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Law B, Windsor J, Connor S, Koea J, Srinivasa S. Best supportive care in advanced pancreas cancer: a systematic review to define a patient-care bundle. ANZ J Surg 2024. [PMID: 38366699 DOI: 10.1111/ans.18906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of patients with pancreatic adenocarcinoma (PDAC) have advanced disease at presentation, preventing treatment with curative intent. Management of these patients is often provided by surgical teams for whom there are a lack of widely accepted strategies for care. The aim of this study was to conduct a systematic review to identify key issues in patients with advanced PDAC and integrate the evidence to form a care bundle checklist for use in surgical clinics. METHODS A systematic review of the literature was performed regarding best supportive care for advanced PDAC according to the PRISMA guidelines. Interventions pertaining to supportive care were included whilst preventative and curative treatments were excluded. A narrative review was planned. RESULTS Forty-four studies were assessed and four themes were developed: (i) Pain is an undertreated symptom, requiring escalating analgesics and sometimes invasive modalities. (ii) Health-related quality of life necessitates optimisation by involving family, carers and multi-disciplinary teams. (iii) Malnutrition and weight loss can be mitigated with early assessment, replacement therapies and resistance exercise. (iv) Biliary and duodenal obstruction can often be relieved by endoscopic/radiological interventions with surgery rarely required. CONCLUSION This is the first systematic review to evaluate the different types of interventions utilized during best supportive care in patients with advanced PDAC. It provides a comprehensive care bundle for surgeons that informs management of the common issues experienced by patients within a multidisciplinary environment.
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Affiliation(s)
- Bena Law
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John Windsor
- The Department of Surgery, University of Auckland, Auckland, New Zealand
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Saxon Connor
- The Department of Surgery, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand
| | - Jonathan Koea
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sanket Srinivasa
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
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Glinka J, Diaz F, Alva A, Mazza O, Sanchez Claria R, Ardiles V, de Santibañes E, Pekolj J, de Santibañes M. Use of radiotherapy in patients with palliative double bypass for locally advanced pancreatic adenocarcinoma. Radiat Oncol J 2018; 36:210-217. [PMID: 30309212 PMCID: PMC6226143 DOI: 10.3857/roj.2018.00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/17/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose Pancreatic cancer (PC) has not changed overall survival in recent years despite therapeutic efforts. Surgery with curative intent has shown the best long-term oncological results. However, 80%–85% of patients with these tumors are unresectable at the time of diagnosis. In those patients, first therapeutic attempts are minimally invasive or surgical procedures to alleviate symptoms. The addition of radiotherapy (RT) to standard chemotherapy, ergo chemoradiation, in patients with locally advanced pancreatic cancer (LAPC) is still controversial. The study aims to compare outcomes in patients with a double bypass surgery due to LAPC treated or not with RT. Materials and Methods A retrospective cohort study of patients with double bypass for LAPC were registered and divided into two groups: treated or not with postoperative RT. Baseline characteristics, postoperative complications, those related to RT and their relation to the main event (mortality) were compared. Results Seventy-four patients were included. Surgical complications between the groups did not offer significant differences. Complications related to RT were mostly mild, and 86% of patients completed the treatment. Overall survival at 1 and 2 years for patients in the exposed group was 64% and 35% vs. 50% and 28% in the non-exposed group, respectively (p = 0.11; power 72%; hazard ratio = 0.53; 95% confidence interval, 0.24–1.18). Conclusion We observed a tendency for survival improvement in patients with postoperative RT. However, we’ve not had enough power to demonstrate this difference, possibly due to the small sample size. It is indispensable to develop randomized and prospective trials to guide more specific treatment lines in this patients.
