Management of Locally Advanced Pancreatic Cancer: Results of an International Survey of Current Practice.

Published on Aug 21, 2019in Annals of Surgery10.13
· DOI :10.1097/SLA.0000000000003568
Bradley N. Reames2
Estimated H-index: 2
(UNMC: University of Nebraska Medical Center),
Bradley N. Reames19
Estimated H-index: 19
(UNMC: University of Nebraska Medical Center)
+ 9 AuthorsJin He40
Estimated H-index: 40
(Johns Hopkins University)
Sources
Abstract
MiniAn international survey of high-volume pancreas cancer surgeons revealed wide variations in management preferences, attitudes regarding contraindications to surgery, and the propensity to offer exploration. When presented with 6 hypothetical clinical vignettes using details from real patients th
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References2
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#1Mark J. TrutyH-Index: 31
#2Michael L. KendrickH-Index: 58
Last. Axel GrotheyH-Index: 86
view all 14 authors...
MiniTotal neoadjuvant therapy, or systemic induction chemotherapy followed by chemoradiation, is an optimal preoperative sequencing strategy for patients with borderline resectable or locally advanced pancreatic adenocarcinoma. This strategy allows high rate of negative margins despite low frequency
72 CitationsSource
#1Weiwei JinH-Index: 1
#2Tom Tan-To Cheung (HKU: University of Hong Kong)H-Index: 2
Last. Yiping MouH-Index: 1
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1 CitationsSource
#1Jörg Kleeff (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 94
#2Ulrich Ronellenfitsch (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 22
Last. Christoph W. Michalski (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 49
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2 CitationsSource
#1Camille L. Stewart (City of Hope National Medical Center)H-Index: 13
#2Philip H.G. Ituarte (City of Hope National Medical Center)H-Index: 30
Last. Yanghee Woo (City of Hope National Medical Center)H-Index: 22
view all 8 authors...
Background Robotic surgery is offered at most major medical institutions. The extent of its use within general surgical oncology, however, is poorly understood. We hypothesized that robotic surgery adoption in surgical oncology is increasing annually, that is occurring in all surgical sites, and all regions of the US.
30 CitationsSource
#1Georgios Gemenetzis (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 17
#2Vincent P. Groot (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 16
Last. Jin He (Johns Hopkins University)H-Index: 40
view all 14 authors...
Objective:The aim of the study was to identify the survival of patients with locally advanced pancreatic cancer (LAPC) and assess the effect of surgical resection after neoadjuvant therapy on patient outcomes.Background:An increasing number of LAPC patients who respond favorably to neoadjuvant thera
86 CitationsSource
#1Stefan HeinrichH-Index: 33
#2Marc G. Besselink (UvA: University of Amsterdam)H-Index: 84
Last. Mickael Lesurtel (University of Lyon)H-Index: 36
view all 10 authors...
Background Several new treatment options have become available for pancreatic ductal adenocarcinoma (PDAC), but the support for their use for resectable, borderline resectable and locally advanced PDAC is unclear.
8 CitationsSource
#1Jakob Kirkegård (Aarhus University Hospital)H-Index: 10
#2Eirik Kjus AahlinH-Index: 6
Last. Frank Viborg Mortensen (Aarhus University Hospital)H-Index: 23
view all 16 authors...
Background: Multidisciplinary team (MDT) meetings have been adopted widely to ensure optimal treatment for patients with cancer. Agreements in tumour staging, resectability assessments and treatment allocation between different MDTs were assessed. Methods: Of all patients referred to one hospital, 19 patients considered to have non-metastatic pancreatic cancer for evaluation were selected randomly for a multicentre study of MDT decisions in seven units across Northern Europe. Anonymized clinical...
14 CitationsSource
#1Rebecca L. Siegel (ACS: American Cancer Society)H-Index: 67
#2Kimberly D. Miller (ACS: American Cancer Society)H-Index: 28
Last. Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
view all 3 authors...
: Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the Nati...
8,491 CitationsSource
#1Michele Reni (UniSR: Vita-Salute San Raffaele University)H-Index: 68
#2Silvia Zanon (UniSR: Vita-Salute San Raffaele University)H-Index: 9
Last. Luca Gianni (UniSR: Vita-Salute San Raffaele University)H-Index: 85
view all 17 authors...
Abstract Background The current trial assessed whether the addition of cisplatin and capecitabine to the nab-paclitaxel–gemcitabine backbone is feasible and active against borderline and locally advanced pancreatic adenocarcinoma (PDAC). Method Fifty-four chemo-naive patients, aged between 18 and 75 years, with a pathological diagnosis of locally advanced or borderline resectable PDAC were randomised to receive either nab-paclitaxel, gemcitabine, cisplatin and oral capecitabine (PAXG; arm A; N =...
14 CitationsSource
#1Georgios Gemenetzis (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 17
#2Vincent P. Groot (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 16
Last. Christopher L. WolfgangH-Index: 102
view all 13 authors...
OBJECTIVES: Previous retrospective studies demonstrated that circulating tumor cells (CTCs) subtypes correlate with overall survival in patients with pancreatic ductal adenocarcinoma (PDAC). Herein, we report results of a prospective observational study on CTCs dynamics to assess their clinical significance. METHODS: The CLUSTER study is a prospective longitudinal study on PDAC CTCs dynamics (NCT02974764). Multiple peripheral blood samples were collected from 200 consecutively enrolled patients ...
