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Mehtsun WT, Hashimoto DA, Ferrone CR. Status of 5-Year Survivors of the Whipple Procedure for Pancreatic Adenocarcinoma. Adv Surg 2019; 53:253-269. [PMID: 31327451 DOI: 10.1016/j.yasu.2019.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Winta T Mehtsun
- Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC 460, Boston, MA 02114, USA
| | - Daniel A Hashimoto
- Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC 460, Boston, MA 02114, USA
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC 460, Boston, MA 02114, USA.
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Xia BT, Fu B, Wang J, Kim Y, Ahmad SA, Dhar VK, Levinsky NC, Hanseman DJ, Habib DA, Wilson GC, Smith M, Olowokure OO, Kharofa J, Al Humaidi AH, Choe KA, Abbott DE, Ahmad SA. Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy? J Surg Oncol 2017; 115:376-383. [DOI: 10.1002/jso.24538] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/24/2016] [Accepted: 12/04/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Brent T. Xia
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Baojin Fu
- Department of Pathology; University of Cincinnati; Cincinnati Ohio
| | - Jiang Wang
- Department of Pathology; University of Cincinnati; Cincinnati Ohio
| | - Young Kim
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - S. Ameen Ahmad
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Vikrom K. Dhar
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Nick C. Levinsky
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Dennis J. Hanseman
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - David A. Habib
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Gregory C. Wilson
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Milton Smith
- Division of Gastroenterology, Department of Internal Medicine; University of Cincinnati; Cincinnati Ohio
| | - Olugbenga O. Olowokure
- Division of Medical Oncology, Department of Internal Medicine; University of Cincinnati; Cincinnati Ohio
| | - Jordan Kharofa
- Department of Radiation Oncology; University of Cincinnati; Cincinnati Ohio
| | - Ali H. Al Humaidi
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Kyuran A. Choe
- Department of Radiology; University of Cincinnati; Cincinnati Ohio
| | - Daniel E. Abbott
- Division of Surgical Oncology, Department of Surgery; Univesity of Wisconsin; Madison Wisconsin
| | - Syed A. Ahmad
- Division of Surgical Oncology, Department of Surgery; University of Cincinnati; Cincinnati Ohio
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Hoffman JP, Reddy SS. Is It Time for Total Neoadjuvant Therapy for Patients With Resectable Pancreatic Adenocarcinoma? J Oncol Pract 2016; 12:780-781. [DOI: 10.1200/jop.2016.016352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- John P. Hoffman
- Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
| | - Sanjay S. Reddy
- Fox Chase Cancer Center and Temple University School of Medicine, Philadelphia, PA
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Sigel C, Reidy-Lagunes D, Lin O, Basturk O, Aggarwal G, Klimstra DS, Tang L. Cytological features contributing to the misclassification of pancreatic neuroendocrine tumors. J Am Soc Cytopathol 2016; 5:266-276. [PMID: 31042503 DOI: 10.1016/j.jasc.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/26/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Pancreatic neuroendocrine tumors are a diverse group of malignant neoplasms of varying biological behavior, with outcomes predicted by tumor differentiation and grade. Initial diagnosis is often made by fine-needle aspiration cytology via endoscopic ultrasound of the pancreas primary. We retrospectively reviewed our institutional experience with pancreatic neuroendocrine cytology diagnosis and evaluated for tumor typing accuracy and causes of misdiagnosis. MATERIALS AND METHODS We searched our institutional database (1994-2012) for all pancreas fine-needle aspirations with corresponding pancreatic histology and a neuroendocrine diagnosis. Cases with discrepant cytology and histology diagnoses were reviewed for factors contributing to misclassification. RESULTS 143 patients were identified with a neuroendocrine diagnosis either by cytology or histology. In the 129 cytology cases classified as positive/neoplastic/suspicious, tumor type was diagnosed correctly in 101 (78%) cases, incorrectly in 17 (13%), and unclassified (epithelioid neoplasm) in 11 (9%). The most common tumor classification error (7 cases) was misclassifying a neuroendocrine tumor as adenocarcinoma on cytology, which in one case led to inappropriate neoadjuvant chemotherapy. Features of neuroendocrine cytology misdiagnosed as adenocarcinoma included cell clustering and anisonucleosis. Features of non-neuroendocrine cytology misclassified as neuroendocrine included abundant acinar cells or problematic interpretation of immunohistochemical stains. CONCLUSIONS Cytology can accurately identify neuroendocrine differentiation in the majority of cases; nevertheless, there are potential serious pitfalls. Misclassification of a neuroendocrine tumor as adenocarcinoma or vice versa can have significant clinical impact. Clinical and radiological correlation is essential.