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Affiliation(s)
- Juan Glinka
- Department of General Surgery, Hepato-Bilio-Pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Federico Diaz
- Department of Radiation Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Augusto Alva
- Department of Radiation Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Oscar Mazza
- Department of General Surgery, Hepato-Bilio-Pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Sanchez Claria
- Department of General Surgery, Hepato-Bilio-Pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Department of General Surgery, Hepato-Bilio-Pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery, Hepato-Bilio-Pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Hepato-Bilio-Pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martín de Santibañes
- Department of General Surgery, Hepato-Bilio-Pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Paiella S, Salvia R, Girelli R, Frigerio I, Giardino A, D’Onofrio M, De Marchi G, Bassi C. Role of local ablative techniques (Radiofrequency ablation and Irreversible Electroporation) in the treatment of pancreatic cancer. Updates Surg 2016; 68:307-311. [DOI: 10.1007/s13304-016-0385-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/15/2016] [Indexed: 02/08/2023]
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Williamsson C, Wennerblom J, Tingstedt B, Jönsson C. A wait-and-see strategy with subsequent self-expanding metal stent on demand is superior to prophylactic bypass surgery for unresectable periampullary cancer. HPB (Oxford) 2016; 18:107-12. [PMID: 26776858 PMCID: PMC4750237 DOI: 10.1016/j.hpb.2015.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A patient with unresectable periampullary malignancy found at laparotomy has traditionally received a prophylactic double bypass (biliary and duodenal), associated with considerable morbidity. With modern endoscopic treatments, surgical bypass has become questionable. This study aims to compare the two strategies. Sahlgrenska University Hospital (SU) performs a double bypass (DoB) routinely, and Skåne University Hospital Lund (SUL) secures biliary drainage endoscopically and treats only symptomatic duodenal obstruction (Wait and See, WaS). METHOD Between 2004 and 2013, 73 patients from SU and 70 from SUL were retrospectively identified. Demographics, tumour-related factors and postoperative outcomes during the remaining lifetime were noted. RESULTS The DoB group had significantly more complications (67% vs. 31%, p = 0.00002) and longer hospital stay (14 vs. 8 days, p = 0.001) than the WaS-group. The two groups had similar proportion of patients in need of readmission. The DoB patients and the WaS patients with metallic biliary stents were comparable regarding their need of re-interventions and hospitalisation due to biliary obstruction. Surgical duodenal bypass did not prevent future duodenal obstructions. CONCLUSION Patients with unresectable periampullary malignancies can safely be managed with endoscopic drainage on demand and with lower morbidity and shorter hospital stay than with surgical prophylactic bypass.
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Affiliation(s)
- Caroline Williamsson
- Department of Surgery, Skåne University Hospital at Lund and Lund University, Sweden
| | - Johanna Wennerblom
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg and Gothenburg University, Sweden
| | - Bobby Tingstedt
- Department of Surgery, Skåne University Hospital at Lund and Lund University, Sweden
| | - Claes Jönsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg and Gothenburg University, Sweden,Correspondence Claes Jönsson, Department of Surgery, Sahlgrenska University Hospital, Per Dubbsgatan 15, 413 45 Göteborg, Sweden. Tel: +46 31 342 10 00. Fax: +46 31 821811.
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Williamsson C, Wennerblom J, Tingstedt B, Jönsson C. A wait-and-see strategy with subsequent self-expanding metal stent on demand is superior to prophylactic bypass surgery for unresectable periampullary cancer. HPB (Oxford) 2015:n/a-n/a. [PMID: 26473999 DOI: 10.1111/hpb.12513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/12/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A patient with unresectable periampullary malignancy found at laparotomy has traditionally received a prophylactic double bypass (biliary and duodenal), associated with considerable morbidity. With modern endoscopic treatments, a surgical bypass has become questionable. This study aims to compare the two strategies. Sahlgrenska University Hospital (SU) performs a double bypass (DoB) routinely, and Skåne University Hospital Lund (SUL) secures biliary drainage endoscopically and treats only symptomatic duodenal obstruction (Wait and See, WaS). METHOD Between 2004 and 2013, 73 patients from SU and 70 from SUL were retrospectively identified. Demographics, tumour-related factors and post-operative outcomes during the remaining lifetime of the patients were noted. RESULTS The DoB group had significantly more complications (67% versus 31%, P = 0.00002) and a longer hospital stay (14 versus 8 days, P = 0.001) than the WaS group. The two groups had a similar proportion of patients in need of readmission. The DoB patients and the WaS patients with metallic biliary stents were comparable regarding their need of re-interventions and hospitalization as a result of biliary obstruction. A surgical duodenal bypass did not prevent future duodenal obstructions. CONCLUSION Patients with unresectable periampullary malignancies can safely be managed with endoscopic drainage on demand and with a lower morbidity and a shorter hospital stay than with a surgical prophylactic bypass.
