Ammar A Javed1,2, Michael J Wright1,2, Ayat Siddique1,2, Alex B Blair1,2, Ding Ding2,3, Richard A Burkhart1,2, Martin Makary1,2, John L Cameron1,2, Amol Narang2,4, Joseph Herman2,4, Lei Zheng2,3, Daniel Laheru2,3, Matthew J Weiss1,2, Christopher Wolfgang1,2, Jin He5,6. 1. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 614, Baltimore, MD, 21287, USA. 2. The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 4. Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Halsted 614, Baltimore, MD, 21287, USA. jhe11@jhmi.edu. 6. The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. jhe11@jhmi.edu.
Abstract
INTRODUCTION: Approximately, 20% of patients with pancreatic ductal adenocarcinoma have resectable disease at diagnosis. Given improvements in locoregional and systemic therapies, some patients with borderline resectable pancreatic cancer (BRPC) can now undergo successful resection. The outcomes of patients with BRPC after neoadjuvant therapy remain unclear. METHODS: A prospectively maintained single-institution database was utilized to identify patients with BRPC who were managed at the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC) between 2013 and 2016. BRPC was defined as any tumor that presented with radiographic evidence of the involvement of the portal vein (PV) or superior mesenteric vein (SMV) that was deemed to be technically resectable (with or without the need for reconstruction), or the abutment (< 180° involvement) of the common hepatic artery (CHA) or superior mesenteric artery (SMA), in the absence of involvement of the celiac axis (CA). We collected data on treatment, the course of the disease, resection rate, and survival. RESULTS: Of the 866 patients evaluated at the PMDC during the study period, 151 (17.5%) were staged as BRPC. Ninety-six patients (63.6%) underwent resection. Neoadjuvant chemotherapy was administered to 142 patients (94.0%), while 78 patients (51.7%) received radiation therapy in the neoadjuvant setting. The median overall survival from the date of diagnosis, of resected BRPC patients, was 28.8 months compared to 14.5 months in those who did not (p < 0.001). Factors associated with increased chance of surgical resection included lower ECOG performance status (p = 0.011) and neck location of the tumor (p = 0.001). Forty-seven patients with BRPC (31.1%) demonstrated progression of disease; surgical resection was attempted and aborted in 12 patients (7.9%). Eight patients (5.3%) were unable to tolerate chemotherapy; six had disease progression and two did not want to pursue surgery. Lastly, four patients (3.3%) were conditionally unresectable due to medical comorbidities at the time of diagnosis due to comorbidities and failed to improve their status and subsequently had progression of the disease. CONCLUSION: After initial management, 31.1% of patients with BRPC have progression of disease, while 63.6% of all patients successfully undergo resection, which was associated with improved survival. Factors associated with increased likelihood of surgical resection include lower ECOG performance status and tumor location in the neck.
INTRODUCTION: Approximately, 20% of patients with pancreatic ductal adenocarcinoma have resectable disease at diagnosis. Given improvements in locoregional and systemic therapies, some patients with borderline resectable pancreatic cancer (BRPC) can now undergo successful resection. The outcomes of patients with BRPC after neoadjuvant therapy remain unclear. METHODS: A prospectively maintained single-institution database was utilized to identify patients with BRPC who were managed at the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC) between 2013 and 2016. BRPC was defined as any tumor that presented with radiographic evidence of the involvement of the portal vein (PV) or superior mesenteric vein (SMV) that was deemed to be technically resectable (with or without the need for reconstruction), or the abutment (< 180° involvement) of the common hepatic artery (CHA) or superior mesenteric artery (SMA), in the absence of involvement of the celiac axis (CA). We collected data on treatment, the course of the disease, resection rate, and survival. RESULTS: Of the 866 patients evaluated at the PMDC during the study period, 151 (17.5%) were staged as BRPC. Ninety-six patients (63.6%) underwent resection. Neoadjuvant chemotherapy was administered to 142 patients (94.0%), while 78 patients (51.7%) received radiation therapy in the neoadjuvant setting. The median overall survival from the date of diagnosis, of resected BRPC patients, was 28.8 months compared to 14.5 months in those who did not (p < 0.001). Factors associated with increased chance of surgical resection included lower ECOG performance status (p = 0.011) and neck location of the tumor (p = 0.001). Forty-seven patients with BRPC (31.1%) demonstrated progression of disease; surgical resection was attempted and aborted in 12 patients (7.9%). Eight patients (5.3%) were unable to tolerate chemotherapy; six had disease progression and two did not want to pursue surgery. Lastly, four patients (3.3%) were conditionally unresectable due to medical comorbidities at the time of diagnosis due to comorbidities and failed to improve their status and subsequently had progression of the disease. CONCLUSION: After initial management, 31.1% of patients with BRPC have progression of disease, while 63.6% of all patients successfully undergo resection, which was associated with improved survival. Factors associated with increased likelihood of surgical resection include lower ECOG performance status and tumor location in the neck.
Authors: Ammar A Javed; Ding Ding; Erum Baig; Michael J Wright; Jonathan A Teinor; Daniyal Mansoor; Elizabeth Thompson; Ralph H Hruban; Amol Narang; William R Burns; Richard A Burkhart; Kelly Lafaro; Matthew J Weiss; John L Cameron; Christopher L Wolfgang; Jin He Journal: World J Surg Date: 2022-01-07 Impact factor: 3.352
Authors: Georgios Gemenetzis; Alex B Blair; Minako Nagai; William R Burns; Christopher L Wolfgang; Jin He; Vincent P Groot; Ding Ding; Ammar A Javed; Richard A Burkhart; Elliot K Fishman; Ralph H Hruban; Matthew J Weiss; John L Cameron; Amol Narang; Daniel Laheru; Kelly Lafaro; Joseph M Herman; Lei Zheng Journal: Ann Surg Oncol Date: 2021-08-27 Impact factor: 5.344
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: Ammar A Javed; Joseph R Habib; Benedict Kinny-Köster; Mary Hodgin; Lindsay Parish; Dea Cunningham; Amy Hacker-Prietz; Richard A Burkhart; William R Burns; Christopher R Shubert; John L Cameron; Atif Zaheer; Linda C H Chu; Satomi Kawamoto; Elizabeth D Thompson; Eun J Shin; Amol Narang; Lei Zheng; Daniel A Laheru; Ralph H Hruban; Jin He; Christopher L Wolfgang; Elliot K Fishman; Kelly Lafaro Journal: Curr Probl Diagn Radiol Date: 2022-05-25