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Pancreatic cancer surgery

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https://www.readbyqxmd.com/read/29241394/neoadjuvant-therapy-offers-longer-survival-than-upfront-surgery-for-poorly-differentiated-and-higher-stage-pancreatic-cancer
#1
Anna Nurmi, Harri Mustonen, Helka Parviainen, Katriina Peltola, Caj Haglund, Hanna Seppänen
BACKGROUND: Neoadjuvant therapy for pancreatic cancer remains controversial. Our aim was to assess differences in survival, disease recurrence and histopathological tumor characteristics between patients treated with neoadjuvant therapy followed by subsequent surgery and patients undergoing upfront surgery. MATERIAL AND METHODS: Out of 399 consecutive pancreatic ductal adenocarcinoma (PDAC) patients operated at Helsinki University Hospital in 2000-2015, 75 borderline resectable patients were treated with neoadjuvant therapy...
December 15, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/29240007/alternative-fistula-risk-score-for-pancreatoduodenectomy-a-frs-design-and-international-external-validation
#2
Timothy H Mungroop, L Bengt van Rijssen, David van Klaveren, F Jasmijn Smits, Victor van Woerden, Ralph J Linnemann, Matteo de Pastena, Sjors Klompmaker, Giovanni Marchegiani, Brett L Ecker, Susan van Dieren, Bert Bonsing, Olivier R Busch, Ronald M van Dam, Joris Erdmann, Casper H van Eijck, Michael F Gerhards, Harry van Goor, Erwin van der Harst, Ignace H de Hingh, Koert P de Jong, Geert Kazemier, Misha Luyer, Awad Shamali, Salvatore Barbaro, Thomas Armstrong, Arjun Takhar, Zaed Hamady, Joost Klaase, Daan J Lips, I Quintus Molenaar, Vincent B Nieuwenhuijs, Coen Rupert, Hjalmar C van Santvoort, Joris J Scheepers, George P van der Schelling, Claudio Bassi, Charles M Vollmer, Ewout W Steyerberg, Mohammed Abu Hilal, Bas Groot Koerkamp, Marc G Besselink
OBJECTIVE: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS...
December 12, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/29230694/anthropometric-changes-in-patients-with-pancreatic-cancer-undergoing-preoperative-therapy-and-pancreatoduodenectomy
#3
Jordan M Cloyd, Graciela M Nogueras-González, Laura R Prakash, Maria Q B Petzel, Nathan H Parker, An T Ngo-Huang, David Fogelman, Jason W Denbo, Naveen Garg, Michael P Kim, Jeffrey E Lee, Ching-Wei D Tzeng, Jason B Fleming, Matthew H G Katz
BACKGROUND: The changes in body composition that occur in response to therapy for localized pancreatic ductal adenocarcinoma (PDAC) and during the early survivorship period, as well as their clinical significance, are poorly understood. METHODS: One hundred twenty-seven consecutive patients with PDAC who received preoperative therapy followed by pancreatoduodenectomy (PD) at a single institution between 2009 and 2012 were longitudinally evaluated. Changes in skeletal muscle (SKM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were measured on serial computed tomography images obtained upon presentation, prior to pancreatectomy, and approximately 3 and 12 months after surgery...
December 11, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29227344/predictors-of-resectability-and-survival-in-patients-with-borderline-and-locally-advanced-pancreatic-cancer-who-underwent-neoadjuvant-treatment-with-folfirinox
#4
Theodoros Michelakos, Ilaria Pergolini, Carlos Fernández-Del Castillo, Kim C Honselmann, Lei Cai, Vikram Deshpande, Jennifer Y Wo, David P Ryan, Jill N Allen, Lawrence S Blaszkowsky, Jeffrey W Clark, Janet E Murphy, Ryan D Nipp, Aparna Parikh, Motaz Qadan, Andrew L Warshaw, Theodore S Hong, Keith D Lillemoe, Cristina R Ferrone
OBJECTIVE: The aim of this study was to determine (1) whether preoperative factors can predict resectability of borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant FOLFIRINOX, (2) which patients might benefit from adjuvant therapy, and (3) survival differences between resected BR/LA patients who received neoadjuvant FOLFIRINOX and upfront resected patients. BACKGROUND: Patients with BR/LA PDAC are often treated with FOLFIRINOX to obtain a margin-negative resection, yet selection of patients for resection remains challenging...
