36 …”

Section: Discussionmentioning

confidence: 99%

Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer. How I do It

Klompmaker

Boggi

Hackert

et al. 2018

Journal of Gastrointestinal Surgery

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Approximately 30% of all pancreatic cancer patients have locally advanced (AJCC stage 3) disease. A sub-group of these patients—where the cancer only involves the celiac axis—may benefit from distal pancreatectomy with celiac axis resection (DP-CAR). Previous studies have shown that DP-CAR offers a survival benefit to a selected group of patients with otherwise unresectable pancreatic cancer, when performed by experienced pancreatic cancer treatment teams at high-volume centers. This article proposes a standardized approach to DP-CAR, including routine neoadjuvant (FOLFIRINOX) chemotherapy. This approach to selecting patients and performing DP-CAR has the potential to improve short-term outcomes and overall survival in selected patients, but it should be reserved for high-volume centers.

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“…Patients achieved a median survival of 35 months with a 79% rate of R0 resections . Another matched analysis of 17 patients undergoing a modified Appleby at Johns Hopkins Hospital shows a median survival of 20 months . A Japanese series comparing 16 patient with distal pancreatectomy and celiac artery resection to 27 patients with distal pancreatectomy alone demonstrated higher rates of R1 resection in the group with arterial resection, and ensuing shorter survival.…”

Section: Surgical Treatment Of Borderline and Locally Advanced Pancrementioning

confidence: 99%

Surgical strategies and novel therapies for locally advanced pancreatic cancer

Abou-Khalil

Rocha

2017

Journal of Surgical Oncology

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Many patients with pancreatic cancer are not candidates for surgical resection due to involvement of critical mesenteric vascular structures. We compare and contrast the commonly used classification systems for borderline resectable and locally advanced pancreatic cancer. We describe the current strategies in managing venous and arterial involvement, as well as the role of neoadjuvant chemotherapy and chemoradiation, before explanding on a novel clinical trial in this patient population.

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Modified Appleby Procedure for Pancreatic Adenocarcinoma: Does Improved Neoadjuvant Therapy Warrant Such an Aggressive Approach?

Abstract: In light of improved neoadjuvant therapeutic regimens, the modified Appleby procedure is a feasible and safe treatment option for patients with LAPC involving the CA, with morbidity and mortality similar to patients undergoing classic DP.

Cited by 55 publications

References 41 publications

Surgery for Pancreatic Cancer after neoadjuvant treatment

Surgery for Pancreatic Cancer after neoadjuvant treatment

Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer. How I do It

Surgical strategies and novel therapies for locally advanced pancreatic cancer

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