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Surgical Treatment of Pancreatic Ductal Adenocarcinoma

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (10 February 2021) | Viewed by 39787

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Special Issue Editor

Prof. Dr. Sohei Satoi

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Guest Editor

Department of Surgery, Kansai Medical University, Osaka 573-1191, Japan
Interests: pancreatic surgery; pancreatic cancer; IPMN; clinical pathway for pancreatic disease in the clinical setting

Special Issue Information

Dear Colleagues,

Surgical resection has been the only chance for a cure in patients with pancreatic ductal adenocarcinoma (PDAC) in recent decades, but the 5-year survival rate is still low (approximately 20%) in PDAC patients who have undergone margin-negative resection only.

A multimodal approach is widely accepted for treating PDAC in the modern era. Implementation of adjuvant chemotherapy or neo-adjuvant treatment has dramatically been enhanced to increase the long-term survival rate of patients with resectable, borderline resectable, and unresectable PDAC in the world. Margin-negative surgical resection still plays a pivotal role in multimodal treatment in patients with PDAC. Therefore, a growing amount of interest has focused on the optimization of the perioperative therapeutic strategy, including regimens of chemo(radio)therapy, introduction of extended pancreatectomy, and advanced peri-operative managements.

This Special Issue will highlight the role of surgical resection during multimodal treatments in patients with PDAC from resectable to unresectable diseases for advancing our understanding of surgical treatment of PDAC.

Prof. Dr. Sohei Satoi
Guest Editor

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Keywords

extended pancreatectomy
adjuvant therapy
neo-adjuvant therapy
multimodal treatment
resectable PDAC
borderline resectable PDAC
unresectable PDAC

Published Papers (14 papers)

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Editorial

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4 pages, 165 KiB

Open AccessEditorial

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

by Sohei Satoi

Cancers 2021, 13(16), 4015; https://doi.org/10.3390/cancers13164015 - 10 Aug 2021

Cited by 6 | Viewed by 1260

Abstract

This special issue, “Surgical Treatment of Pancreatic Ductal Adenocarcinoma” contains 13 articles (five original articles, five reviews, and three systematic reviews/meta-analyses) authored by international leaders and surgeons who treat patients with pancreatic ductal adenocarcinoma (PDAC) [...] Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

Research

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15 pages, 11130 KiB

Open AccessArticle

Clinical Benefits of Conversion Surgery for Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Institution, Retrospective Analysis

by Yuko Mataki, Hiroshi Kurahara, Tetsuya Idichi, Kiyonori Tanoue, Yuto Hozaka, Yota Kawasaki, Satoshi Iino, Kosei Maemura, Hiroyuki Shinchi and Takao Ohtsuka

Cancers 2021, 13(5), 1057; https://doi.org/10.3390/cancers13051057 - 2 Mar 2021

Cited by 8 | Viewed by 2154

Abstract

Background: Unresectable pancreatic ductal adenocarcinoma (UR-PDAC) has a poor prognosis. Conversion surgery is considered a promising strategy for improving the prognosis of UR-PDAC. This study aimed to investigate the clinical benefits of conversion surgery in patients with UR-PDAC. Methods: We retrospectively evaluated patients with PDAC who were referred to our department for possible surgical resection between January 2006 and December 2019. Conversion surgery was performed only in patients with UR-PDAC who could expect R0 resection. We analyzed the prognostic factors for overall survival among patients who underwent conversion surgery. Results: Overall, 638 patients with advanced pancreatic cancer were enrolled in this study. According to resectability, resectable cancer (R) was present in 180 patients, borderline resectable cancer (BR) was present in 60 patients, unresectable locally advanced cancer (UR-LA) was present in 252 patients, and unresectable cancer with distant metastasis (UR-M) was present in 146 patients. Conversion surgery was performed in 20 of the 398 UR cases (5.1%). The median period between the initial therapy and conversion surgery was 15.5 months. According to the Response Evaluation Criteria in Solid Tumors (RECIST) evaluation, the treatment response was CR in one patient, PR in 13, SD in five, and PD in one. Downstaging was pathologically determined in all cases. According to the Evans grading system, grade I was observed in four patients (20%), grade IIb was observed in seven (35%), III was observed in seven (35%), and IV was observed in two (10%). We compared the overall survival period from initial treatment among patients undergoing conversion surgery; the median overall survival durations in the conversion surgery, R, BR, UR-LA, and UR-M groups were 73.7, 32.7, 22.7, 15.7, and 8.8 months, respectively. Multivariate analysis revealed that the presence or absence of chemoradiotherapy (CRT) and the RECIST partial response (PR)/complete response (CR) for the main tumor were statistically significant prognostic factors for overall survival among patients undergoing conversion surgery (p = 0.004 and 0.03, respectively). Conclusion: In UR-PDAC, it is important to perform multidisciplinary treatment, including CRT with conversion surgery. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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16 pages, 1166 KiB

