Pancreatic Adenocarcinoma: Complete Tumor Extirpation Improves Survival Benefit Despite Larger Tumors for Patients Who Undergo Distal Pancreatectomy and Splenectomy

Toomey, Paul; Hernandez, Jonathan M.; Golkar, Farhaad C.; Ross, Sharona; Luberice, Kenneth; Rosemurgy, Alexander S.

doi:10.1007/s11605-011-1765-6

Cited by 25 publications

(22 citation statements)

References 19 publications

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“…Complete tumor resection for pancreatic cancer is the only hope for cure and has been shown to significantly improve survival [4][5][6][7][8]. Even still, patients who undergo pancreatic resection for pancreatic adenocarcinoma portend a 5-year survival of only about 20% [9,10].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Neoadjuvant Therapy Compared to the “Resection First” Approach for Patients with Borderline Resectable Pancreatic Adenocarcinoma

Toomey¹,

Ross²,

Shah³

et al. 2014

JCT

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Background: Survival for patients with pancreatic adenocarcinoma continues to be poor. Patients with pancreatic adenocarcinoma that is deemed borderline resectable have imaging that shows disease involvement of the portal vein and/or superior mesenteric vein that is amenable to reconstruction or abutment (≤180 degrees) of the superior mesenteric artery. The best initial treatment for patients with borderline resectable pancreatic adenocarcinoma has yet to be determined. Proponents of neoadjuvant therapy purport its utility for patients with borderline resectable pancreatic adenocarcinoma with the intention of increasing the likelihood of a microscopically negative (R0) margin, but the consequences of this approach are not established. This study was undertaken to systematically review the outcomes for patients with borderline resectable pancreatic adenocarcinoma to compare neoadjuvant therapy to a "resection first" approach. Methods: A MEDLINE/PubMed search was undertaken to find all studies regarding patients who underwent neoadjuvant therapy for patients with borderline resectable pancreatic adenocarcinoma. Results: A total of 112 studies were found regarding borderline resectable pancreatic cancer. Fourteen studies contained cohorts of patients with borderline resectable pancreatic adenocarcinoma who received neoadjuvant therapy (n = 471 patients) or a resection-first approach (n = 76 patients). Resection after neoadjuvant therapy was undertaken for 233 (49%) patients. Neoadjuvant therapy followed by an R0 resection occurred for 42% of patients. For patients who underwent resection first, 71% (54/76) had an R0 margin. Conclusion: Patients with borderline resectable pancreatic adenocarcinoma were more often found to undergo neoadjuvant therapy than a "resection first" approach in the available literature. Although neoadjuvant therapy portends a high rate of R0 resections, less than half of the patients who undergo neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma undergo resection. Patients who undergo "resection first" for borderline resectable pancreatic adenocarcinoma have an increased chance for a resection and an R0 margin compared to patients who undergo neoadjuvant therapy for borderline pancreatic adenocarcinoma.

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Section: Introductionmentioning

confidence: 99%

A Systematic Review of Neoadjuvant Therapy Compared to the “Resection First” Approach for Patients with Borderline Resectable Pancreatic Adenocarcinoma

Toomey¹,

Ross²,

Shah³

et al. 2014

JCT

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“…El diagnóstico precoz permite la posibilidad de obtener una resección completa con márgenes negativos (R0) lo que mejora el pronóstico de los pacientes 3 . La resección completa de los tumores pancreáticos mejora significativamente la sobrevivencia de los pacientes sin importar la localización del tumor en el páncreas [1][2][3] . La resección agresiva de los tumores del cuerpo y cola ha mejorado la sobrevivencia a largo plazo de los pacientes y se recomienda su intento debido a que se estima que es posible en 75% o más de los casos 2 .…”

Section: Discussionunclassified

“…El cáncer de páncreas es más común en pacientes ancianos y sólo entre 10% y 20% de los pacientes se presentan con tumores localizados y potencialmente curables 1,3 . La resección de los tumores localizados en la cabeza del páncreas es posible en 20% a 43% de los casos; en los tumores del cuerpo y cola la posibilidad de resección varía entre 10% y 22%, debido a que la ausencia de síntomas en las etapas tempranas de la enfermedad habitualmente lleva a la presentación tardía cuando los órganos vecinos y las estructuras vasculares se encuentran invadidos por el tumor [2][3][4] . La mayoría de las neoplasias pancreáticas se desarrollan en la cabeza del páncreas, los tumores que se desarrollan en el cuerpo y cola son menos frecuentes con una incidencia de 30% de todas las neoplasias pancreáticas 1,2 .…”

Section: Introductionunclassified

Manejo Quirúrgico Simultáneo De Una Paciente Con Cáncer De Páncreas Distal, Tumores Del Estroma Gastrointestinal (Gist) Gástricos Y Hemangioma Hepático

