Pancreatic Body Cancer Research Articles

Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail.

The definition of resection margin (R) status in pancreatic cancer is under debate. Although a margin of at least 1 mm is an independent predictor of survival after resection for pancreatic head cancer, its relevance to pancreatic body and tail cancers remains unclear. This study aimed to validate R status based on a 1-mm tumour-free margin as a prognostic factor for resected adenocarcinoma involving the pancreatic body and tail. Patients who underwent distal or total pancreatectomy for adenocarcinomas of the pancreatic body and tail between January 2006 and December 2014 were identified from a prospective database. Resection margins were evaluated using a predefined cut-off of 1 mm. Rates of R0, R1 with invasion within 1 mm of the margin (R1 less than 1 mm), and R1 with direct invasion of the resection margin (R1 direct) were determined, and overall survival in each group assessed by Kaplan-Meier analysis. Univariable and multivariable Cox regression analyses were performed to identify predictors of survival. R0 resection was achieved in 107 (23·5 per cent) and R1 in 348 (76·5 per cent) of 455 patients. Among R1 resections, invasion within 1 mm of the margin was found in 104 (22·9 per cent) and direct invasion in 244 (53·6 per cent). The R0 rate was 28·9 per cent after distal and 18·6 per cent after total pancreatectomy. In the total cohort, median survival times for patients with R0, R1 (less than 1 mm) and R1 (direct) status were 62·4, 24·6 and 17·2 months respectively, with 5-year survival rates of 52·6, 16·8 and 13·0 per cent (P < 0·001). In patients who received adjuvant chemotherapy, respective median survival times were 68·6, 32·8 and 21·4 months, with 5-year survival rates of 56, 22 and 16·0 per cent (P < 0·001). In multivariable analysis, R status was independently associated with survival. A cut-off of at least 1 mm for evaluation of resection margins is an independent determinant of survival after resection of adenocarcinomas of the pancreatic body and tail.

Do patients with pancreatic body or tail cancer benefit from adjuvant therapy?A cohort study

IntroductionEvidence supporting adjuvant therapy for resected pancreatic cancer is limited primarily to head tumors. We analyzed data from the National Cancer Database (NCDB) to evaluate the relationship of tumor site with benefit from adjunctive (adjuvant, neoadjuvant, perioperative) therapy (Rx). MethodsAll NCDB patients with clinical stage I and II pancreatic cancer, diagnosed from 2003 to 2013, who underwent surgical resection and had data on site of primary were included. Overall survival (OS) analyses with hazard ratios (HR), 95% confidence intervals (CI), and two-sided p-values are presented. ResultsA total of 27,930 patients met inclusion criteria; median age 66 years, 51% males, 86% white. Primary site was coded as head (74.4%), body (9.3%), or tail (16.3%). Pathologic stage was predominantly stage II (77%); 81% had negative margins. Perioperative Rx was used in 4%, neoadjuvant in 8%, adjuvant in 48%. Median OS for the cohort was 24 months; for head, body and tail tumors, it was 21.6, 34.5, and 42.5 months, respectively. In univariable analyses, adjunctive Rx was associated with improved OS in head tumors (HR, any Rx vs. no Rx: 0.87; 95% CI 0.84–0.91; p < 0.0001) but not in body (1.82; 1.59–2.08; <0.0001) and tail (2.28; 2.05–2.53; <0.0001) tumors; multivariable models including statistically significant predictors (Charlson-Deyo comorbidity score, tumor grade and stage, positive resection margin) confirmed these results. ConclusionsOur study suggests that the benefit of adjunctive Rx is restricted to pancreatic head tumors; body and tail tumors have a much better prognosis. These results warrant further evaluation in prospective studies.

Cystic gastric metastasis from pancreatic cancer

Gastrointestinal tract metastasis from pancreatic cancer is quite rare. We present the case of a 58-year-old male patient who underwent distal pancreatectomy for pancreatic body cancer 5 years prior. Four years after the initial operation, a 15-mm cystic submucosal tumor was found in the antrum of the stomach. Because the tumor had grown to 25 mm and the level of carcinoembryonic antigen in the cystic fluid derived by ultrasound-guided fine-needle aspiration biopsy was high, partial resection of the stomach was performed 5 years after the distal pancreatectomy. Pathological diagnosis was gastric metastasis of pancreatic cancer. The patient has been alive without recurrence for 13 months after the resection of the cystic tumor. We are not aware of any similar cases of cystic gastric metastasis from pancreatic cancer published in the English literature.