Open AccessArticle

Optimal Preoperative Multidisciplinary Treatment in Borderline Resectable Pancreatic Cancer

by Nana Kimura, Suguru Yamada, Hideki Takami, Kenta Murotani, Isaku Yoshioka, Kazuto Shibuya, Fuminori Sonohara, Yui Hoshino, Katsuhisa Hirano, Toru Watanabe, Hayato Baba, Kosuke Mori, Takeshi Miwa, Mitsuro Kanda, Masamichi Hayashi, Koshi Matsui, Tomoyuki Okumura, Yasuhiro Kodera and Tsutomu Fujii

Cancers 2021, 13(1), 36; https://doi.org/10.3390/cancers13010036 - 24 Dec 2020

Cited by 12 | Viewed by 2222

Abstract

Background: The objective of this study was to investigate the optimal neoadjuvant therapy (NAT) for borderline resectable pancreatic cancer invading the portal vein (BR-PV) or abutting major arteries (BR-A). Methods: We retrospectively analyzed 88 patients with BR-PV and 111 patients with BR-A. Results: In BR-PV patients who underwent upfront surgery (n = 46)/NAT (n = 42), survival was significantly better in the NAT group (3-year overall survival (OS): 5.8%/35.5%, p = 0.004). In BR-A patients who underwent upfront surgery (n = 48)/NAT (n = 63), survival was also significantly better in the NAT group (3-year OS:15.5%/41.7%, p < 0.001). The prognosis tended to be better in patients who received newer chemotherapeutic regimens, such as FOLFIRINOX and gemcitabine with nab-paclitaxel. In 36 BR-PV patients who underwent surgery after NAT, univariate analysis revealed that normalization of tumor marker (TM) levels (p = 0.028) and preoperative high prognostic nutritional index (PNI) (p = 0.022) were significantly associated with a favorable prognosis. In 39 BR-A patients who underwent surgery after NAT, multivariate analysis revealed that preoperative PNI > 42.5 was an independent prognostic factor (HR: 0.15, p = 0.014). Conclusions: NAT using newer chemotherapy is essential for improving the prognosis of BR pancreatic cancer. These findings suggest that prognosis may be prolonged by maintaining good nutritional status during preoperative treatment. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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17 pages, 2732 KiB

Open AccessArticle

Predictive Features of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Meta-Analysis

by Wooil Kwon, Youngmin Han, Yoonhyeong Byun, Jae Seung Kang, Yoo Jin Choi, Hongbeom Kim and Jin-Young Jang

