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borderline resectable for colorectal liver metastases:Present status and future perspective

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World Journal of Gastrointestinal Surgery 2021年第8期13卷 756-763页

作者： Yuki Kitano Hiromitsu Hayashi Takashi Matsumoto Shotaro Kinoshita Hiroki Sato Yuta Shiraishi Yosuke Nakao Takayoshi Kaida Katsunori Imai Yo-ichi Yamashita Hideo Baba Department of Gastroenterological Surgery Graduate School of Medical SciencesKumamoto UniversityKumamoto 860-8556Japan

Surgical resection for colorectal liver metastases(CRLM)may offer the best opportunity to improve ***,only about 20% of CRLM cases are indicated for resection at the time of diagnosis(initially resectable),and the remaining cases are treated as unresectable(initially unresectable).Thanks to recent remarkable developments in chemotherapy,interventional radiology,and surgical techniques,the resectability of CRLM is ***,some metastases are technically resectable but oncologically questionable for upfront *** pancreatic cancer,such cases are categorized as"borderline resectable",and their definition and treatment strategies are ***,in CRLM,although various poor prognosis factors have been identified in previous reports,no clear definition or treatment strategy for borderline resectable has yet been *** the efficacy of hepatectomy for CRLM was reported in the 1970 s,multidisciplinary treatment for unresectable cases has improved resectability and prognosis,and clarifying the definition and treatment strategy of borderline resectable CRLM should yield further improvement in *** review outlines the present status and the future perspective for borderline resectable CRLM,based on previous studies.

关键词： borderline resectable Colorectal liver metastases Adjuvant chemotherapy Hepatectomy Colorectal cancer

Pancreaticoduodenectomy for borderline resectable pancreatic head cancer with a modified artery-first approach technique

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Hepatobiliary & Pancreatic Diseases International 2017年第2期16卷 215-221页

作者： Min Wang Hang Zhang Feng Zhu Feng Peng Xin Wang Ming Shen Ren-Yi Qin Department of Pancreatic-Biliary Surgery Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China

BACKGROUND： The treatment of borderline resectable pancreatic head cancer（BRPHC） is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach（MAFA）, with conventional techniques for the surgical treatment of ***： A total of 117 patients with BRPHC undergone pancreaticoduodenectomy（PD） from January 2013 to June 2015 were included. They were divided into an MAFA group（n=78） and a conventional-technique group（n=39）. Background characteristics, operative data and complications were compared between the two ***： Mean operation time was significantly shorter in the MAFA group than that in the conventional-technique group（313 vs 384 min; P=0.014）; mean volume of intraoperative blood loss was significantly lower in the MAFA group than that in the conventional-technique group（534 vs 756 m L; P=0.043）; and mean rate of venous resection was significantly higher in the conventional-technique group than that in the MAFA group（61.5% vs 35.9%; P=0.014）. Pathologic data, early mortality and morbidity were not different significantly between the two ***： MAFA is safe, simple, less time-consuming, less intraoperative blood loss and less venous resection, and therefore, may become a standard surgical approach to PD for BRPHC with the superior mesenteric vein-portal vein involvement but without superior mesenteric artery invasion.

关键词： pancreatic head cancer pancreaticoduodenectomy borderline resectable

Neoadjuvant chemoradiation is associated with decreased lymph node ratio in borderline resectable pancreatic cancer:A propensity score matched analysis

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 74-79页

作者： June S Peng Gareth Morris-Stiff Noaman S Ali Jane Wey Sricharan Chalikonda Kevin M El-Hayek R Matthew Walsh Department of Surgery The Pennsylvania State UniversityCollege of MedicineHersheyPA 17033-0850USA Department of General Surgery Digestive Disease and Surgery InstituteCleveland Clinic FoundationClevelandOH 44195-0001USA

Background:Lymph node ratio(LNR)and margin status have prognostic significance in pancreatic *** we examined the pathologic and clinical outcomes in patients with borderline resectable pancreatic cancer(BRPC)following neoadjuvant therapy(NAT)and ***:Patients who underwent treatment between January 1,2012 and June 30,2017 were *** patients in the BRPC group were compared to a propensity score matched cohort of patients with radiographically resectable pancreatic cancer who underwent upfront surgical *** BRPC group was also compared to sequential patients with radiographically resectable pancreatic cancer who required vein resection(VR)during upfront ***:There were 50 patients in the BRPC group,50 patients in the matched control group,and 38 patients in the VR *** margins(R0)were seen in 72%,64%,and 34%of the BRPC,control,and VR groups,respectively(P=0.521 for BRPC ***;P=0.002 for BRPC ***),with 24%of the BRPC group requiring a vascular *** stage was N0 in 64%,20%,and 18%of the BRPC,control,and VR groups,respectively(Presectable disease.