44 CitationsSource
Cited By14
Newest
#1Vincenza GranataH-Index: 20
#2Roberta Grassi (Seconda Università degli Studi di Napoli)H-Index: 10
Last. Francesco IzzoH-Index: 48
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BACKGROUND Currently, the technologies most commonly used to treat locally advanced pancreatic cancer are radiofrequency ablation (RFA), microwave ablation, and irreversible (IRE) or reversible electroporation combined with low doses of chemotherapeutic drugs. AIM To report an overview and updates on ablative techniques in pancreatic cancer. METHODS Several electronic databases were searched. The search covered the years from January 2000 to January 2021. Moreover, the reference lists of the fou...
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#1Lilly J Brada (UvA: University of Amsterdam)H-Index: 1
#2M.S. Walma (UvA: University of Amsterdam)H-Index: 1
Last. Sebastiaan FestenH-Index: 21
view all 0 authors...
BACKGROUND AND OBJECTIVES Patients with locally advanced pancreatic cancer (LAPC) are increasingly treated with FOLFIRINOX, resulting in improved survival and resection of tumors that were initially unresectable. It remains unclear, however, which specific patients benefit from FOLFIRINOX. Two nomograms were developed predicting overall survival (OS) and resection at the start of FOLFIRINOX for LAPC. METHODS From our multicenter, prospective LAPC registry in 14 Dutch hospitals, LAPC patients sta...
Source
#1Wilson Luiz da Costa (BCM: Baylor College of Medicine)H-Index: 10
#2Hop S. Tran Cao (University of Texas MD Anderson Cancer Center)H-Index: 22
Last. Nader N. Massarweh (BCM: Baylor College of Medicine)H-Index: 23
view all 6 authors...
Neoadjuvant therapy (NAT) is increasingly being used in the management of patients with resectable pancreatic ductal adenocarcinoma (PDAC); however, there is a lack of evidence regarding the benefit among these patients. The aim of this study was to evaluate overall survival (OS) in PDAC patients with resectable disease treated with NAT or upfront resection through instrumental variable (IV) analysis. A national cohort study of resectable PDAC patients in the National Cancer Data Base (2007–2015...
2 CitationsSource
#1Alex B. Blair (Johns Hopkins University)H-Index: 17
#2Robert W. KrellH-Index: 17
Last. Bradley N. Reames (UNMC: University of Nebraska Medical Center)H-Index: 3
view all 12 authors...
BACKGROUND AND PURPOSE There is limited high-level evidence to guide locally advanced pancreas cancer (LAPC) management. Recent work shows that surgeons' preferences in LAPC management vary broadly. We sought to examine whether surgeon volume was associated with attitudes regarding LAPC management. METHODS An electronic survey was distributed by email to an international cohort of pancreas surgeons to evaluate practice patterns regarding LAPC management. Clinical vignette-based questions evaluat...
Source
#1Ibrahim Nassour (University of Pittsburgh)H-Index: 15
#2Samer Tohme (University of Pittsburgh)H-Index: 20
Last. Paniccia Alessandro (University of Pittsburgh)H-Index: 1
view all 6 authors...
BACKGROUND: Emerging data from multi-institutional and national databases suggest that robotic pancreaticoduodenectomy is safe and feasible for pancreatic adenocarcinoma. Nevertheless, there are limited reports evaluating its safety and oncologic efficacy following neoadjuvant chemotherapy. METHOD: This is a retrospective study from the 2010-2016 National Cancer Database comparing the postoperative, pathological and long-term oncologic outcomes between robotic pancreaticoduodenectomy (RPD) and o...
2 CitationsSource
#1Marc A Attiyeh (City of Hope National Medical Center)
#2Arya Amini (City of Hope National Medical Center)H-Index: 22
Last. Laleh G. Melstrom (City of Hope National Medical Center)H-Index: 29
view all 4 authors...
The annual incidence of pancreatic cancer is nearly 50,000 patients. The 5-year overall survival is only 9%, and there remains a great need for better therapy. A subset of these patients presents with locally advanced disease. Multidisciplinary therapy has evolved to include some combination of systemic chemotherapy, locoregional radiation, and surgery in select patients with excellent biology. This review will address the thoughtful evidence-based and individualized approach to these patients.
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Summary Background The optimal preoperative treatment for locally advanced pancreatic cancer is unknown. We aimed to compare the efficacy and safety of nab-paclitaxel plus gemcitabine with nab-paclitaxel plus gemcitabine followed by fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) as multidrug induction chemotherapy regimens in locally advanced pancreatic cancer. Methods In this open-label, multicentre, randomised phase 2 study, done at 28 centres in Germany, eligible patients ...
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#1Robert W. KrellH-Index: 17
#2Logan R. McNeil (UNMC: University of Nebraska Medical Center)H-Index: 1
Last. Bradley N. Reames (UNMC: University of Nebraska Medical Center)H-Index: 19
view all 5 authors...
BACKGROUND The use of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) is increasing. While there is an association between NAT and improved post-pancreatectomy complication rates in limited patient populations, the strength of the relationship and its applicability to a broader and modern pancreatectomy cohort remains unclear. METHODS We used the 2014-2018 American College of Surgeons National Surgical Quality Improvement Project to evaluate NAT use for PDAC patients underg...
3 CitationsSource
#1Lilly J Brada (UvA: University of Amsterdam)H-Index: 1
#2M.S. Walma (UvA: University of Amsterdam)H-Index: 1
Last. I.Q. MolenaarH-Index: 4
view all 27 authors...
Abstract Background The treatment options for patients with locally advanced pancreatic cancer (LAPC) have improved in recent years and consequently survival has increased. It is unknown, however, if elderly patients benefit from these improvements in therapy. With the ongoing aging of the patient population and an increasing incidence of pancreatic cancer, this patient group becomes more relevant. This study aims to clarify the association between increasing age, treatment and overall survival ...
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