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Affiliation(s)
- Carlie Sigel
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, New York.
| | - Diane Reidy-Lagunes
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, New York
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, New York
| | - Gitika Aggarwal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, New York
| | - David S Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, New York
| | - Laura Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, New York
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A single-arm, nonrandomized phase II trial of neoadjuvant gemcitabine and oxaliplatin in patients with resectable pancreas adenocarcinoma. Ann Surg 2014; 260:142-8. [PMID: 24901360 DOI: 10.1097/sla.0000000000000251] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The role for neoadjuvant systemic therapy in resectable pancreas adenocarcinoma remains undefined. OBJECTIVE We evaluated the efficacy of gemcitabine and oxaliplatin administered as preoperative therapy in patients with resectable pancreas adenocarcinoma. METHODS Eligible patients were screened using computed tomography-pancreas angiography, laparoscopy, endoscopic ultrasonography, and fine-needle aspiration cytology to identify 38 patients who received 4 cycles of neoadjuvant gemcitabine 1000 mg/m intravenously over 100 minutes and oxaliplatin 80 mg/m intravenously over 2 hours, every 2 weeks. Patients whose tumors remained resectable at restaging proceeded to operation and subsequently received 5 cycles of adjuvant gemcitabine (1000 mg/m intravenously over 30 minutes days 1, 8, and 15 every 4 weeks). The primary endpoint was 18-month overall survival and secondary endpoints included radiological, tumor marker and pathological response to neoadjuvant therapy, time to recurrence, patterns of failure, and feasibility of obtaining preoperative core biopsies. RESULTS Thirty-five of 38 patients (92%) completed neoadjuvant therapy. Twenty-seven patients underwent tumor resection (resectability rate 71%), of which 26 initiated adjuvant therapy for a total of 23 patients (60.5%) who completed all planned therapy. The 18-month survival was 63% (24 patients alive). The median overall survival for all 38 patients was 27.2 months (95% confidence interval: 17-NA) and the median disease-specific survival was 30.6 months (95% confidence interval: 19-NA). CONCLUSIONS This study met its endpoint and provided a signal suggesting that exploration of neoadjuvant systemic therapy is worthy of further investigation in resectable pancreas adenocarcinoma. Improved patient selection and more active systemic regimens are key. Clinical trials identification: NCT00536874.
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Rose JB, Rocha FG, Alseidi A, Biehl T, Moonka R, Ryan JA, Lin B, Picozzi V, Helton S. Extended neoadjuvant chemotherapy for borderline resectable pancreatic cancer demonstrates promising postoperative outcomes and survival. Ann Surg Oncol 2014; 21:1530-7. [PMID: 24473642 DOI: 10.1245/s10434-014-3486-z] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The optimum approach to neoadjuvant therapy for patients with borderline resectable pancreatic cancer is undefined. Herein we report the outcomes of an extended neoadjuvant chemotherapy regimen in patients presenting with borderline resectable adenocarcinoma of the pancreatic head. METHODS Patients identified as having borderline resectable pancreatic head cancer by American Hepato-Pancreato-Biliary Association/Society of Surgical Oncology consensus criteria from 2008 to 2012 were tracked in a prospectively maintained registry. Included patients were initiated on a 24-week course of neoadjuvant chemotherapy. Medically fit patients who completed neoadjuvant treatment without radiographic progression were offered resection with curative intent. Clinicopathologic variables and surgical outcomes were collected retrospectively and analyzed. RESULTS Sixty-four patients with borderline resectable pancreatic cancer started neoadjuvant therapy. Thirty-nine (61 %) met resection criteria and underwent operative exploration with curative intent, and 31 (48 %) were resected. Of the resected patients, 18 (58 %) had positive lymph nodes, 15 (48 %) required en-bloc venous resection, 27 (87 %) had a R0 resection, and 3 (10 %) had a complete pathologic response. There were no postoperative deaths at 90 days, 16 % of patients had a severe complication, and the 30-day readmission rate was 10 %. The median overall survival of all 64 patients was 23.6 months, whereas that of unresectable patients was 15.4 months. Twenty-five of the resected patients (81 %) are still alive at a median follow-up of 21.6 months. CONCLUSIONS Extended neoadjuvant chemotherapy is well tolerated by patients with borderline resectable pancreatic head adenocarcinoma, selects a subset of patients for curative surgery with low perioperative morbidity, and is associated with favorable survival.
