Surgical management of pancreatic cancer at a regional health system.

Abstract

486 Background: 53,070 new PC in the US (2016) are expected with 41,780 deaths. PC care is evolving, multidisciplinary care, neoadjuvant chemotherapy (NCT) and Radiation (RT) and new adjuvant chemotherapy (ACT) regimens (GTX, GAX, FOLFIRINOX) now improve survival. Methods: Reviewed all surgeries for presumed PC to determine how many pts had NCT, ACT and/or RT, determine how many had RO (margin negative) resection, and proportion of >10 lymph nodes (LNs) removed and subsequent pt outcome. Results: PC was dx in 371 pts in 2014-15 (2014-192, 2015-179). During this period 82 pts were explored for proven or suspected PC. 50 (61%) had PC, and 35(70%) had resection with curative intent (30% unresectable or metastatic). Other DX included cancers of the ampulla (5), bile duct (4), or other cancers (7) and benign disease (16). The majority were performed at 1 hospital (84%). 82% of resections were RO, and 74% had >10 LNs removed. 86% of pts referred for surgery received CT, of which 51% received NAC and 52% received RT (37% pre-operatively). 42% of resected PC pts are alive and 24% are without evidence of disease (NED) up to 31 months post-operatively. 50% of pts with an R0 resection are alive (32% NED) as are 46% of those who had >10 LNs removed (31% NED). 45% of those with both an R0 resection and >10 LNs removed are alive (25% NED) 50% of pts with negative LNs (38% NED) compared to 47% of pts who had positive LNs (27% NED). Conclusions: NAC+/- RT is becoming the standard for most pts with operable or borderline resectable PC, allowing early metastatic disease to be recognized, and a higher probability of RO resection. Predictability of resection can be difficult even with sophisticated preoperative imaging. Interdisciplinary cooperation and treatment planning between medical, surgical and radiation oncology is key to improving survival and allowing for a seamless transition between treatment modalities. Negative surgical margins and negative lns provide the best survival. Only through the integration of pre and post-op therapies can we hope to see continued survival improvements.