Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma
Open Access
- 31 May 2020
- Vol. 12 (6), 1428
- https://doi.org/10.3390/cancers12061428
Abstract
Background: Traditionally, the treatment options for unresectable locally advanced (UR-LA) and metastatic (UR-M) pancreatic ductal adenocarcinoma (PDAC) are palliative chemotherapy or chemoradiotherapy. The benefits of surgery for such patients remains unknown. The present study investigated clinical outcomes of patients undergoing conversion surgery (CS) after chemo(radiation)therapy for initially UR-PDAC. Methods: We recruited patients with UR-PDAC who underwent chemo(radiation)therapy for initially UR-PDAC between April 2006 and September 2017. We analyzed resectability of CS, predictive parameters for overall survival, and early recurrence (within six months). Results: A total of 468 patients (108 with UR-LA and 360 with UR-M PDAC) were enrolled in this study, of whom, 17 (15.7%) with UR-LA and 15 (4.2%) with UR-M underwent CS. The median survival time (MST) and five-year survival of patients who underwent CS was 37.2 months and 34%, respectively; significantly better than non-resected patients (nine months and 1%, respectively, p < 0.0001). MST did not differ according to UR-LA or UR-M (50.5 vs. 29.0 months, respectively, p = 0.53). Early recurrence after CS occurred in eight patients (18.8%). Lymph node metastasis, positive washing cytology, large tumor size (>35 mm), and lack of postoperative adjuvant chemotherapy were statistically significant predictive factors for early recurrence. Moreover, the site of pancreatic lesion and administration of postoperative adjuvant chemotherapy were statistically significant prognostic factors for overall survival in the patients undergoing CS. Conclusion: Conversion surgery offers benefits in terms of increase survival for initially UR-PDAC for patients who responded favorably to chemo(radiation)therapy when combined with postoperative adjuvant chemotherapy.This publication has 37 references indexed in Scilit:
- Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in OncologyJournal of the National Comprehensive Cancer Network, 2017
- Phase II study of chemoselection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy and subsequent conversion surgery for locally advanced unresectable oesophageal cancerBritish Journal of Cancer, 2016
- A clinical role of staging laparoscopy in patients with radiographically defined locally advanced pancreatic ductal adenocarcinomaWorld Journal of Surgical Oncology, 2015
- Prognostic Role of Conversion Surgery for Unresectable Gastric CancerAnnals of Surgical Oncology, 2015
- Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus GemcitabineThe New England Journal of Medicine, 2013
- Pancreatic Cancer: Advances in Treatment, Results and LimitationsDigestive Diseases, 2013
- Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer (SCALOP): a multicentre, randomised, phase 2 trialThe Lancet Oncology, 2013
- Japan Pancreatic Cancer Registry; 30th Year AnniversaryPancreas, 2012
- FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic CancerThe New England Journal of Medicine, 2011
- Selective Use of Staging Laparoscopy Based on Carbohydrate Antigen 19-9 Level and Tumor Size in Patients With Radiographically Defined Potentially or Borderline Resectable Pancreatic CancerPancreas, 2011