AB056. P027. Preoperative chemotherapy for resectable pancreatic cancer improves prognosis of node positive pancreatic head cancer

: Recently, preoperative chemotherapy or chemoradiotherapy has been tried to improve the prognosis of pancreatic cancer after resection. We retrospectively evaluate the efficacy of preoperative neoadjuvant chemotherapy (NAC) with gemcitabine (GEM) based regimen for resectable pancreatic cancer. Between 2006 and 2015, NAC with GEM was performed for 52 cases out of 86 resectable pancreatic cancer cases in our department. In the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines for the treatment effect, partial response (PR) in 5 cases, stable disease (SD) in 35 cases and progressive disease (PD) in 2 cases were respectively observed. However, standardized uptake value (SUVmax) values of fluorodeoxyglucose-positron emission tomography (FDG-PET) and cancer antigen 19-9 (CA19-9) values were significantly reduced after preoperative chemotherapy. The treatment effect was grade I in 31 patients, grade IIa in 8 and grade IIb in 3 cases, judged with the Evans grading system. There were not significant differences in overall 5-year survival rate between the NAC group (pancreatic head cancer 45.4% and pancreatic body and tail cancer 26.7%) and control (non-NAC) group (pancreatic head cancer 29.2% and body and tail cancer 47.1%). However, survival period of the NAC group was slightly extended compared with the control group in the patients with node positive [Union for International Cancer Control (UICC) stage IIB] pancreatic head cancer. On the other hand, in early recurrent cases within a year, significantly higher CA19-9 value of peripheral blood and higher lymph node metastasis and plexus invasion rates were observed. In conclusion, NAC with GEM prolong survival period of node positive pancreatic head cancer cases, and it is considered that PET-CT and tumor marker (CA19-9) is useful for judgment of preoperative treatment effect. Furthermore, high CA19-9 value, lymph node metastasis and plexus invasion would be the risk factors of early tumor recurrence after surgery.

The clinical impact of left gastric artery reconstruction/preservation during distal pancreatectomy with celiac axis resection for pancreatic body cancer

The clinical impact of left gastric artery reconstruction/preservation during distal pancreatectomy with celiac axis resection for pancreatic body cancer

Clinical value of Fluorine-18-fluorodeoxyglucose PET/CT examination to predict the prognosis of patients with pancreatic cancer

Clinical value of Fluorine-18-fluorodeoxyglucose PET/CT examination to predict the prognosis of patients with pancreatic cancer

Robotic distal pancreatectomy combined with celiac axis resection.

A subset of pancreatic body and tail cancers present with locally advanced disease due to involvement of the celiac axis. Previously considered unresectable, these T4 tumors may be extirpated with a distal pancreatectomy and en bloc resection of the celiac trunk in carefully selected patients. In the setting of multimodality treatment, these resections can yield survival similar to resectable and borderline resectable lesions. Robotic surgery has been shown to be safe and feasible in complex pancreatic resections. This article summarizes our patient selection criteria and operative approach to robotic distal pancreatectomy with celiac axis resection (DP-CAR) for locally advanced body and tail tumors of the pancreas.