December 7, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/29224265/-analysis-on-the-clinical-therapeutic-effects-of-arterial-first-approach-pancreatoduodenectomy-in-the-treatment-of-borderline-resectable-pancreatic-adenocarcinoma
#5
G Jin, K L Zheng, S W Guo, Z Shao, C Liu, X H Shi, R D Liu, S J Bai, H Jiang, Y Bian, X G Hu
Objective: To compare the clinical therapeutic effects of arterial first approach pancreaticoduodenectomy(AFA-PD) with standard approach pancreaticoduodenectomy(SPD) in the treatment of borderline resectable pancreatic cancer (BRPC). Methods: A retrospective analysis of the clinical data of 113 cases of pancreatic cancer patients from January 2014 to August 2015 at Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, including 43 cases in AFA-PD group and 70 cases in SPD group...
December 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/29224259/-expert-consensus-of-precise-diagnosis-and-treatment-for-pancreatic-head-cancer-using-three-dimensional-visualization-technology
#6
(no author information available yet)
Three-dimensional (3D) visualization technology in pancreatic head cancers could offer decision-making support to preoperative diagnosis, resectability assessment and individualized surgical planning. In addition, the pancreas 3D printing helps to realize the leapfrog development from 3D images to 3D physical models and provides better guidance of the precise surgery of complicated cancers of the pancreatic head. In order to standardize the application of 3D visualization and 3D printing technology in the diagnosis and treatment of pancreatic head cancer, Chinese experts in relevant fields were organized by four committees to formulate this expert consensus...
December 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/29221990/molecular-and-cellular-mechanisms-of-chemoresistance-in-pancreatic-cancer
#7
REVIEW
Aleksandra Adamska, Omar Elaskalani, Aikaterini Emmanouilidi, Minkyoung Kim, Norbaini Binti Abdol Razak, Pat Metharom, Marco Falasca
Pancreatic Ductal Adenocarcinoma (PDAC) is one of the most chemoresistant cancers, and current therapies targeting cancer-associated molecular pathways have not given satisfactory results, owing in part to rapid upregulation of alternative compensatory pathways. Most of the available treatments are palliative, focussing on improving the quality of life. At present, available options are surgery, embolization, radiation, chemotherapy, immunotherapy and use of other more targeted drugs. In this review, we describe the cellular and molecular effects of current chemotherapy drugs such as gemcitabine, FOLFIRINOX (5-fluorouracil [5-FU], oxaliplatin, irinotecan, and leucovorin) and ABRAXANE (nab-Paclitaxel), which have shown a survival benefit, although modest, for pancreatic cancer patients...
November 22, 2017: Advances in Biological Regulation
https://www.readbyqxmd.com/read/29216532/spontaneous-regression-of-pancreatic-cancer-a-case-report-and-literature-review
#8
Ken Min Chin, Chung Yip Chan, Ser Yee Lee
INTRODUCTION: Spontaneous regression of cancer is defined as the partial or complete disappearance of malignant disease without treatment, or in the presence of therapy that is deemed inadequate to exert an influence on malignant disease, as composed by Tilden Everson and Warren Cole in the 1960s. It has been a topic of major interest in the field of medical and surgical oncology. It is poorly understood and scantily documented. Factors associated and postulated pathogeneses are at best, hypothetical...
December 2, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29214453/neoadjuvant-therapy-versus-upfront-resection-for-pancreatic-cancer-the-actual-spectrum-and-clinical-burden-of-postoperative-complications
#9
Giovanni Marchegiani, Stefano Andrianello, Chiara Nessi, Marta Sandini, Laura Maggino, Giuseppe Malleo, Salvatore Paiella, Enrico Polati, Claudio Bassi, Roberto Salvia
BACKGROUND: Neoadjuvant therapy (NAT) is used for borderline-resectable or locally advanced pancreatic cancer (PDAC) and exhibits promising results in terms of pathological outcomes. However, little is known about its effect on surgical complications. METHODS: We analyzed 445 pancreatic resections for PDAC from 2014 to 2016 at The Pancreas Institute, Verona University Hospital. The Modified Accordion Severity Grading System and average complication burden (ACB) were used to compare patients treated with NAT with patients who underwent upfront surgery (UFS)...
December 6, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29212734/predictors-of-response-and-survival-in-locally-advanced-adenocarcinoma-of-the-pancreas-following-neoadjuvant-gtx-with-or-without-radiation-therapy
#10
William H Sherman, Elizabeth Hecht, David Leung, Kyung Chu
LESSONS LEARNED: There is no presenting parameter that predicts the success of neoadjuvant therapy for pancreatic cancer.Despite the images on scans following neoadjuvant therapy, all patients should be evaluated, because inflammation following radiation therapy (RT) may overstate the extent of tumor and vascular involvement. BACKGROUND: In patients presenting with locally advanced pancreatic adenocarcinoma deemed unresectable by two pancreatic cancer surgeons, we analyzed presenting tumor size, extent of vascular involvement, tumor markers, response to neoadjuvant gemcitabine (G), docetaxel (T), and capecitabine (X) with or without additional chemoradiotherapy with GX on R0 resection rates (≥2 mm margins), and survival...
