SY21-5 Conversion surgery in unresectable pancreatic cancer – surgery perspectives

Abstract

The standard care of the patients with unresectable pancreatic cancer (URPC) is principally non-curative (palliative) approach, including chemotherapy and radiation therapy aiming at an inhibition of rapid disease progression and a consequent extension of a life prognosis. Conversion surgery (CS) is a clinical challenge to convert this non-curative treatment strategy in the patients with URPC into the curative-intended treatment strategy, including surgical resection following chemotherapy and/or chemoradiation therapy. Recent advances in chemotherapy with an improved antitumor activity and radiation therapy increase the URPC cases with clinically significant down-staging after chemo (radiation) therapy, and thereby, the CS is now being actively investigated as a promising treatment strategy for the patients with URPC who exhibit favorable response to precedent non-surgical treatment. Although the concept of CS is widely accepted, the clinical validity of CS remains debatable. In general, the clinical significance of CS is assessed from a viewpoint of the patient survival. The presence of a subgroup of the patients with long-term survival is a robust advantage of CS in the patients with URPC even though the median survival of the entire cohort of the patients with CS is modestly favorable. Also, the duration of disease-free survival should be evaluated as a potential advantage of CS as well. On contrary, the early recurrence is not a rare event after CS, and the survival of those patients with early recurrences is quite dismal. In this context, the clinical significance of CS is multi-factorial, and the establishment of how to evaluate the clinical validity of CS is required to further promote the clinical application of CS for URPC patients. In our institute, we have performed more than 70 CSs. In this presentation, the details of the outcomes of CS in our institute will be presented, and we will discuss a clinical goal of CS for the patient with URPC.