Cancers 2020, 12(9), 2618; https://doi.org/10.3390/cancers12092618 - 14 Sep 2020

Cited by 16 | Viewed by 3487

Abstract

The current guidelines on branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) recommend various predictive features of malignancy as well as different treatment strategies. This study aimed to identify the risk factors for malignancy with higher level of evidence. A meta-analysis was performed on 40 literatures published between 2000 and 2019. These literatures included 6301 patients with pathologically proven IPMN. Malignancy was defined as high-grade dysplasia and invasive carcinoma. It was significantly associated with symptoms (odds ratio [OR] 1.35, confidence interval [CI] 1.01–1.79), size ≥ 3 cm (OR 1.90, CI 1.51–2.40), cystic wall thickening (OR 2.53, CI 1.50–4.27), mural nodule (OR 4.10, CI 3.38–4.97), main pancreatic duct dilatation (OR 2.98, CI 2.11–4.21), abrupt caliber change of the pancreatic duct (OR 7.41, CI 2.49–22.06), lymphadenopathy (OR 8.55, CI 3.25–22.51), elevated carbohydrate antigen 19-9 (OR 4.01, CI 2.55–6.28), and elevated carcinoembryonic antigen (OR 2.04, CI 1.60–2.61). Multilocular cysts and multiple cysts did not show a significant association with malignancy. This study examined the clinical, radiological, and biochemical features of BD-IPMN, often used as malignancy predictors according to the widely used guidelines. The results confirmed that all the features currently being used are valid. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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14 pages, 817 KiB

Open AccessArticle

The Role of Location of Tumor in the Prognosis of the Pancreatic Cancer

by Mirang Lee, Wooil Kwon, Hongbeom Kim, Yoonhyeong Byun, Youngmin Han, Jae Seung Kang, Yoo Jin Choi and Jin-Young Jang

Cancers 2020, 12(8), 2036; https://doi.org/10.3390/cancers12082036 - 24 Jul 2020

Cited by 14 | Viewed by 3741

Abstract

Identification of prognostic factors is important to improve treatment outcomes in pancreatic cancer. This study aimed to investigate the effect of the location of pancreatic cancer on survival and to determine whether it was a significant prognostic factor. Altogether, 2483 patients diagnosed with pancreatic cancer were examined. Comparative analysis of clinicopathologic characteristics, survival analysis, and multivariate analysis were performed. Cancers of the pancreatic head or the uncinate process were present in 49.5% of patients. The head/uncinate cancers had more clinical T1/T2 tumors (59.4% vs. 35.5%, p < 0.001) and a significantly higher 5-year survival rate (8.9% vs. 7.3%, p < 0.001) than the body/tail cancers. The 5-year survival rate in patients with head/uncinate cancers was significantly lower in the resectable (p = 0.014) and the locally advanced groups (p = 0.007). In patients who underwent resection with curative intent, the 5-year survival rate was lower in the head/uncinate group (p = 0.046). The overall outcome of the head/uncinate cancers was better than the body/tail cancers, due to the high proportion of resectable cases. In patients who underwent curative resection, the head/uncinate cancers had a higher number of T1/T2 tumors, but worse outcomes. In the multivariate analysis, tumor location was not an independent prognostic factor for pancreatic cancer. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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12 pages, 1241 KiB

Open AccessArticle

Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma

by Hiroaki Yanagimoto, Sohei Satoi, Tomohisa Yamamoto, So Yamaki, Satoshi Hirooka, Masaya Kotsuka, Hironori Ryota, Mitsuaki Ishida, Yoichi Matsui and Mitsugu Sekimoto

Cancers 2020, 12(6), 1428; https://doi.org/10.3390/cancers12061428 - 31 May 2020

Cited by 11 | Viewed by 2201

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. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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Review

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16 pages, 5136 KiB

Open AccessReview

Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment

by Yuichi Nagakawa, Naoya Nakagawa, Chie Takishita, Ichiro Uyama, Shingo Kozono, Hiroaki Osakabe, Kenta Suzuki, Nobuhiko Nakagawa, Yuichi Hosokawa, Tomoki Shirota, Masayuki Honda, Tesshi Yamada, Kenji Katsumata and Akihiko Tsuchida

Cancers 2021, 13(14), 3605; https://doi.org/10.3390/cancers13143605 - 19 Jul 2021

Cited by 4 | Viewed by 3912

Abstract

Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by chemotherapy. The survival benefit of “regional lymph node dissection” for pancreatic head cancer remains unclear. We reviewed the literature that could be helpful in determining the appropriate resection range. Regional lymph nodes with no suspected metastases on preoperative imaging may become areas treated with preoperative and postoperative adjuvant chemotherapy. Many studies have reported that the R0 resection rate is associated with prognosis. Thus, “dissection to achieve R0 resection” is required. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Therefore, it is possible to simulate the dissection range to achieve R0 resection preoperatively. However, it is often difficult to distinguish between areas of inflammatory changes and cancer infiltration during resection. Even if the “dissection to achieve R0 resection” range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of anatomical landmarks to determine the appropriate dissection range during surgery. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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16 pages, 1757 KiB

