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Potential risk of residual cancer cells in the surgical treatment of initially unresectable pancreatic carcinoma after chemoradiotherapy.

Takano H, Tsuchikawa T, Nakamura T, Okamura K, Shichinohe T, Hirano S - World J Surg Oncol (2015)

Bottom Line: Overall survival from initial treatment was much better for patients with R0 resection than for patients with R1/2 resection.It was shown that tumors did not shrink continuously from the tumor front, but parts remained discontinuously at the distal portion in the process of tumor regression by chemo(radio)therapy.Achieving R0 resection will lead to an improved prognosis, and it is necessary to consider how well the extent of resection is after a favorable response to chemoradiotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N-15 W-7, Sapporo, Hokkaido, 060-8638, Japan. htakano1231@yahoo.co.jp.

ABSTRACT

Background: With development of chemoradiotherapy for pancreatic carcinoma, borderline resectable or initially unresectable cases sometimes become operable after long-term intensive chemoradiotherapy. However, there is no established strategy for adjuvant surgery with respect to whether the surgical resection should be extensive or downsized accordingly with diminished disease areas following response to chemoradiotherapy.

Methods: The clinical and pathological aspects of 18 patients with initially unresectable pancreatic cancer who underwent adjuvant surgery after chemo(radio)therapy in our department from 2007 were evaluated.

Results: Overall survival from initial treatment was much better for patients with R0 resection than for patients with R1/2 resection. In two of three patients who had complete improvement of plexus (PL) invasion after chemo(radio)therapy, there had still remained pathological plexus invasion. It was shown that tumors did not shrink continuously from the tumor front, but parts remained discontinuously at the distal portion in the process of tumor regression by chemo(radio)therapy.

Conclusions: In adjuvant surgery for patients with locally advanced pancreatic cancer, the potential risk of residual cancer in the regression area following chemoradiotherapy should be considered. Achieving R0 resection will lead to an improved prognosis, and it is necessary to consider how well the extent of resection is after a favorable response to chemoradiotherapy.

No MeSH data available.


Related in: MedlinePlus

Histopathological mapping on the macroscopic section at the plexus around the CA, indicating residual cancer cells at the plexus around the CA (left, area encircled with solid line). hematoxylin-eosin staining showed the residual cancer cells present at the area encircled with the broken line (right)
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Fig2: Histopathological mapping on the macroscopic section at the plexus around the CA, indicating residual cancer cells at the plexus around the CA (left, area encircled with solid line). hematoxylin-eosin staining showed the residual cancer cells present at the area encircled with the broken line (right)

Mentions: Of the 18 patients, 12 patients (66 %) were initially diagnosed as having unresectable disease with arterial plexus invasion around the CA in 1 patient, the GDA in 4 patients, the SMA in 3 patients with pancreatic body cancer, and the CHA in 4 patients with head of the pancreas cancer. After the chemoradiotherapy, these findings on CT imaging had improved with the plexus around the artery of all patients. These fields, initially considered to include cancer cells, were totally resected in an en bloc-wise manner using already described procedures. Among them, 2 out of 3 patients in complete improvement after chemoradiotherapy and 7 out of 9 patients in partial improvement had still remained pathological plexus invasion (Table 4). Here, we show one characteristic case (no. 10 in Table 4) that was initially diagnosed as having unresectable disease with invasion to the plexus around the SMA. After chemotherapy including GEM and TS-1 for 15 months, adjuvant surgery was performed because PR was achieved (Fig. 1). CT scan after chemotherapy showed tumor shrinkage, which was amenable to radical resection by DP. However, DP-CAR was performed because of the policy described above. The pathological findings after resection showed tumor cells remaining around the celiac artery discontinuously (Fig. 2).Table 4


Potential risk of residual cancer cells in the surgical treatment of initially unresectable pancreatic carcinoma after chemoradiotherapy.

Takano H, Tsuchikawa T, Nakamura T, Okamura K, Shichinohe T, Hirano S - World J Surg Oncol (2015)

Histopathological mapping on the macroscopic section at the plexus around the CA, indicating residual cancer cells at the plexus around the CA (left, area encircled with solid line). hematoxylin-eosin staining showed the residual cancer cells present at the area encircled with the broken line (right)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4482054&req=5

Fig2: Histopathological mapping on the macroscopic section at the plexus around the CA, indicating residual cancer cells at the plexus around the CA (left, area encircled with solid line). hematoxylin-eosin staining showed the residual cancer cells present at the area encircled with the broken line (right)
Mentions: Of the 18 patients, 12 patients (66 %) were initially diagnosed as having unresectable disease with arterial plexus invasion around the CA in 1 patient, the GDA in 4 patients, the SMA in 3 patients with pancreatic body cancer, and the CHA in 4 patients with head of the pancreas cancer. After the chemoradiotherapy, these findings on CT imaging had improved with the plexus around the artery of all patients. These fields, initially considered to include cancer cells, were totally resected in an en bloc-wise manner using already described procedures. Among them, 2 out of 3 patients in complete improvement after chemoradiotherapy and 7 out of 9 patients in partial improvement had still remained pathological plexus invasion (Table 4). Here, we show one characteristic case (no. 10 in Table 4) that was initially diagnosed as having unresectable disease with invasion to the plexus around the SMA. After chemotherapy including GEM and TS-1 for 15 months, adjuvant surgery was performed because PR was achieved (Fig. 1). CT scan after chemotherapy showed tumor shrinkage, which was amenable to radical resection by DP. However, DP-CAR was performed because of the policy described above. The pathological findings after resection showed tumor cells remaining around the celiac artery discontinuously (Fig. 2).Table 4

Bottom Line: Overall survival from initial treatment was much better for patients with R0 resection than for patients with R1/2 resection.It was shown that tumors did not shrink continuously from the tumor front, but parts remained discontinuously at the distal portion in the process of tumor regression by chemo(radio)therapy.Achieving R0 resection will lead to an improved prognosis, and it is necessary to consider how well the extent of resection is after a favorable response to chemoradiotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N-15 W-7, Sapporo, Hokkaido, 060-8638, Japan. htakano1231@yahoo.co.jp.

ABSTRACT

Background: With development of chemoradiotherapy for pancreatic carcinoma, borderline resectable or initially unresectable cases sometimes become operable after long-term intensive chemoradiotherapy. However, there is no established strategy for adjuvant surgery with respect to whether the surgical resection should be extensive or downsized accordingly with diminished disease areas following response to chemoradiotherapy.

Methods: The clinical and pathological aspects of 18 patients with initially unresectable pancreatic cancer who underwent adjuvant surgery after chemo(radio)therapy in our department from 2007 were evaluated.

Results: Overall survival from initial treatment was much better for patients with R0 resection than for patients with R1/2 resection. In two of three patients who had complete improvement of plexus (PL) invasion after chemo(radio)therapy, there had still remained pathological plexus invasion. It was shown that tumors did not shrink continuously from the tumor front, but parts remained discontinuously at the distal portion in the process of tumor regression by chemo(radio)therapy.

Conclusions: In adjuvant surgery for patients with locally advanced pancreatic cancer, the potential risk of residual cancer in the regression area following chemoradiotherapy should be considered. Achieving R0 resection will lead to an improved prognosis, and it is necessary to consider how well the extent of resection is after a favorable response to chemoradiotherapy.

No MeSH data available.


Related in: MedlinePlus