Valenzuela

Rodrı́guez

et al. 2014

Rev Chil Cir

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Simultaneous surgical management of a patient with distal pancreatic cancer, gastric gastrointestinal tumors (GIST) and hepatic hemangiomaIntroduction: The occurrence of gastric Gastrointestinal Stromal Tumors (GIST) associated to pancreatic adenocarcinoma has been reported in 0.2% pancreatic cancers. There are no published reports on distal pancreatic adenocarcinoma associated to gastric antral GIST and the surgical management of this clinical condition. Case report: Herein, we discuss a 75 years-old female patient who was admitted to our institution with upper digestive hemorrhage. The endoscopy showed large, superficial erosions over the cardia and on the posterior wall of the antrum a rounded sub-mucosal non-eroded lesion suspected of gastric GIST. An abdominal computed tomography scan found a hepatic hemangioma on the left hepatic lobe. In the pancreatic distal body and tail a solid exophytic lesion was identified. In the gastric antrum a rounded submucosal tumor in close contact with the pancreatic lesion was found. The patient was subjected to distal pancreatectomy, splenectomy, and distal gastrectomy. The biopsy identified a well-differentiated ductal adenocarcinoma localized in the pancreatic tail and the proximal part of the body, resected with negative margins. The gastric tumor was positive for CD117, CD34, and DOG-1; it had a positive Ki67 in less than 2%, and 2 or less mitoses per 50 high-power fields. Conclusion. This uncommon case illustrates the occurrence of synchronous tumors of different cellular origins incidentally diagnosed and their simultaneous surgical treatment. The individual incidence of these tumors is low and if associated they probably will continue to be found incidentally. ResumenIntroducción: La ocurrencia simultánea de tumores del estroma gastrointestinal (GIST) del estómago con cáncer de páncreas, ha sido reportada en 0,2%. No existen reportes publicados sobre cáncer de páncreas

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“…122-126 Patients who undergo pancreatic resection for pancreatic adenocarcinoma portend a 5-year survival rate of up to 20%. 127,128 Treatment with chemotherapy, including gemcitabine and FOLFIRINOX (5-FU, leucovorin, irinotecan, oxaliplatin), results in a median OS of 6.8 months and 11.1 months, respectively, for patients with unresectable pancreatic cancer. 129 …”

Section: Immunotherapeutic Approaches To Gi Malignanciesmentioning

confidence: 99%

Immunotherapy for Gastrointestinal Malignancies

et al. 2013

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Background Gastrointestinal (GI) cancers are the most common human tumors encountered worldwide. The majority of GI cancers are unresectable at the time of diagnosis, and in the subset of patients undergoing resection, few are cured. There is only a modest improvement in survival with the addition of modalities such as chemotherapy and radiation therapy. Due to an increasing global cancer burden, it is imperative to integrate alternative strategies to improve outcomes. It is well known that cancers possess diverse strategies to evade immune detection and destruction. This has led to the incorporation of various immunotherapeutic strategies, which enable reprogramming of the immune system to allow effective recognition and killing of GI tumors. Methods A review was conducted of the results of published clinical trials employing immunotherapy for esophageal, gastroesophageal, gastric, hepatocellular, pancreatic, and colorectal cancers. Results Monoclonal antibody therapy has come to the forefront in the past decade for the treatment of colorectal cancer. Immunotherapeutic successes in solid cancers such as melanoma and prostate cancer have led to the active investigation of immunotherapy for GI malignancies, with some promising results. Conclusions To date, monoclonal antibody therapy is the only immunotherapy approved by the US Food and Drug Administration for GI cancers. Initial trials validating new immunotherapeutic approaches, including vaccination-based and adoptive cell therapy strategies, for GI malignancies have demonstrated safety and the induction of antitumor immune responses. Therefore, immunotherapy is at the forefront of neoadjuvant as well as adjuvant therapies for the treatment and eradication of GI malignancies.

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Pancreatic Adenocarcinoma: Complete Tumor Extirpation Improves Survival Benefit Despite Larger Tumors for Patients Who Undergo Distal Pancreatectomy and Splenectomy

Cited by 25 publications

References 19 publications

A Systematic Review of Neoadjuvant Therapy Compared to the “Resection First” Approach for Patients with Borderline Resectable Pancreatic Adenocarcinoma

A Systematic Review of Neoadjuvant Therapy Compared to the “Resection First” Approach for Patients with Borderline Resectable Pancreatic Adenocarcinoma

Manejo Quirúrgico Simultáneo De Una Paciente Con Cáncer De Páncreas Distal, Tumores Del Estroma Gastrointestinal (Gist) Gástricos Y Hemangioma Hepático

Immunotherapy for Gastrointestinal Malignancies

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