Downstaging in Stage IV Pancreatic Cancer: A New Population Eligible for Surgery?

Annals of Surgical Oncology
Isabella FrigerioGiovanni Butturini

Abstract

Recent papers consider surgery as an option for synchronous liver oligometastatic patients [metastatic pancreatic ductal adenocarcinoma (mPDAC)]. In this study, we present our series of resected mPDACs after neoadjuvant chemotherapy (nCT). All patients resected after downstaging of mPDAC were included in this study. Downstaging criteria were disappearance of liver metastasis and a decrease in cancer antigen (CA) 19-9. The type and duration of nCT, last nCT surgery interval, histology, morbidity, and mortality were recorded, and overall survival (OS) and disease-free survival (DFS) were analyzed. Overall, 24 of 535 patients (4.5%) observed with mPDAC were included. These patients received gemcitabine alone (5/24), gemcitabine + nanoparticle albumin-bound (nab)-paclitaxel (3/24), and FOLFIRINOX (16/24). Primary tumor size decreased from 31 to 19 mm (p < 0.001), and serum CA19-9 decreased from 596 to 18 U/mL (p < 0.001). In 14/24 patients, the tumor was located in the head. Median interval nCT surgery was 2 months, there were no mortalities, and the postoperative course was uneventful in 34% of cases. Grade B/C pancreatic fistula, postoperative bleeding, and sepsis occurred in 17/4, 4, and 12% of cases, respectively, and reoperati...Continue Reading

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Citations

Mar 21, 2018·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·F GebauerC Bruns
Jan 3, 2019·Minerva chirurgica·Victor Lopez-LopezPascual Parrilla
Jan 23, 2019·AJR. American Journal of Roentgenology·Alejandro Garces-DescovichKoenraad J Mortele
Aug 28, 2018·World Journal of Gastrointestinal Oncology·Rachael Chang LeeTimothy J Price
Nov 14, 2019·Journal of Clinical Medicine·Thomas Hank, Oliver Strobel
Jan 1, 2020·BMC Cancer·Alexander I DamanakisFelix Popp
Nov 27, 2020·Cancer Control : Journal of the Moffitt Cancer Center·Wentao ZhouWenhui Lou
Nov 18, 2020·Journal of Hepato-biliary-pancreatic Sciences·Masakazu YamamotoTadahiro Takada
Oct 30, 2020·Frontiers in Pharmacology·Mingxing WangDongsheng Huang
Feb 4, 2021·Annals of Gastroenterological Surgery·Keinosuke IshidoTaiichi Wakiya
Oct 27, 2020·Canadian Journal of Gastroenterology & Hepatology·Antonella ArgentieroOronzo Brunetti
Jun 2, 2021·Seminars in Oncology·Johannes KloseJörg Kleeff
Nov 13, 2020·Visceral Medicine·Stefan HeinrichHauke Lang

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