Open AccessReview

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

by Kongyuan Wei and Thilo Hackert

Cancers 2021, 13(8), 1971; https://doi.org/10.3390/cancers13081971 - 20 Apr 2021

Cited by 20 | Viewed by 3327

Abstract

Pancreatic ductal adenocarcinoma (PDAC) represents an aggressive tumor of the digestive system with still low five-year survival of less than 10%. Although there are improvements for multimodal therapy of PDAC, surgery still remains the effective way to treat the disease. Combined with adjuvant and/or neoadjuvant treatment, pancreatic surgery is able to enhance the five-year survival up to around 20%. However, pancreatic resection is always associated with a high risk of complications and regarded as one of the most complex fields in abdominal surgery. This review gives a summary on the surgical treatment for PDAC based on the current literature with a special focus on resection techniques. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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16 pages, 890 KiB

Open AccessReview

Radical Resection for Locally Advanced Pancreatic Cancers in the Era of New Neoadjuvant Therapy—Arterial Resection, Arterial Divestment and Total Pancreatectomy

by Yosuke Inoue, Atushi Oba, Yoshihiro Ono, Takafumi Sato, Hiromichi Ito and Yu Takahashi

Cancers 2021, 13(8), 1818; https://doi.org/10.3390/cancers13081818 - 10 Apr 2021

Cited by 16 | Viewed by 3291

Abstract

Aggressive arterial resection (AR) or total pancreatectomy (TP) in surgical treatment for locally advanced pancreatic cancer (LAPC) had long been discouraged because of their high mortality rate and unsatisfactory long-term outcomes. Recently, new chemotherapy regimens such as FOLFIRINOX or Gemcitabine and nab-paclitaxel have provided more adequate patient selection and local tumor suppression, justifying aggressive local resection. In this review, we investigate the recent reports focusing on arterial resection and total pancreatectomy for LAPC and discuss the rationale of such an aggressive approach in the treatment of PC. AR for LAPCs is divided into three, according to the target vessel. The hepatic artery resection is the simplest one, and the reconstruction methods comprise end-to-end, graft or transposition, and no reconstruction. Celiac axis resection is mainly done with distal pancreatectomy, which allows collateral arterial supply to the liver via the pancreas head. Resection of the superior mesenteric artery is increasingly reported, though its rationale is still controversial. Total pancreatectomy has been re-evaluated as an effective option to balance both the local control and postoperative safety. In conclusion, more and more aggressive pancreatectomy has become justified by the principle of total neoadjuvant therapy. Further technical standardization and optimal neoadjuvant strategy are mandatory for the global dissemination of aggressive pancreatectomies. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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24 pages, 781 KiB

Open AccessReview

Achieving ‘Marginal Gains’ to Optimise Outcomes in Resectable Pancreatic Cancer

by Sarah Powell-Brett, Rupaly Pande and Keith J. Roberts

Cancers 2021, 13(7), 1669; https://doi.org/10.3390/cancers13071669 - 1 Apr 2021

Cited by 4 | Viewed by 2000

Abstract

Improving outcomes among patients with resectable pancreatic cancer is one of the greatest challenges of modern medicine. Major improvements in survival will result from the development of novel therapies. However, optimising existing pathways, so that patients realise benefits of already proven treatments, presents a clear opportunity to improve outcomes in the short term. This narrative review will focus on treatments and interventions where there is a clear evidence base to improve outcomes in pancreatic cancer, and where there is also evidence of variation and under-treatment. Avoidance of preoperative biliary drainage, treatment of pancreatic exocrine insufficiency, prehabiliation and enhanced recovery after surgery, reducing perioperative complications, optimising opportunities for elderly patients to receive therapy, optimising adjuvant chemotherapy and regular surveillance after surgery are some of the strategies discussed. Each treatment or pathway change represents an opportunity for marginal gain. Accumulation of marginal gains can result in considerable benefit to patients. Given that these interventions already have evidence base, they can be realised quickly and economically. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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20 pages, 3787 KiB