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Affiliation(s)
- Caroline Williamsson
- Department of Surgery, Skåne University Hospital at Lund, Lund University, Lund, Sweden
| | - Johanna Wennerblom
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Gothenburg University, Gothenburg, Sweden
| | - Bobby Tingstedt
- Department of Surgery, Skåne University Hospital at Lund, Lund University, Lund, Sweden
| | - Claes Jönsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Gothenburg University, Gothenburg, Sweden
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Wang XY, Yang F, Jin C, Fu DL. Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer. World J Gastroenterol 2014; 20:15580-15589. [PMID: 25400441 PMCID: PMC4229522 DOI: 10.3748/wjg.v20.i42.15580] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/11/2014] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is one of the most common gastrointestinal tumors, with its incidence staying at a high level in both the United States and China. However, the overall 5-year survival rate of pancreatic cancer is still extremely low. Surgery remains the only potential chance for long-term survival. Early diagnosis and precise staging are crucial to make proper clinical decision for surgery candidates. Despite advances in diagnostic technology such as computed tomography (CT) and endoscopic ultrasound, diagnosis, staging and monitoring of the metabolic response remain a challenge for this devastating disease. Positron emission tomography/CT (PET/CT), a relatively novel modality, combines metabolic detection with anatomic information. It has been widely used in oncology and achieves good results in breast cancer, lung cancer and lymphoma. Its utilization in pancreatic cancer has also been widely accepted. However, the value of PET/CT in pancreatic disease is still controversial. Will PET/CT change the treatment strategy for potential surgery candidates? What kind of patients benefits most from this exam? In this review, we focus on the utility of PET/CT in diagnosis, staging, and assessment of resectability of pancreatic cancer. In addition, its ability to monitor metabolic response and recurrence after treatment will be emphasis of discussion. We hope to provide answers to the questions above, which clinicians care most about.
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Cesmebasi A, Malefant J, Patel SD, Plessis MD, Renna S, Tubbs RS, Loukas M. The surgical anatomy of the lymphatic system of the pancreas. Clin Anat 2014; 28:527-37. [PMID: 25220721 DOI: 10.1002/ca.22461] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/22/2014] [Accepted: 08/16/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Alper Cesmebasi
- Departments of Neurologic and Orthopedic Surgery; Mayo Clinic; Rochester Minnesota
- Department of Anatomical Sciences; School of Medicine, St George's University; Grenada West Indies
| | - Jason Malefant
- Department of Anatomical Sciences; School of Medicine, St George's University; Grenada West Indies
| | - Swetal D. Patel
- Department of Anatomical Sciences; School of Medicine, St George's University; Grenada West Indies
- Department of Medicine; University of Nevada SOM; Las Vegas Nevada
| | - Maira Du Plessis
- Department of Anatomical Sciences; School of Medicine, St George's University; Grenada West Indies
| | - Sarah Renna
- Department of Anatomical Sciences; School of Medicine, St George's University; Grenada West Indies
| | - R. Shane Tubbs
- Department of Anatomical Sciences; School of Medicine, St George's University; Grenada West Indies
- Section of Pediatric Neurosurgery; Children's Hospital Birmingham Alabama
| | - Marios Loukas
- Department of Anatomical Sciences; School of Medicine, St George's University; Grenada West Indies
- Department of Anatomy; Medical School Varmia and Mazuria; Olsztyn Poland
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Abstract
The surgical palliation of pancreatic cancer remains an important component of the treatment of this disease. The introduction of a new aggressive and effective chemotherapy regimen (FOLFIRINOX), interdisciplinary palliative care, and minimally invasive approaches for providing palliation are all factors that expand the role of the surgeon in the care of patients with unresectable disease. Currently, the role of the surgeon in the palliation of pancreatic cancer is (1) to identify patients with incurable disease (either preoperatively or intraoperatively), (2) to determine the optimal palliative technique to optimize results and preserve resources, and (3) to perform palliation of symptoms with low morbidity and mortality. The 3 most common symptoms of pancreatic cancer requiring surgical palliation are obstructive jaundice, gastric outlet obstruction, and tumor-associated pain. It is important that the surgeon recognizes the full range of surgical and nonoperative techniques available and contributes to the decision making as to the most appropriate method for each individual patient.