关键词： Neoadjuvant therapy Lymph node ratio Pancreatic cancer borderline resectable Vein resection

The role of systemic therapy in borderline resectable and locally advanced pancreatic ductal adenocarcinoma

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Journal of Cancer Metastasis and Treatment 2022年第1期8卷 281-292页

作者： Victor C.K.Lo Rachel A.Goodwin Michael M.Vickers Department of Medicine Division of Medical OncologyThe Ottawa Hospital Cancer CentreOttawaON K1H 8L6Canada

Pancreatic ductal adenocarcinoma(PDAC)remains a deadly disease,even in patients whose cancer is localized and *** resection provides the only option for cure,but long-term survival rates remain *** patients with borderline resectable(BR)disease who undergo upfront resection,many patients are either too unwell for subsequent adjuvant systemic therapy,develop recurrence soon after,or are found to have unresectable disease *** is increasing evidence for a neoadjuvant approach,using more conventional multi-agent chemotherapy regimens,which have demonstrated higher activity in the metastatic setting compared to single *** patients with locally advanced(LA)disease,which is unresectable by current definitions,there is mounting evidence that effective neoadjuvant systemic therapy is able to convert some patients’disease to a resectable state,offering the potential for long-term survival and *** we present a review of key trials focusing on prospective,randomized studies to provide high-level evidence supporting a neoadjuvant approach to both BR and LA ***,many knowledge gaps exist,such as the optimal neoadjuvant multi-agent chemotherapy regimen,the role of radiotherapy,and the safety and efficacy of adding immunotherapy to chemo/radiation *** challenges in determining the optimal approach to patients with BR or LA PDAC include not only overcoming the inherent difficulties in conducting complex,multidisciplinary,multicentre randomized trials in patients with a high-morbidity and mortality disease,but also trying to standardize disease definitions,treatment regimens,and outcome measures.

关键词： borderline resectable locally advanced pancreatic ductal adenocarcinoma neoadjuvant chemotherapy

Preoperative defining system for pancreatic head cancer considering surgical resection

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World Journal of Gastroenterology 2016年第26期22卷 6076-6082页

作者： Seok Jeong Yang Ho Kyoung Hwang Chang Moo Kang Woo Jung Lee Department of Surgery Ulsan University Hospital University of Ulsan College of Medicine Department of Hepatobiliary and Pancreatic Surgery Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic Yonsei Cancer Center Institute of Gastroenterology Yonsei Severance Hospital

AIM: To provide appropriate treatment, it is crucial to share the clinical status of pancreas head cancer among multidisciplinary treatment ***: A retrospective analysis of the medical records of 113 patients who underwent surgery for pancreas head cancer from January 2008 to December 2012 was performed. We developed preoperative defining system of pancreatic head cancer by describing “resectability - tumor location - vascular relationship - adjacent organ involvement - preoperative CA19-9 (initial bilirubin level) - vascular anomaly”. The oncologic correlations with this reporting system were ***: Among 113 patients, there were 75 patients (66.4%) with resectable, 34 patients (30.1%) with borderline resectable, and 4 patients (3.5%) with locally advanced pancreatic cancer. Mean disease-free survival was 24.8 mo (95%CI: 19.6-30.1) with a 5-year disease-free survival rate of 13.5%. Pretreatment tumor size ≥ 2.4 cm [Exp(B) = 3.608, 95%CI: 1.512-8.609, P = 0.044] and radiologic vascular invasion [Exp(B) = 5.553, 95%CI: 2.269-14.589, P = 0.002] were independent predictive factors for neoadjuvant treatment. borderline resectability [Exp(B) = 0.222, P = 0.008], pancreatic head cancer involving the pancreatic neck [Exp(B) = 9.461, P = 0.001] and arterial invasion [Exp(B) = 6.208, P = 0.010], and adjusted CA19-9 ≥ 50 [Exp(B) = 1.972 P = 0.019] were identified as prognostic clinical factors to predict tumor ***: The suggested preoperative defining system can help with designing treatment plans and also predict oncologic outcomes.