Isolated Gastric Varices: A Rare Presentation of Pancreatic Cancer

Pancreatic cancer remains a disease with high morbidity and mortality. Due to vague symptoms at presentation, the disease is often diagnosed at late stages, with a 5-year survival rate of only 8%. Approximately 75% of all pancreatic carcinomas occur within the head or neck of the pancreas, 15-20% occur in the body of the pancreas, and 5-10% occur in the tail. This case describes a new diagnosis of a pancreatic tail mass presenting as obscure overt gastrointestinal bleeding in the context of portal hypertension. A 60-year-old male presented with recurrent melena associated with fatigue and dyspnea. His symptoms started two months prior to presentation, at which time he underwent upper endoscopy, colonoscopy, tagged-RBC scan, and capsule endoscopy, all of which were negative. Upon hospital presentation, he underwent a repeat upper endoscopy. He was found to have isolated gastric varices that bled during the procedure. Abdominal CT scan with portal venous phase contrast revealed a nodular and heterogenous appearance of the liver parenchyma, splenomegaly, and a recanalized umbilical vein suggestive of portal hypertension. There was a 3.4 cm area of hypo-enhancement of the midpole of the spleen with some mildly enlarged retroperitoneal lymph nodes, suggestive of a mass lesion. He underwent urgent transjugular intrahepatic portosystemic shunt (TIPS) placement, with successful reduction of the hepatic venous pressure gradient from 15 to 2 mmHg, with occlusion of the distal portion of the splenic vein near the splenic hilum. Thereafter, he underwent laparoscopic distal pancreatectomy and splenectomy. The pathology revealed invasive, undifferentiated carcinoma of the pancreas with local lymph node involvement. He subsequently commenced adjuvant chemotherapy. Pancreatic body and tail cancer may cause left sided portal hypertension, with isolated gastric varices, splenomegaly, and hypersplenism. Other patients may have established portal hypertension, but the finding of isolated gastric varices should raise suspicion for left-sided portal hypertension. Endoscopists evaluating obscure gastrointestinal bleeding must maintain a high index of suspicion for less common causes of bleeding. When isolated gastric varices are detected, abdominal cross-sectional imaging should be considered to evaluate for splenic vein thrombosis and/or a pancreatic or splenic mass leading to left-sided portal hypertension.

A Surgical Case of Synchronous Double Primary Cancers of the Bile Duct and Pancreas

A 54-year-old woman was seen at another hospital because of jaundice. Computed tomography showed an unclear boundary and a poorly enhanced mass lesion in the pancreatic body, measuring 28 mm in diameter. Magnetic resonance cholangiopancreatography showed stenosis of the lower bile duct and the main pancreatic duct in the pancreatic body, and slight dilatation of the main pancreatic duct in the pancreatic tail. According to these findings, the preoperative diagnosis was synchronous double cancers of primary lower bile duct cancer and pancreatic body cancer. We performed pylorus-preserving pancreaticoduodenectomy with splenic artery and vein resection. A histopathologic examination revealed that the lower bile duct tumor was moderately differentiated tubular adenocarcinoma, and the pancreatic body tumor was moderately differentiated tubular adenocarcinoma. These 2 tumors showed no histopathologic continuity. According to these pathologic findings, we gave the patient a diagnosis of synchronous double cancers of primary lower bile duct cancer and pancreatic body cancer. The patient was discharged from the hospital on the 48th day after surgery. However, she died of multiple organ failure due to cancer recurrence 22 months after surgery.

Extended versus peripancreatic lymph node dissection for the treatment of left-sided pancreatic cancer.

PurposeThe pathways of lymphatic metastases differ according to the tumor location in pancreatic cancer patients. However, it is unclear whether extended lymph node dissection (LND) is essential for all left-sided pancreatic cancer. The aim of this study is to evaluate the survival outcomes according to the extent of LND and tumor location in patients with left-sided pancreatic cancer.MethodsJanuary 2005 to December 2013, we retrospectively identified 107 patients who underwent curative intent surgery for left-sided pancreatic cancer. The left-sided pancreatic cancer was defined as a tumor located in pancreatic body or tail. The extent of LND was divided into 2 groups: extended LND and peripancreatic LND. The extended LND group included celiac and superior mesenteric LNs.ResultsWe included 107 patients with left-sided pancreatic cancer; 59 patients with pancreatic body cancer and 48 patients with pancreatic tail cancer. The median follow-up period was 17 months (range, 3–110 months). Fifty patients with pancreatic body cancer and 30 patients with pancreatic tail cancer underwent extended LND. In patients with pancreatic body cancer, extended LND was associated with improved disease-free survival (DFS) (P = 0.010) and overall survival (P = 0.014). However, extended LND was not associated with DFS in patients with pancreatic tail cancer.ConclusionExtended LND could improve survival in patients with pancreatic body cancer. However, extended LND had no survival benefit for the treatment of pancreatic tail cancer.