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Giardino A, Girelli R, Frigerio I, Regi P, Cantore M, Alessandra A, Lusenti A, Salvia R, Bassi C, Pederzoli P. Triple approach strategy for patients with locally advanced pancreatic carcinoma. HPB (Oxford) 2013; 15:623-7. [PMID: 23458679 PMCID: PMC3731584 DOI: 10.1111/hpb.12027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/29/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a relatively new technique, applied to metastatic solid tumours which, in recent studies, has been shown to be feasible and safe on locally advanced pancreatic carcinoma (LAPC). RFA can be combined with radio-chemotherapy (RCT) and intra-arterial plus systemic chemotherapy (IASC). The aim of this study was to investigate the impact on the prognosis of a multimodal approach to LAPC and define the best timing of RFA. METHODS This is a retrospective observational study of patients who have consecutively undergone RFA associated with multiple adjuvant approaches. RESULTS Between February 2007 and December 2011, 168 consecutive patients were treated by RFA, of which 107 were eligible for at least 18 months of follow-up. Forty-seven patients (group 1) underwent RFA as an up-front treatment and 60 patients as second treatment (group 2) depending on clinician choice. The median overall survival (OS) of the whole series was 25.6 months: 14.7 months in the group 1 and 25.6 months in the group 2 (P = 0.004). Those patients who received the multimodal treatment (RFA, RCT and IASC-triple approach strategy) had an OS of 34.0 months. CONCLUSIONS The multimodal approach seems to be feasible and associated with an improved longer survival rate.
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Affiliation(s)
| | - Roberto Girelli
- Pancreatic Unit, Casa di Cura PederzoliPeschiera del Garda (VR), Italy
| | - Isabella Frigerio
- Pancreatic Unit, Casa di Cura PederzoliPeschiera del Garda (VR), Italy
| | - Paolo Regi
- Pancreatic Unit, Casa di Cura PederzoliPeschiera del Garda (VR), Italy
| | - Maurizio Cantore
- Oncology Department, Casa di Cura PederzoliPeschiera del Garda (VR), Italy
| | | | - Annita Lusenti
- Oncology Department, Casa di Cura PederzoliPeschiera del Garda (VR), Italy
| | - Roberto Salvia
- Surgical and Oncological Department, University of VeronaVerona (VR), Italy
| | - Claudio Bassi
- Surgical and Oncological Department, University of VeronaVerona (VR), Italy
| | - Paolo Pederzoli
- Pancreatic Unit, Casa di Cura PederzoliPeschiera del Garda (VR), Italy
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Girelli R, Frigerio I, Giardino A, Regi P, Gobbo S, Malleo G, Salvia R, Bassi C. Results of 100 pancreatic radiofrequency ablations in the context of a multimodal strategy for stage III ductal adenocarcinoma. Langenbecks Arch Surg 2012; 398:63-9. [DOI: 10.1007/s00423-012-1011-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 09/18/2012] [Indexed: 02/07/2023]
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Cantore M, Girelli R, Mambrini A, Frigerio I, Boz G, Salvia R, Giardino A, Orlandi M, Auriemma A, Bassi C. Combined modality treatment for patients with locally advanced pancreatic adenocarcinoma. Br J Surg 2012; 99:1083-8. [PMID: 22648697 DOI: 10.1002/bjs.8789] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is an emerging treatment for patients with locally advanced pancreatic carcinoma, and can be combined with radiochemotherapy and intra-arterial plus systemic chemotherapy. METHODS This observational study compared two groups of patients with locally advanced pancreatic carcinoma treated with either primary RFA (group 1) or RFA following any other primary treatment (group 2). RESULTS Between February 2007 and May 2010, 107 consecutive patients were treated with RFA. There were 47 patients in group 1 and 60 in group 2. Median overall survival was 25·6 months. Median overall survival was significantly shorter in group 1 than in group 2 (14·7 versus 25·6 months; P = 0·004) Patients treated with RFA, radiochemotherapy and intra-arterial plus systemic chemotherapy (triple-approach strategy) had a median overall survival of 34·0 months. CONCLUSION RFA after alternative primary treatment was associated with prolonged survival. This was further extended by use of a triple-approach strategy in selected patients. Further evaluation of this approach seems warranted.
