Surgery for Pancreatic Cancer after neoadjuvant treatment

Abstract

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.

An Efficient Photodynamic Therapy Treatment for Human Pancreatic Adenocarcinoma

“…Chemotherapy is offered when surgery is not possible. Statistically more than 60% of the patients are diagnosed at the metastatic stage, 25% at a locally advanced stage without metastasis, and 15% at a surgically respectable stage or after neoadjuvant radio-chemotherapy [8,9].…”

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

“…This has also been suggested by a retrospective Euro- pean multicenter study [15] and a recent analysis of the surveillance, epidemiology and end results (SEER) database in the United States, showing a potentially improved survival in a subset of patients with isolated liver and lung metastases [16]. Furthermore, successes reported for poly-chemotherapy combined with progressive surgery in locally advanced or borderline-resectable PC [1,[17][18][19] as well as adjuvant treatment [20,21] have once more inspired interdisciplinary discussions on the selection criteria and usefulness of curative-intent surgical resection for oligometastatic PC in the era of effective, modern chemotherapies [22]. However, no high-level evidence via prospective trials or meta-analyses has been generated on this topic to date, as studies are ongoing [23].…”

Neue Studiendaten zu Systemtherapien bei gastrointestinalen Tumoren

“…Auch bei Resektabilität (nur etwa 15-20% der Tumoren) besteht weiterhin ein hohes Risiko [4]. In einer japanischen Phase-II/III-Studie konnte nun gezeigt werden, dass sich das OS nach Pankreasresektion signifikant verbesserte bei einer zweizyk- 836 [0,489-1,428]).…”