Surgical treatment of pancreatic adenocarcinoma

Kuhlmann, Koert F. D.; Castro, S. M. M. de; Wesseling, John G.; Kate, Fiebo J.W. ten; Offerhaus, G.J.A.; Busch, Olivier R.; Gulik, Thomas M. van; Obertop, H.; Gouma, Dirk J.

doi:10.1016/j.ejca.2003.10.026

Cited by 259 publications

(58 citation statements)

References 31 publications

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“…Lymph node (LN) metastasis has been indicated as a major prognostic factor in resectable pancreatic cancer [1,2,3,4,5,6,7]. In previous investigations, vascular endothelial growth factor (VEGF)-C [8, 9] and VEGF-D [9] expression in pancreatic cancer cells was associated with LN metastasis.…”

Section: Introductionmentioning

confidence: 99%

Chemokine Receptor CCR7 Expression Correlates with Lymph Node Metastasis in Pancreatic Cancer

Nakata

Fukunaga²,

Noda³

et al. 2008

Oncology

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Aims: The clinical significance of chemokine receptor CCR7 expression in pancreatic ductal cancer was investigated. Methods: Immunohistochemical staining of 89 pancreatic cancers treated macroscopically with curative resection without hematogenous metastases or peritoneal dissemination were analyzed in association with clinicopathological data. Results: The positivity of CCR7 in pancreatic cancer was 32.6% (29/89). A significant correlation was detected between CCR7-positive expression and lymph node metastasis. Patients with CCR7-positive tumors had significantly shorter survival times than those with CCR7-negative tumors (median, 12.8 vs. 21.9 months, respectively; p = 0.0039). CCR7 expression was an independent prognostic factor (hazard ratio, 1.949; p = 0.0364) by multivariate survival analysis; however, it was not an indicator for any particular site of recurrence. Conclusion: The survival impact of CCR7 expression on resectable pancreatic cancer may be associated with lymphatic spread. The results from the present study should foster further investigation of treatments using an inhibitor for the CCR7 protein to improve the survival of pancreatic cancer.

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Section: Introductionmentioning

confidence: 99%

Chemokine Receptor CCR7 Expression Correlates with Lymph Node Metastasis in Pancreatic Cancer

Nakata

Fukunaga²,

Noda³

et al. 2008

Oncology

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“…All patients were operated on by the same surgical staff during the 12-year study period. These patients have been described previously in a different paper in which the prognostic factors associated with pancreatic adenocarcinoma were analyzed [2]. …”

Section: Methodsmentioning

confidence: 99%

“…Unfortunately only 20% of the patients undergo exploratory laparotomy after diagnostic workup [2]. Of these patients another 30% will not undergo resection because of unresectable disease (local ingrowth or distant metastases) found during exploratory laparotomy.…”

Section: Introductionmentioning

confidence: 99%

POSSUM Predicts Survival in Patients with Unresectable Pancreatic Cancer

Castro¹,

Houwert²,

Lagard³

et al. 2009

Dig Surg

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Background: The aim of this study was to evaluate the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) for patients with unresectable pancreatic cancer and to analyze whether POSSUM can predict the long-term outcome in these patients. Such a scoring system could be useful to aid in the decision between surgical and endoscopic palliation. Methods: Between January 1993 and December 2004, 241 patients were found to have unresectable pancreatic cancer during exploratory laparotomy and underwent a double bypass procedure consisting of a gastrojejunostomy and a hepaticojejunostomy. Results: Overall, 64 of 240 patients (27%) had one or more complications after bypass surgery and 4 patients (2%) died. POSSUM predicted morbidity in 114 patients (47%). The observed:predicted (O:P) ratio for morbidity was 0.56 and the model had a significant lack of fit (p < 0.001) using a goodness-of-fit analysis. The overall median survival was 7 months. The POSSUM scoring system was, however, an independent predictor of survival in multivariate analysis. Conclusions: Overall, POSSUM overpredicted morbidity but was an independent predictor of survival.

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“…The Karnofsky performance status was >80 points for both SG and EG. The whole group of patients from the AMC is also described in detail elsewhere [9, 15, 17]. …”

Section: Methodsmentioning

confidence: 99%

“…Since 1990, and currently, 5-FU has been given as a continuous infusion in a dose of 25 mg/kg/24 h, with a maximum of 1,500 mg, the first 4 days of both radiation courses. This protocol was developed on the basis of the results of GITSG [16, 17]. The choice of radiation dose of 50 Gy was a compromise between the 40- and 60-Gy doses used in the GITSG study.…”

Section: Methodsmentioning

confidence: 99%

Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

Smeenk

Castro²,

Jeekel³

et al. 2005

Dig Surg

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Aim of the Study: In two institutions, a retrospective analysis was performed on patients with histologically proven locally advanced pancreatic cancer without distant metastases. The aim of this analysis is to assess whether chemoradiotherapy provides survival benefit for patients with locally advanced pancreatic cancer. Methods: Forty-five patients from the Erasmus Medical Centre (Erasmus MC), Rotterdam, received 5-fluorouracil (5-FU) and radiotherapy and, 38 patients from the Academic Medical Centre Amsterdam (AMC) were offered the best supportive care. Radiotherapy consisted of 50 Gy external upper abdomen radiation in two courses, concomitant with intravenous 5-FU 25 mg/kg/ 24 h continuously on the first 4 days of each treatment course. Results: The treatment protocol was completed in 38 of 45 patients (84%) without complications. Radiological response was evaluated in 38 patients. Ten patients (26%) showed a partial response, stable disease was seen in 6 (16%) patients and progressive disease in 22 (58%) patients. A second-look operation was performed in 8 of 10 patients (72%) showing a radiological response, in 3 patients the tumour could be resected. Median overall survival time for the Erasmus MC group (n = 45) was 9.8 months compared to 7.6 months when the best supportive care was given (AMC group, p = 0.04). Conclusion: Although overall survival remains poor, treatment with 5-FU and radiotherapy might benefit some patients with locally advanced pancreatic cancer.

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Surgical treatment of pancreatic adenocarcinoma

Cited by 259 publications

References 31 publications

Chemokine Receptor CCR7 Expression Correlates with Lymph Node Metastasis in Pancreatic Cancer

Chemokine Receptor CCR7 Expression Correlates with Lymph Node Metastasis in Pancreatic Cancer

POSSUM Predicts Survival in Patients with Unresectable Pancreatic Cancer

Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

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