Distal pancreatectomy and celiac axis resection for pancreatic body carcinoma involving celiac artery

Pancreatic body or tail cancer with invasion to major vessels, including the common hepatic artery and the celiac artery, was previously considered to be unresectable. However, an increasing number of surgeons have aggressively adopted distal pancreatectomy, splenectomy, and celiac axis resection (DP-CAR) in this scenario to attempt curative resection, thus improving long-term survival. In this paper, we present the case of a 45-year-old man with pancreatic body cancer invading the celiac axis who underwent DP-CAR with negative margins (R0) and subsequently exhibited an uneventful postoperative course. We also reviewed literature, which unequivocally demonstrates a comparable oncological outcome between pancreatic body or tail cancer with and without celiac artery resection. To the best of our knowledge, our study is the first documented case in which DP-CAR was successfully performed in Taiwan.

術前化学療法後に腹腔動脈幹合併尾側膵切除術を施行し，固有肝動脈-空腸動脈バイパスを併施した局所進行膵体尾部癌の1 例

膵体部癌は腹腔動脈や総肝動脈などの重要な血管に近接しており，その直接浸潤で手術非適応とされることが多い．腹腔動脈浸潤症例については，術前に総肝動脈を塞栓し，側副血行路の発達により肝血流を維持して腹腔動脈幹合併切除を伴った尾側膵切除術を行うことで切除可能な症例がある．症例は68 歳，男性．膵体尾部癌の診断であった．術前化学療法を施行し，総肝動脈を塞栓し，膵切除を行った．術中に肝血流障害を認め，固有肝動脈-空腸動脈バイパスにより回避し得た症例である．このような症例は，われわれは経験がなく，文献的考察を加え報告する．

集学的治療で完全奏効が得られた肝転移を伴うcStage IV膵体部癌の1例

症例は69歳の女性で，背部痛を主訴に近医を受診し膵腫瘍を指摘され，当科紹介となった．生検結果は腺癌であり，膵体部癌，TS3（35 mm），cT3，cS1，cRP1，cPV1（PVp，PVsp），cA1（Asp），cPL1，cN0，cM1（HEP），cStage IVの診断であった．遠隔転移を伴う切除不能膵癌に対してgemcitabine+nab-paclitaxel療法を施行した．6コース施行後に肝転移の消失を確認した．残存する原発巣に対してS-1+放射線療法（56 Gy）を施行し，その後S1による維持療法を施行した．治療開始から12か月後の効果判定ではcomplete response（以下，CRと略記）であり，CA 19-9は1,846 U/mlから13.3 U/mlまで著明に低下した．組織学的な癌遺残の可能性を考慮し，脾合併膵体尾部切除術+肝部分切除術を施行した．病理組織学的検査では切除した膵臓，肝臓ともに腫瘍細胞を認めず，最終病理診断はCRであった．遠隔転移と局所進行を伴う切除不能膵癌の予後は極めて不良であるが，集学的治療が著効し，病理組織学的CRを得られた症例を経験したので報告する．

Utility of Amplatzer Vascular Plug with Preoperative Common Hepatic Artery Embolization for Distal Pancreatectomy with En Bloc Celiac Axis Resection.

To evaluate the feasibility and safety of the Amplatzer vascular plug (AVP) for preoperative common hepatic embolization (CHA) before distal pancreatectomy with en bloc celiac axis resection (DP-CAR) to redistribute blood flow to the stomach and liver via the superior mesenteric artery (SMA). Four patients (3 males, 1 female; median age 69years) with locally advanced pancreatic body cancer underwent preoperative CHA embolization with AVP. After embolization, SMA arteriography was performed to confirm the alteration of blood flow from the SMA to the proper hepatic artery. In three of four patients, technical successes were achieved with sufficient margin from the origin of gastroduodenal artery. In one patient, the margin was less than 5mm, although surgery was successfully performed without any problem. Eventually, all patients underwent the DP-CAR without arterial reconstruction or liver ischemia. AVP application is feasible and safe as an embolic procedure for preoperative CHA embolization of DP-CAR.