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Affiliation(s)
- M Cantore
- Oncological Department, Carrara Hospital, Carrara, Italy.
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Slaar A, Eshuis WJ, van der Gaag NA, Nio CY, Busch ORC, van Gulik TM, Reitsma JB, Gouma DJ. Predicting Distant Metastasis in Patients With Suspected Pancreatic and Periampullary Tumors for Selective Use of Staging Laparoscopy. World J Surg 2011; 35:2528-34. [DOI: 10.1007/s00268-011-1204-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Riemann JF, Eickhoff A. Pancreas: preoperative biliary drainage for pancreatic cancer. Nat Rev Gastroenterol Hepatol 2010; 7:308-9. [PMID: 20523350 DOI: 10.1038/nrgastro.2010.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Girelli R, Frigerio I, Salvia R, Barbi E, Tinazzi Martini P, Bassi C. Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg 2010; 97:220-5. [PMID: 20069610 DOI: 10.1002/bjs.6800] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND : Radiofrequency ablation (RFA) may be a valuable treatment option for locally advanced pancreatic cancer. The present study examined its feasibility and safety. METHODS : Fifty patients with locally advanced pancreatic cancer were studied prospectively. Ultrasound-guided RFA was performed during laparotomy. The main outcome measures were short-term morbidity and mortality. RESULTS : The tumour was located in the pancreatic head or uncinate process in 34 patients and in the body or tail in 16; median diameter was 40 (interquartile range 30-50) mm. RFA was the only treatment in 19 patients. RFA was combined with biliary and gastric bypass in 19 patients, gastric bypass alone in eight, biliary bypass alone in three and pancreaticojejunostomy in one. The 30-day mortality rate was 2 per cent. Abdominal complications occurred in 24 per cent of patients; in half they were directly associated with RFA and treated conservatively. Three patients with surgery-related complications needed reoperation. Reduction of RFA temperature from 105 degrees C to 90 degrees C resulted in a significant reduction in complications (ten versus two of 25 patients; P = 0.028). Median postoperative hospital stay was 10 (range 7-31) days. CONCLUSION : RFA of locally advanced pancreatic cancer is feasible and relatively well tolerated, with a 24 per cent complication rate.
