Neoadjuvant therapy and major arterial resection for potentially reconstructable arterial involvement by stage 3 adenocarcinoma of the pancreas

Loveday, Benjamin; Zilbert, Nathan; Serrano, Pablo E.; Tomiyama, Koji; Tremblay, A.S.; Fox, Adrian; Segedi, Maja; O’Malley, Martin; Borgida, Ayelet; Bianco, Teresa; Creighton, Sean; Dodd, Anna; Fraser, Adriana; Moore, Malcolm J.; Kim, John; Cleary, Sean P.; Moulton, Carol-Anne; Greig, Paul D.; Wei, Alice C.; Gallinger, Steven; Dhani, Neesha C.; McGilvray, Ian D.

doi:10.1016/j.hpb.2018.10.004

Cited by 21 publications

(14 citation statements)

References 25 publications

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“…For many years, the high morbidity and mortality [7,9,10] and the uncertain survival advantage of P-Ar [6,9] have discouraged surgeons from undertaking such major procedures. More recently, several groups have reported encouraging results [8,9,12,[34][35][36][37], the AJCC has removed the status "unresectable" from the definition of T4 [38], and NCCN guidelines included resection among the treatment options for LAPC following neoadjuvant treatments [39]. The growing interest in P-Ar is also shown by the description of newer approaches to deal with LAPC, such as arterial divestment following primary chemotherapy [40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

et al. 2020

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Pancreatectomy with arterial resection is a treatment option in selected patients with locally advanced pancreatic cancer. This study aimed to identify factors predicting cancer-specific survival in this patient population. A single-Institution prospective database was used. Pre-operative prognostic factors were identified and used to develop a prognostic score. Matching with pathologic parameters was used for internal validation. In a patient population with a median Ca 19.9 level of 19.8 U/mL(IQR: 7.1–77), cancer-specific survival was predicted by: metabolic deterioration of diabetes (OR = 0.22, p = 0.0012), platelet count (OR = 1.00; p = 0.0013), serum level of Ca 15.3 (OR = 1.01, p = 0.0018) and Ca 125 (OR = 1.02, p = 0.00000137), neutrophils-to-lymphocytes ratio (OR = 1.16; p = 0.00015), lymphocytes-to-monocytes ratio (OR = 0.88; p = 0.00233), platelets-to-lymphocytes ratio (OR = 0.99; p = 0.00118), and FOLFIRINOX neoadjuvant chemotherapy (OR = 0.57; p = 0.00144). A prognostic score was developed and three risk groups were identified. Harrell’s C-Index was 0.74. Median cancer-specific survival was 16.0 months (IQR: 12.3–28.2) for the high-risk group, 24.7 months (IQR: 17.6–33.4) for the intermediate-risk group, and 39.0 months (IQR: 22.7–NA) for the low-risk group (p = 0.0003). Matching the three risk groups against pathology parameters, N2 rate was 61.9, 42.1, and 23.8% (p = 0.04), median value of lymph-node ratio was 0.07 (IQR: 0.05–0.14), 0.04 (IQR:0.02–0.07), and 0.03 (IQR: 0.01–0.04) (p = 0.008), and mean value of logarithm odds of positive nodes was − 1.07 ± 0.5, − 1.3 ± 0.4, and − 1.4 ± 0.4 (p = 0.03), in the high-risk, intermediate-risk, and low-risk groups, respectively. An online calculator is available at www.survivalcalculator-lapdac-arterialresection.org. The prognostic factors identified in this study predict cancer-specific survival in patients with locally advanced pancreatic cancer and low Ca 19.9 levels undergoing pancreatectomy with arterial resection.

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Section: Discussionmentioning

confidence: 99%

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

et al. 2020

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“…From the 31 studies, seven cohort studies with a total of 579 patients were included in the meta-analysis. In the risk of bias assessment, only the Loveday et al [25] study was classified as low risk (Table 3).…”

Section: Meta-analysismentioning

confidence: 99%

Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

Rebelo

Büdeyri

Heckler

et al. 2020

Langenbecks Arch Surg

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Objective Advances in multimodality treatment paralleled increasing numbers of complex pancreatic procedures with major vascular resections. The aim of this meta-analysis was to evaluate the current outcomes of arterial resection (AR) in pancreatic surgery. Methods A systematic literature search was carried out from January 2011 until January 2020. MOOSE guidelines were followed. Predefined outcomes were morbidity, pancreatic fistula, postoperative bleeding and delayed gastric emptying, reoperation rate, mortality, hospital stay, R0 resection rate, and lymph node positivity. Duration of surgery, blood loss, and survival were also analyzed. Results Eight hundred and forty-one AR patients were identified in a cohort of 7111 patients. Morbidity and mortality rates in these patients were 66.8% and 5.3%, respectively. Seven studies (579 AR patients) were included in the meta-analysis. Overall morbidity (48% vs 39%, p = 0.1) and mortality (3.2% vs 1.5%, p = 0.27) were not significantly different in the groups with or without AR. R0 was less frequent in the AR group, both in patients without (69% vs 89%, p < 0.001) and with neoadjuvant treatment (50% vs 86%, p < 0.001). Weighted median survival was shorter in the AR group (18.6 vs 32 months, range 14.8–43.1 months, p = 0.037). Conclusions Arterial resections increase the complexity of pancreatic surgery, as demonstrated by relevant morbidity and mortality rates. Careful patient selection and multidisciplinary planning remain important.

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“…Arterial resection for pancreatic resection remains controversial but is being performed with success in highly selected patients. 20,21 Since involvement of major visceral arteries is often a key determinant of resectability, early dissection along the arteries has become an important principle that may be associated with improved perioperative outcomes. 22 Distal pancreatectomy for pancreatic cancer mandates splenectomy in order to achieve the required lymphadenectomy, and appropriate vaccinations should be administered preoperatively.…”

Section: Surgerymentioning

confidence: 99%

Pancreatic cancer: An update on diagnosis and management

Loveday¹,

Lipton

Thomson³

2019

Aust J Gen Pract

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Neoadjuvant therapy and major arterial resection for potentially reconstructable arterial involvement by stage 3 adenocarcinoma of the pancreas

Cited by 21 publications

References 25 publications

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

Pancreatic cancer: An update on diagnosis and management

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