Open AccessReview

Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma?

by Chang Moo Kang and Woo Jung Lee

Cancers 2020, 12(11), 3430; https://doi.org/10.3390/cancers12113430 - 18 Nov 2020

Cited by 11 | Viewed by 2532

Abstract

Margin-negative radical pancreatectomy is the essential condition to obtain long-term survival of patients with pancreatic cancer. With the investigation for early diagnosis, introduction of potent chemotherapeutic agents, application of neoadjuvnat chemotherapy, advancement of open and laparoscopic surgical techniques, mature perioperative management, and patients’ improved general conditions, survival of the resected pancreatic cancer is expected to be further improved. According to the literatures, laparoscopic pancreaticoduodenectomy (LPD) is also thought to be good alternative strategy in managing well-selected resectable pancreatic cancer. LPD with combined vascular resection is also feasible, but only expert surgeons should handle these challenging cases. LPD for pancreatic cancer should be determined based on surgeons’ proficiency to fulfil the goals of the patient’s safety and oncologic principles. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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Other

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21 pages, 3901 KiB

Open AccessSystematic Review

Meta-Analysis of Circulating Cell-Free DNA’s Role in the Prognosis of Pancreatic Cancer

by Jelena Milin-Lazovic, Petar Madzarevic, Nina Rajovic, Vladimir Djordjevic, Nikola Milic, Sonja Pavlovic, Nevena Veljkovic, Natasa M. Milic and Dejan Radenkovic

Cancers 2021, 13(14), 3378; https://doi.org/10.3390/cancers13143378 - 6 Jul 2021

Cited by 9 | Viewed by 2861

Abstract

Introduction: The analysis of cell-free DNA (cfDNA) for genetic abnormalities is a promising new approach for the diagnosis and prognosis of pancreatic cancer patients. Insights into the molecular characteristics of pancreatic cancer may provide valuable information, leading to its earlier detection and the development of targeted therapies. Material and Methods: We conducted a systematic review and a meta-analysis of studies that reported cfDNA in pancreatic ductal adenocarcinoma (PDAC). The studies were considered eligible if they included patients with PDAC, if they had blood tests for cfDNA/ctDNA, and if they analyzed the prognostic value of cfDNA/ctDNA for patients’ survival. The studies published before 22 October 2020 were identified through the PubMED, EMBASE, Web of Science and Cochrane Library databases. The assessed outcomes were the overall (OS) and progression-free survival (PFS), expressed as the log hazard ratio (HR) and standard error (SE). The summary of the HR effect size was estimated by pooling the individual trial results using the Review Manager, version 5.3, Cochrane Collaboration. The heterogeneity was assessed using the Cochran Q test and I² statistic. Results: In total, 48 studies were included in the qualitative review, while 44 were assessed in the quantitative synthesis, with the total number of patients included being 3524. Overall negative impacts of cfDNA and KRAS mutations on OS and PFS in PDAC (HR = 2.42, 95% CI: 1.95–2.99 and HR = 2.46, 95% CI: 2.01–3.00, respectively) were found. The subgroup analysis of the locally advanced and metastatic disease presented similar results (HR = 2.51, 95% CI: 1.90–3.31). In the studies assessing the pre-treatment presence of KRAS, there was a moderate to high degree of heterogeneity (I² = 87% and I² = 48%, for OS and PFS, respectively), which was remarkably decreased in the analysis of the studies measuring post-treatment KRAS (I² = 24% and I² = 0%, for OS and PFS, respectively). The patients who were KRAS positive before but KRAS negative after treatment had a better prognosis than the persistently KRAS-positive patients (HR = 5.30, 95% CI: 1.02–27.63). Conclusion: The assessment of KRAS mutation by liquid biopsy can be considered as an additional tool for the estimation of the disease course and outcome in PDAC patients. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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13 pages, 3949 KiB