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Affiliation(s)
- R Girelli
- Hepatopancreatobiliary Unit, University of Verona, Verona, Italy
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Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent pancreatic cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Mol Imaging Biol 2009; 12:452-9. [PMID: 19949988 DOI: 10.1007/s11307-009-0271-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 07/30/2009] [Accepted: 10/09/2009] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the accuracy of 2-deoxy-2-[F-18]fluoro-D: -glucose-positron emission tomography (FDG-PET)/computed tomography (CT) with intravenous contrast for depiction of recurrent pancreatic cancer, compared with PET/non-enhanced CT and CT. PROCEDURE Forty-five patients previously treated for pancreatic cancer underwent PET/CT for suspected recurrence. Lesion status was determined on the basis of histopathology and radiological imaging follow-up. RESULTS Patient-based analysis showed that sensitivity, specificity, and accuracy of PET/contrast-enhanced CT were 91.7%, 95.2%, and 93.3%, respectively, whereas those of PET/non-enhanced CT were 83.3%, 90.5%, and 86.7%, respectively, and those of enhanced CT were 66.7%, 85.7%, and 75.6%, respectively. In 21 patients whom the final diagnosis was obtained from the histopathologic examination, those figures of PET/contrast-enhanced CT were 94.7%, 50.0%, and 90.4%, respectively. The sensitivity of PET/contrast-enhanced CT in detecting local recurrence, abdominal lymph node metastasis, and peritoneal dissemination were 83.3%, 87.5%, and 83.3%, respectively. CONCLUSION PET/contrast-enhanced CT is an accurate modality for assessing recurrence of pancreatic cancer.
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Müller MW, Friess H, Köninger J, Martin D, Wente MN, Hinz U, Ceyhan GO, Blaha P, Kleeff J, Büchler MW. Factors influencing survival after bypass procedures in patients with advanced pancreatic adenocarcinomas. Am J Surg 2008; 195:221-8. [PMID: 18154768 DOI: 10.1016/j.amjsurg.2007.02.026] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 02/19/2007] [Accepted: 02/19/2007] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients with occult metastasis or locally nonresectable pancreatic cancer found during surgical exploration have a limited life expectancy. We sought to define markers in these patients that could predict survival and thus aid decision making for selection of the most appropriate therapeutic palliative option. METHODS In a prospective 4-year single-center study, 136 consecutive patients with obstructive pancreatic cancer and intraoperative diagnosis of nonresectable or disseminated pancreatic cancer underwent a palliative surgical bypass procedure. Potential factors predicting survival were evaluated. RESULTS Ninety-eight patients had metastatic disease and 38 locally advanced disease. Surgical morbidity rate was 16 %, re-operation rate 1%, and overall in-hospital mortality 4%. Univariate analysis showed American Society of Anesthesiologists (ASA) score, pain, operation time, presence of metastasis, and levels of leukocytes, albumin, C-reactive protein (CRP), carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19-9 were associated significantly with survival. The multivariate analysis identified ASA score, presence of liver metastasis, pain, CA 19-9, and CEA levels as independent indicators for poor survival. Patients with none or 1 of these risk factors had a median survival of 13.5 months, whereas patients with 4 or 5 risk factors had a median survival of 3.5 months. CONCLUSIONS The clinical markers identified predict poor outcome for patients with palliative bypass surgery and therefore aid the appropriate selection of either surgical bypass or endoscopic stenting in these patients.
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Affiliation(s)
- Michael W Müller
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany
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Michalski CW, Weitz J, Büchler MW. Surgery insight: surgical management of pancreatic cancer. NATURE CLINICAL PRACTICE. ONCOLOGY 2007; 4:526-35. [PMID: 17728711 DOI: 10.1038/ncponc0925] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 05/11/2007] [Indexed: 12/22/2022]
Abstract
Pancreatic ductal adenocarcinoma is a common malignancy of the gastrointestinal tract. The number of new cases diagnosed and the number of deaths each year are almost identical, demonstrating the particularly dismal prognosis for patients affected by this disease. Despite recent advances in the field of medical and radiation oncology, and the introduction of neoadjuvant and adjuvant regimens, surgery remains the single most important modality for the treatment of pancreatic ductal adenocarcinoma. Surgery for pancreatic cancer is widely viewed as a complex procedure associated with considerable perioperative morbidity and mortality. Many aspects of surgery for pancreatic cancer, such as the extent of resection, the value of vascular resection, the use of laparoscopy, and the importance of treatment at high-volume centers, are currently under debate. This Review describes the current status of surgical treatment for pancreatic ductal adenocarcinoma, and highlights the new developments in this field.
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