OBJECTIVES: The objective of this study was to evaluate the relevance of defining borderline resectable (BR) pancreatic cancer as a distinct entity in the treatment scheme of pancreatic cancer as proposed by the National Comprehensive Cancer Network. METHODS: Among 375 patients with pancreatic cancer, 137 patients were deemed to have resectable disease (R) by preoperative imaging studies, whereas 96 were found to have an unresectable disease during surgery. The remaining 142 patients fulfilled the definition of BR and were further classified into 3 subgroups based on the National Comprehensive Cancer Network guidelines: portal vein invasion (PV[+]), common hepatic artery invasion (CHA[+]), and superior mesenteric artery invasion (SMA[+]). PV(+) was subdivided into types B, C, and D according to the degree of portal vein invasion. RESULTS: Patients in the R group had significantly better survival than those in the PV(+) group (P = 0.0038), who in turn survived significantly longer than those classified as SMA(+) (P = 0.041). Type B patients survived significantly longer than did types C and D patients (P = 0.013 and P = 0.030, respectively). In PV(+) patients, compliance with postoperative chemotherapy at 3 and 6 months was 56.9% and 44.6%, respectively, substantially inferior to patients with resectable disease (72.6% and 54.7%, respectively). CONCLUSIONS: The optimal treatment strategy may differ among various subgroups within the BR category.
OBJECTIVES: The objective of this study was to evaluate the relevance of defining borderline resectable (BR) pancreatic cancer as a distinct entity in the treatment scheme of pancreatic cancer as proposed by the National Comprehensive Cancer Network. METHODS: Among 375 patients with pancreatic cancer, 137 patients were deemed to have resectable disease (R) by preoperative imaging studies, whereas 96 were found to have an unresectable disease during surgery. The remaining 142 patients fulfilled the definition of BR and were further classified into 3 subgroups based on the National Comprehensive Cancer Network guidelines: portal vein invasion (PV[+]), common hepatic artery invasion (CHA[+]), and superior mesenteric artery invasion (SMA[+]). PV(+) was subdivided into types B, C, and D according to the degree of portal vein invasion. RESULTS:Patients in the R group had significantly better survival than those in the PV(+) group (P = 0.0038), who in turn survived significantly longer than those classified as SMA(+) (P = 0.041). Type B patients survived significantly longer than did types C and D patients (P = 0.013 and P = 0.030, respectively). In PV(+) patients, compliance with postoperative chemotherapy at 3 and 6 months was 56.9% and 44.6%, respectively, substantially inferior to patients with resectable disease (72.6% and 54.7%, respectively). CONCLUSIONS: The optimal treatment strategy may differ among various subgroups within the BR category.
Authors: Hop S Tran Cao; Alpana Balachandran; Huamin Wang; Graciela M Nogueras-González; Christina E Bailey; Jeffrey E Lee; Peter W T Pisters; Douglas B Evans; Gauri Varadhachary; Christopher H Crane; Thomas A Aloia; Jean-Nicolas Vauthey; Jason B Fleming; Matthew H G Katz Journal: J Gastrointest Surg Date: 2013-10-16 Impact factor: 3.452
Authors: Hadass Rom; Shlomit Tamir; Jeroen L A Van Vugt; Yael Berger; Gali Perl; Sara Morgenstern; Ana Tovar; Baruch Brenner; Daniel Benchimol; Hanoch Kashtan; Eran Sadot Journal: Ann Surg Oncol Date: 2021-10-30 Impact factor: 5.344
Authors: Matthew H G Katz; Qian Shi; Syed A Ahmad; Joseph M Herman; Robert de W Marsh; Eric Collisson; Lawrence Schwartz; Wendy Frankel; Robert Martin; William Conway; Mark Truty; Hedy Kindler; Andrew M Lowy; Tanios Bekaii-Saab; Philip Philip; Mark Talamonti; Dana Cardin; Noelle LoConte; Perry Shen; John P Hoffman; Alan P Venook Journal: JAMA Surg Date: 2016-08-17 Impact factor: 14.766