Open AccessSystematic Review

Ductal Dilatation of ≥5 mm in Intraductal Papillary Mucinous Neoplasm Should Trigger the Consideration for Pancreatectomy: A Meta-Analysis and Systematic Review of Resected Cases

by Y.H. Andrew Wu, Atsushi Oba, Laurel Beaty, Kathryn L. Colborn, Salvador Rodriguez Franco, Ben Harnke, Cheryl Meguid, Daniel Negrini, Roberto Valente, Steven Ahrendt, Richard D. Schulick and Marco Del Chiaro

Cancers 2021, 13(9), 2031; https://doi.org/10.3390/cancers13092031 - 22 Apr 2021

Cited by 10 | Viewed by 3478

Abstract

Intraductal papillary mucinous neoplasms (IPMN) are common but difficult to manage since accurate tools for diagnosing malignancy are unavailable. This study tests the diagnostic value of the main pancreatic duct (MPD) diameter for detecting IPMN malignancy using a meta-analysis of published data of resected IPMNs. Collected from a comprehensive literature search, the articles included in this analysis must report malignancy cases (high-grade dysplasia (HGD) and invasive carcinoma (IC)) and MPD diameter so that two MPD cut-offs could be created. The sensitivity, specificity, and odds ratios of the two cutoffs for predicting malignancy were calculated. A review of 1493 articles yielded 20 retrospective studies with 3982 resected cases. A cutoff of ≥5 mm is more sensitive than the ≥10 mm cutoff and has pooled sensitivity of 72.20% and 75.60% for classification of HGD and IC, respectively. Both MPD cutoffs of ≥5 mm and ≥10 mm were associated with malignancy (OR = 4.36 (95% CI: 2.82, 6.75) vs. OR = 3.18 (95% CI: 2.25, 4.49), respectively). The odds of HGD and IC for patients with MPD ≥5 mm were 5.66 (95% CI: 3.02, 10.62) and 7.40 (95% CI: 4.95, 11.06), respectively. OR of HGD and IC for MPD ≥10 mm cutoff were 4.36 (95% CI: 3.20, 5.93) and 4.75 (95% CI: 2.39, 9.45), respectively. IPMN with MPD of >5 mm could very likely be malignant. In selected IPMN patients, pancreatectomy should be considered when MPD is >5 mm. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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10 pages, 1596 KiB

Open AccessSystematic Review

Systematic Review and Meta-Analysis of Surgical Treatment for Isolated Local Recurrence of Pancreatic Cancer

by Simone Serafini, Cosimo Sperti, Alberto Friziero, Alessandra Rosalba Brazzale, Alessia Buratin, Alberto Ponzoni and Lucia Moletta

Cancers 2021, 13(6), 1277; https://doi.org/10.3390/cancers13061277 - 13 Mar 2021

Cited by 9 | Viewed by 1930

Abstract

Purpose: To perform a systematic review and meta-analysis on the outcome of surgical treatment for isolated local recurrence of pancreatic cancer. Methods: A systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted in PubMed, Scopus, and Web of Science. Results: Six studies concerning 431 patients with recurrent pancreatic cancer met the inclusion criteria and were included in the analysis: 176 underwent redo surgery, and 255 received non-surgical treatments. Overall survival and post-recurrence survival were significantly longer in the re-resected group (ratio of means (ROM) 1.99; 95% confidence interval (CI), 1.54–2.56, I² = 75.89%, p = 0.006, and ROM = 2.05; 95% CI, 1.48–2.83, I² = 76.39%, p = 0.002, respectively) with a median overall survival benefit of 28.7 months (mean difference (MD) 28.7; 95% CI, 10.3–47.0, I² = 89.27%, p < 0.001) and median survival benefit of 15.2 months after re-resection (MD 15.2; 95% CI, 8.6–21.8, I² = 58.22%, p = 0.048). Conclusion: Resection of isolated pancreatic cancer recurrences is safe and feasible and may offer a survival benefit. Selection of patients and assessment of time and site of recurrence are mandatory. Full article

(This article belongs to the Special Issue Surgical Treatment of Pancreatic Ductal Adenocarcinoma)

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