关键词： Preoperative defining system Pancreas head cancer borderline resectable Adjusted CA19-9 Neoadjuvant therapy

Role of neoadjuvant therapy for nonmetastatic pancreatic cancer:Current evidence and future perspectives

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 911-924页

作者： Gianluca Cassese Ho-Seong Han Yoo-Seok Yoon Jun Suh Lee Boram Lee Antonio Cubisino Fabrizio Panaro Roberto Ivan Troisi Department of Clinical Medicine and Surgery Division of Minimally Invasive HPB Surgery and Transplantation ServiceFederico II University HospitalNaples 80131Italy Department of Surgery Seoul National University College of MedicineSeongnam 13620Gyeonggi-doSouth Korea Department of HPB Surgery and Transplantation Beaujon HospitalClichy 92110France Department of Digestive Surgery and Liver Transplantation CHU MontpellierMontpellier 34100France

Pancreatic adenocarcinoma(PDAC)is one of the most common and lethal human cancers *** followed by adjuvant chemotherapy offers the best chance of a long-term survival for patients with PDAC,although only approximately 20%of the patients have resectable tumors when *** chemotherapy(NACT)is recommended for borderline resectable pancreatic *** studies have investigated the role of NACT in treating resectable tumors based on the recent advances in PDAC biology,as NACT provides the potential benefit of selecting patients with favorable tumor biology and controls potential micro-metastases in high-risk patients with resectable *** such challenging cases,new potential tools,such as ct-DNA and molecular targeted therapy,are emerging as novel therapeutic options that may improve old *** review aims to summarize the current evidence regarding the role of NACT in treating non-metastatic pancreatic cancer while focusing on future perspectives in light of recent evidence.

关键词： Pancreatic cancer Pancreatic duct adenocarcinoma Neoadjuvant chemotherapy borderline resectable Locally advanced pancreatic cancer

Neoadjuvant therapy for resectable pancreatic cancer

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World Journal of Gastrointestinal Oncology 2017年第12期9卷 457-465页

作者： Sheikh Hasibur Rahman Robin Urquhart Michele Molinari Department of Surgery Dalhousie University Department of Surgery University of Pittsburgh Medical Center

The use of neoadjuvant therapies has played a major role for borderline resectable and locally advanced pancreatic cancers(PCs). For this group of patients, preoperative chemotherapy or chemoradiation has increased the likelihood of surgery with negative resection margins and overall survival. On the other hand, for patients with resectable PC, the main rationale for neoadjuvant therapy is that the overall survival with current strategies is unsatisfactory. There is a consensus that we need new treatments to improve the overall survival and quality of life of patients with PC. However, without strong scientific evidence supporting the theoretical advantages of neoadjuvant therapies, these potential benefits might turn out not to be worth the risk of tumors progression while waiting for surgery. The focus of this paper is to provide the readers an overview of the most recent evidence on this subject.

关键词： Pancreatic adenocarcinoma Neoadjuvant chemotherapy Neoadjuvant chemoradiation therapy Meta-analysis Decision analysis borderline resectable Locally advanced Randomized controlled trial Phase I trial Phase II trial Phase III trial

Change in neoadjuvant chemotherapy could alter the prognosis of patients with pancreatic adenocarcinoma: A case report

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World Journal of Clinical Cases 2021年第14期9卷 3418-3423页

作者： Alberto Meyer Bárbara J Carvalho Kayo AA Medeiros Leonardo Z Pipek Fernanda S Nascimento Milena O Suzuki João VT Munhoz Leandro R Iuamoto Luiz A Carneiro-D'Alburquerque Wellington Andraus Gastroenterologia Hospital das Clínicas HCFMUSPFaculdade de MedicinaUniversidade de São PauloSão Paulo 01426-010Brazil Gastroenterologia Faculdade de Medicinada Universidade de São PauloSão Paulo 05403-000Brazil Orthopaedics and Traumatology Faculdade de Medicinada Universidade de São PauloSão Paulo 05403-000Brazil

BACKGROUND Neoadjuvant treatment has become a standard of care for borderline or locally advanced pancreatic cancer and is increasingly considered even for up-front resectable *** aim of this article is to present the case of a 62-year-old patient with locally advanced pancreatic adenocarcinoma who was successfully treated with gemcitabine plus nab-paclitaxel after the failure of the first line *** SUMMARY Computerized tomography scan and magnetic resonance imaging demonstrated a nodular lesion of ill-defined limits in the body of the pancreas,measuring approximately 4.2 cm×2.7 cm,with an infiltrative *** tumor had contact with the superior mesenteric vein,splenomesenteric junction and the proximal segment of the splenic artery,causing focal reduction of its *** to vascular involvement,neoadjuvant chemotherapy treatment with eight cycles of“folinic acid,5-fluorouracil,irinotecan and oxa-liplatine”(FOLFIRINOX)were *** the end of the cycles,surgery was performed,but the procedure was interrupted due to finding of lesions suspected of *** plus nab-paclitaxel was then successfully used for neoadjuvant treatment with subsequent R0 surgical *** Gemcitabine plus nab-paclitaxel may be effective as an alternative regimen when FOLFIRINOX fails as the first line of treatment,suggesting the need for further studies to identify which patients would benefit from each type of therapeutic approach.

关键词： Neoadjuvant chemotherapy Pancreatic cancer resectable pancreatic cancer borderline resectable Neoadjuvant Pancreas Case report