Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy: A Single-Center Experience.

Autor: Theijse RT; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., Stoop TF; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., Leenart PD; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., Lutchman KRD; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., Erdmann JI; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., Daams F; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands., Zonderhuis BM; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands., Festen S; Department of Surgery, OLVG, Amsterdam, The Netherlands., Swijnenburg RJ; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands., van Gulik TM; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., Schoorlemmer A; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., Sterk ALA; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., van Dieren S; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands., Fariña A; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Department of Pathology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands., Voermans RP; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands., Wilmink JW; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands., Kazemier G; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands., Busch OR; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands., Besselink MG; Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV, Amsterdam, The Netherlands. m.g.besselink@amsterdamUMC.nl.; Cancer Center Amsterdam, 1081 HV, Amsterdam, The Netherlands. m.g.besselink@amsterdamUMC.nl.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Sep; Vol. 31 (9), pp. 6180-6192. Date of Electronic Publication: 2024 Jul 02.
DOI: 10.1245/s10434-024-15591-4
Abstrakt: Background: The use of surgery in patients with locally advanced pancreatic cancer (LAPC) following induction chemotherapy is increasing. However, most series do not report on the total cohort of patients undergoing surgical exploration; therefore, this single-center study investigates outcomes among all consecutive patients with LAPC who underwent surgical exploration.
Methods: We conducted a retrospective, single-center analysis including all consecutive patients with LAPC (Dutch Pancreatic Cancer Group criteria) who underwent surgical exploration with curative intent (January 2014-June 2023) after induction therapy. Primary outcomes were resection rate and overall survival (OS) from the time of diagnosis.
Results: Overall, 127 patients underwent surgical exploration for LAPC, whereby 100 patients (78.7%) underwent resection and 27 patients (21.3%) underwent a non-therapeutic laparotomy due to the extent of vascular involvement (n = 11, 8.7%) or occult metastases (n = 16, 12.6%). The overall in-hospital/30-day mortality rate was 0.8% and major morbidity was 31.3% (in patients after resection: 1.0% and 33.3%, respectively). The overall 90-day mortality rate was 5.5%, which included 3.1% mortality due to disease progression. Resection was associated with longer median OS {29 months (95% confidence interval [CI] 26-43) vs. 17 months (95% CI 11-26); p < 0.001} compared with patients undergoing non-therapeutic laparotomy, with corresponding 5-year OS rates of 28.4% and 7.7%. In Cox proportional hazard regression analysis, only pancreatic body/tail tumors independently predicted OS (hazard ratio 1.788 [95% CI 1.042-3.068]).
Conclusion: This single-center series found a resection rate of 78.7% in patients with LAPC selected for surgical exploration, with a low risk of mortality and morbidity in all explored patients and a 5-year OS rate after resection of 28.4%.
(© 2024. The Author(s).)
Databáze: MEDLINE
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