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Affiliation(s)
- J Bart Rose
- Section of General, Thoracic and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
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Coppola R. Pancreas cancer treatment: A surgeon's perspective today. Int J Surg 2012; 10:187-9. [DOI: 10.1016/j.ijsu.2012.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 03/12/2012] [Indexed: 12/21/2022]
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A systematic review and meta-analysis of survival and surgical outcomes following neoadjuvant chemoradiotherapy for pancreatic cancer. J Gastrointest Surg 2011. [PMID: 21913045 DOI: 10.1007/s11605-011-1659-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION This systematic review and meta-analysis aims to characterize the surgically important benefits and complications associated with the use of neoadjuvant chemoradiotherapy for the treatment of both resectable and initially unresectable pancreatic cancer. Studies were identified through a systematic literature search and analyzed by two independent reviewers. Survival, peri-operative complications, death rate, pancreatic fistula rate, and the incidence of involved surgical margins were analyzed and subject to meta-analysis. METHODS Nineteen studies, involving 2,148 patients were identified. Only cohort studies were included. RESULTS The meta-analysis found that patients with unresectable pancreatic cancer who underwent neoadjuvant chemoradiotherapy achieved similar survival outcomes to patients with resectable disease, even though only 40% were ultimately resected. Neoadjuvant chemoradiotherapy was not associated with a statistically significant increase in the rate of pancreatic fistula formation or total complications. CONCLUSION Patients receiving neoadjuvant chemoradiotherapy were less likely to have a positive resection margin, although there was an increase in the risk of peri-operative death.
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Laurence JM, Tran PD, Morarji K, Eslick GD, Lam VWT, Sandroussi C. A systematic review and meta-analysis of survival and surgical outcomes following neoadjuvant chemoradiotherapy for pancreatic cancer. J Gastrointest Surg 2011; 15:2059-69. [PMID: 21913045 DOI: 10.1007/s11605-011-1659-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 08/08/2011] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This systematic review and meta-analysis aims to characterize the surgically important benefits and complications associated with the use of neoadjuvant chemoradiotherapy for the treatment of both resectable and initially unresectable pancreatic cancer. Studies were identified through a systematic literature search and analyzed by two independent reviewers. Survival, peri-operative complications, death rate, pancreatic fistula rate, and the incidence of involved surgical margins were analyzed and subject to meta-analysis. METHODS Nineteen studies, involving 2,148 patients were identified. Only cohort studies were included. RESULTS The meta-analysis found that patients with unresectable pancreatic cancer who underwent neoadjuvant chemoradiotherapy achieved similar survival outcomes to patients with resectable disease, even though only 40% were ultimately resected. Neoadjuvant chemoradiotherapy was not associated with a statistically significant increase in the rate of pancreatic fistula formation or total complications. CONCLUSION Patients receiving neoadjuvant chemoradiotherapy were less likely to have a positive resection margin, although there was an increase in the risk of peri-operative death.
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Affiliation(s)
- Jerome Martin Laurence
- Department of Surgery, University of Sydney, Blackburn Building D06, Sydney, NSW, 2006, Australia.
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Andriulli A, Festa V, Botteri E, Valvano MR, Koch M, Bassi C, Maisonneuve P, Sebastiano PD. Neoadjuvant/preoperative gemcitabine for patients with localized pancreatic cancer: a meta-analysis of prospective studies. Ann Surg Oncol 2011; 19:1644-62. [PMID: 22012027 DOI: 10.1245/s10434-011-2110-8] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Long-term prognosis for localized pancreatic cancer remains poor. We sought to assess the benefit of neoadjuvant/preoperative chemotherapy with or without radiotherapy. METHODS Prospective studies where gemcitabine with or without radiotherapy was provided before surgery in patients with initially resectable or unresectable disease were reviewed by meta-analysis. Primary outcome was survival, and secondary outcomes were tumor response after therapy, toxicity, surgical exploration, and resection rates. RESULTS Twenty independent studies with 707 participants were included, 366 with resectable lesions and 341 with unresectable lesions. Seven studies were phase I/II trials, 10 phase II, and 3 prospective cohort studies. Estimated 1- and 2-year survival probabilities after resection were 91.7% (95% confidence interval [CI] 75-100) and 67.2% (95% CI 38-87) for initially resectable patients, and 86.3% (95% CI 78-100) and 54.2% (95% CI 25-100) for initially unresectable patients. The complete/partial response rate was 12% (95% CI 4-23) and 27% (95% CI 18-38) in resectable and unresectable lesions, respectively. The rate of treatment-related grade 3-4 toxicity was 31% (95% CI 21-42). Of resectable patients evaluable after restaging, 91% (95% CI 83-97) underwent surgery, and 82% (95% CI 65-95) of explored patients underwent resection. R0 resections amounted to 89% (95% CI 83-94). Of unresectable patients evaluable after restaging, 39% (95% CI 28-50) underwent surgery, and 68% (95% CI 53-82) of explored patients were resected, with 60% (95% CI 50-71) R0 resections. CONCLUSIONS Current analysis provides marginal support to the assumed benefits of neoadjuvant therapies for patients with resectable cancer, and indicates a potential advantage only for a minority of those with unresectable lesions.
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Affiliation(s)
- Angelo Andriulli
- Division of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
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