December 6, 2017: Oncologist
https://www.readbyqxmd.com/read/29198676/case-report-primary-de-novo-sarcoma-in-transplant-pancreas-allograft
#11
S Nagaraju, S J Grethlein, S Vaishnav, A A Sharfuddin, J A Powelson, J A Fridell
BACKGROUND: The majority of malignancies after transplantation appear to be virally mediated and of recipient origin. Donor-derived neoplasms occur early, whereas recipient-origin tumors typically occur many years after transplantation. Sarcomas are a relatively rare form of cancer. The etiology of sarcomas remains largely unknown, although some are linked to viruses, familial cancer syndromes, or therapeutic radiation exposure. Primary sarcomas are extremely rare, accounting for <0...
December 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29198548/embolization-of-arterial-gastrointestinal-hemorrhage-with-fuaile-medical%C3%A2-adhesive
#12
Min Xu, Xiaoli Zhu, Yizhi Liu, Zhi Li, Tianzhi An, Tianpeng Jiang, Jie Song, Lizhou Wang, Shi Zhou, Caifang Ni
BACKGROUND: To investigate the safety and effectiveness of Fuaile medical adhesive (FAL) with superselective catheterization in endovascular embolotherapy for the treatment of gastrointestinal hemorrhage (GIH) that was unresponsive to internal medicine treatment and gastroscopy management. METHODS: A total of 25 patients with GIH, confirmed using angiography but with failed results after internal medicine treatment or gastroscopy were retrospectively analyzed. A mixture of lipiodol and FAL (1:1) was used to embolize the bleeding vessels...
November 30, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/29191689/does-the-surgical-waiting-list-affect-pathological-and-survival-outcome-in-resectable-pancreatic-ductal-adenocarcinoma
#13
Giovanni Marchegiani, Stefano Andrianello, Giampaolo Perri, Erica Secchettin, Laura Maggino, Giuseppe Malleo, Claudio Bassi, Roberto Salvia
BACKGROUND: High-volume centers have to deal with long surgical waiting-lists leading to a potential delay in treatment. This study assessed whether a longer time from diagnosis to surgery worsened pathological and survival outcomes in resectable pancreatic ductal adenocarcinoma (PDAC). METHODS: A retrospective analysis of patients treated for resectable PDAC. Difference in size between preoperative CT-scan and specimen, pathological features, the rate of vascular and R1 resections as well as recurrence and survival were analyzed depending on the waiting time using a 30-day cut-off...
November 27, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/29191281/adjuvant-or-neoadjuvant-therapy-in-the-treatment-in-pancreatic-malignancies-where-are-we
#14
REVIEW
Robert A Wolff
Since the advent of modern surgery for pancreatic cancer, clinicians have recognized this cancer's propensity to recur locally, metastasize, and cause death. Despite significant efforts to improve patient outcomes with better adjuvant therapy, only modest gains in survival have been observed. An alternative strategy of neoadjuvant therapy followed by surgery has the potential to improve patient selection and survival, and expand the pool of patients eligible for curative surgery. This article summarizes large, randomized trials of adjuvant therapy, explains the limitations imposed by up-front surgery, and suggests neoadjuvant therapy as a rational alternative to initial surgery and adjuvant therapy...
February 2018: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29189330/clinical-management-resectable-disease
#15
Rebekah R White, Andrew M Lowy
Despite the identification of more active systemic therapy combinations for pancreatic cancer, cures remain elusive and feasible only in patients with localized, operable disease. When examining outcome data from phase III adjuvant trials conducted during the past decade, the survival for patients with localized disease has improved, likely owing to a combination of factors including more active adjuvant therapy and improved surgical and perioperative care. Perhaps the greatest recent change in the care of patients with localized pancreatic cancer has been the extension of surgery to tumors previously thought to be inoperable because of involvement of major blood vessels...
November 2017: Cancer Journal
https://www.readbyqxmd.com/read/29188307/-criteria-for-resectability-of-pancreatic-cancer-and-postoperative-imaging
#16
L Grenacher, M Juchems
By improving the techniques of pancreatic surgery, the mortality and morbidity for pancreatic carcinoma could be significantly reduced. For radiologists a profound knowledge of the surgical techniques is of decisive importance. Based on this knowledge postoperative complications can be reliably uncovered and local recurrences can be detected at an early stage. The complications resulting from pancreatic surgery can be severe and often necessitate a radiological intervention. As pancreatic cancer itself is a severe disease with a poor 5‑year survival, which can only be improved by an R0 resection, it is crucial to identify using imaging those patients who are primarily operable or who can potentially achieve an operable condition through neoadjuvant chemotherapy (borderline) and inoperable patients to avoid postoperative complications which would additionally weaken them and result in unnecessary delays in initiating palliative therapy...