Distal Pancreatectomy with en Bloc Celiac Axis Resection (Modified Appleby Procedure) for Locally Advanced Pancreatic Body Cancer: A Single-Center Review of 80 Consecutive Patients.

Recently, distal pancreatectomy with en bloc celiac axis resection (DP-CAR) or modified Appleby procedure for locally advanced pancreatic body cancer is increasingly reported. However, actual long-term survival data are still unknown. This study retrospectively reviewed 80 consecutive patients with pancreatic body cancer who underwent DP-CAR at a single institution. The study included 40 men and 40 women with a median age of 65years (range, 44-85years). A pancreatic fistula was the most common complication, occurring in 47 patients (57.5%). Other complications with a high incidence were ischemic gastropathy (23 patients, 28.8%) and delayed gastric emptying (20 patients, 25%). According to the Clavien-Dindo classification, the major complications, defined as complications of grade 3 or higher, were observed in 33 patients (41.3%), and the in-hospital mortality involved four patients (5%). For all 80 patients, the 1-, 2-, and 5-year overall survivals (OSs) were respectively 81.1, 56.9, and 32.7%, and the median survival time was 30.9months. The actual 5-year survival for the 61 patients whose surgery was performed five or more years earlier was 27.9% (17 of 61). The 1-, 2-, and 5-year OSs for the patients who underwent preoperative therapy (100, 90, and 78.8%) were significantly better than for those who underwent upfront surgery (77.9, 51.5, and 26.7%; P<0.0001). The findings show DP-CAR to be a valid procedure for treating locally advanced pancreatic body cancer, which might contribute more to patients' survival when performed as part of multidisciplinary treatment.

A case of metastatic cancer from pancreatic body cancer after DP-CAR

A case of metastatic cancer from pancreatic body cancer after DP-CAR

Management of locally advanced pancreatic body cancer adjacent to the celiac axis

We present a study of the global event shape variables thrust and heavy jet mass, of energy-energy correlations and of jet multiplicities based on 250 000 hadronic Z0 decays. The data are compared to new QCD calculations including resummation of leading and next-to-leading logarithms to all orders. We determine the strong coupling constant αs (91.2 GeV) = 0.125±0.003 (exp) ± 0.008 (theor). The first error is the experimental uncertainty. The second error is due to hadronization uncertainties and approximations in the calculations of the higher order corrections.

Robotic and open distal pancreatectomy with celiac axis resection for locally advanced pancreatic body tumors: a single institutional assessment of perioperative outcomes and survival

BackgroundDistal pancreatectomy with celiac axis resection (DP-CAR) is an option for T4 tumors of the pancreatic body. We examined the perioperative and oncologic outcomes of open and robotic DP-CAR at a high-volume pancreatic center. MethodsRetrospective review of all consecutive DP-CARs. Patient demographics, 90-day perioperative outcomes, and disease specific survival were collected. Results30 DP-CARs were performed (11 Robotic, 19 Open). Both groups had similar preoperative/tumor characteristics, and 27 of 28 PDA patients received neoadjuvant chemotherapy. Robotic DP-CAR was associated with decreased OT (316 vs. 476 min), reduced EBL (393 vs. 1736 ml) and lower rates of blood transfusion (0% vs. 54%) (all p < 0.05). No robotic DP-CAR required conversion. Both groups had similar rates of 90-day mortality, major morbidity, LOS, readmission, and receipt of adjuvant therapy. Similarly, both approaches were associated with high R0 resection rates (82% vs. 79%). At a median follow-up of 33 months, median overall survival for the PDA cohort was 35 months, with no difference in the robotic and open approach (33 and 40 months, p = 0.310). ConclusionsWith a median survival approaching 3 years, DP-CAR represents an effective treatment for select patients with locally advanced pancreatic body cancer, regardless of approach.

A case of intragastric wall abscess developing after EUS-FNA in a patient with pancreatic body cancer

A case of intragastric wall abscess developing after EUS-FNA in a patient with pancreatic body cancer

Distal pancreatectomy with celiac axis resection for pancreatic body and tail cancer

Distal pancreatectomy with celiac axis resection for pancreatic body and tail cancer