November 29, 2017: Der Radiologe
https://www.readbyqxmd.com/read/29186684/pancreatic-adenocarcinoma-therapeutic-targets-revealed-by-tumor-stroma-cross-talk-analyses-in-patient-derived-xenografts
#17
Rémy Nicolle, Yuna Blum, Laetitia Marisa, Celine Loncle, Odile Gayet, Vincent Moutardier, Olivier Turrini, Marc Giovannini, Benjamin Bian, Martin Bigonnet, Marion Rubis, Nabila Elarouci, Lucile Armenoult, Mira Ayadi, Pauline Duconseil, Mohamed Gasmi, Mehdi Ouaissi, Aurélie Maignan, Gwen Lomberk, Jean-Marie Boher, Jacques Ewald, Erwan Bories, Jonathan Garnier, Anthony Goncalves, Flora Poizat, Jean-Luc Raoul, Veronique Secq, Stephane Garcia, Philippe Grandval, Marine Barraud-Blanc, Emmanuelle Norguet, Marine Gilabert, Jean-Robert Delpero, Julie Roques, Ezequiel Calvo, Fabienne Guillaumond, Sophie Vasseur, Raul Urrutia, Aurélien de Reyniès, Nelson Dusetti, Juan Iovanna
Preclinical models based on patient-derived xenografts have remarkable specificity in distinguishing transformed human tumor cells from non-transformed murine stromal cells computationally. We obtained 29 pancreatic ductal adenocarcinoma (PDAC) xenografts from either resectable or non-resectable patients (surgery and endoscopic ultrasound-guided fine-needle aspirate, respectively). Extensive multiomic profiling revealed two subtypes with distinct clinical outcomes. These subtypes uncovered specific alterations in DNA methylation and transcription as well as in signaling pathways involved in tumor-stromal cross-talk...
November 28, 2017: Cell Reports
https://www.readbyqxmd.com/read/29184681/prognostic-impact-of-carbohydrate-antigen-19-9-level-at-diagnosis-in-resected-stage-i-iii-pancreatic-adenocarcinoma-a-u-s-population-study
#18
Katelin A Mirkin, Christopher S Hollenbeak, Joyce Wong
Background: Pancreatic adenocarcinoma is a highly aggressive cancer, with surgical resection and systemic therapy offering the only hope for long-term survival. Carbohydrate antigen 19-9 (CA 19-9) has been used as a prognostic marker after resection; however, the relationship between survival and pre-treatment CA 19-9 level remains unclear. This study evaluates pre-treatment serum CA 19-9 level as a predictor for long-term survival. Methods: The U.S. National Cancer Data Base [2004-2012] was reviewed for patients with clinical stages I-III resected pancreatic adenocarcinoma with recorded pre-treatment CA 19-9 levels (U/mL)...
October 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29184679/outcomes-of-adjuvant-radiotherapy-and-lymph-node-resection-in-elderly-patients-with-pancreatic-cancer-treated-with-surgery-and-chemotherapy
#19
Jessica Frakes, Eric A Mellon, Gregory M Springett, Pamela Hodul, Mokenge P Malafa, William J Fulp, Xiuhua Zhao, Sarah E Hoffe, Ravi Shridhar, Kenneth L Meredith
Background: We sought to determine the effects of post-operative radiation therapy (PORT) and lymph node resection (LNR) on survival in patients ≥70 years with pancreatic cancer treated with surgery and chemotherapy. Methods: An analysis of patients ≥70 years with surgically resected pancreatic cancer who received chemotherapy from the SEER database between 2004-2008 was performed to determine association of PORT and LNR on survival. Results: We identified 961 patients who met inclusion criteria...
October 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29184443/training-surgeons-in-shared-decision-making-with-cancer-patients-aged-65-years-and-older-a-pilot-study
#20
Noralie H Geessink, Yvonne Schoon, Marcel Gm Olde Rikkert, Harry van Goor
Objective: Treatment decision-making in older patients with colorectal (CRC) or pancreatic cancer (PC) needs improvement. We introduced the EASYcare in Geriatric Onco-surgery (EASY-GO) intervention to optimize the shared decision-making (SDM) process among these patients. Methods: The EASY-GO intervention comprised a working method with geriatric assessment and SDM training for surgeons. A non-equivalent control group design was used. Newly diagnosed CRC/PC patients aged ≥65 years were included...
2017: Cancer Management and Research
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