Bradley N Reames1, Alex B Blair2, Robert W Krell3, Vincent P Groot4, Georgios Gemenetzis5, James C Padussis1, Sarah P Thayer1, Massimo Falconi6, Christopher L Wolfgang2, Matthew J Weiss7, Chandrakanth Are1, Jin He2. 1. Department of Surgery, University of Nebraska Medical Center, Omaha, NE. 2. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD. 3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands. 5. Department of Surgery, University of Glasgow School of Medicine, Glasgow, UK. 6. Department of Surgery, Università Vita-Salute, San Raffaele Hospital IRCCS, Milano, Italy. 7. Department of Surgery, Northwell Health, Manhasset, NY.
Abstract
OBJECTIVE: The aim of this study was to investigate surgeon preferences for the management of patients with locally advanced pancreatic cancer (LAPC). BACKGROUND: Select patients with LAPC may become candidates for curative resection following neoadjuvant therapy, and recent reports of survival are encouraging. Yet the optimal management approach remains unclear. METHODS: An extensive electronic survey was systematically distributed by email to an international cohort of pancreas surgeons. Data collected included practice characteristics, management preferences, attitudes regarding contraindications to surgery, and 6 clinical vignettes of patients that ultimately received a margin negative resection (with detailed videos of post-neoadjuvant imaging) to assess propensity for surgical exploration if resection status is not known. RESULTS: A total of 153 eligible responses were received from 4 continents. Median duration of practice is 12 years (interquartile range 6-20) and 77% work in a university setting. Most surgeons (86%) are considered high volume (>10 resections/yr), 33% offer a minimally-invasive approach, and 50% offer arterial resections in select patients. Most (72%) always recommend neoadjuvant chemotherapy, and 65% prefer FOLFIRINOX. Preferences for the duration of chemotherapy varied widely: 39% prefer ≥2 months, 43% prefer ≥4 months, and 11% prefer ≥6 months. Forty-one percent frequently recommend neoadjuvant radiotherapy, and 53% prefer 5 to 6 weeks of chemoradiation. The proportion of surgeons favoring exploration following neoadjuvant varied extensively across 5 vignettes of LAPC, from 14% to 53%. In a vignette of oligometastatic liver metastases, 31% would offer exploration if a favorable therapy response is observed. CONCLUSIONS: In an international cohort of pancreas surgeons, there is substantial variation in management preferences, perceived contraindications to surgery, and the propensity to consider exploration in LAPC. These results emphasize the importance of a robust and nuanced multidisciplinary discussion for each patient, and suggest an evolving concept of "resectability."
OBJECTIVE: The aim of this study was to investigate surgeon preferences for the management of patients with locally advanced pancreatic cancer (LAPC). BACKGROUND: Select patients with LAPC may become candidates for curative resection following neoadjuvant therapy, and recent reports of survival are encouraging. Yet the optimal management approach remains unclear. METHODS: An extensive electronic survey was systematically distributed by email to an international cohort of pancreas surgeons. Data collected included practice characteristics, management preferences, attitudes regarding contraindications to surgery, and 6 clinical vignettes of patients that ultimately received a margin negative resection (with detailed videos of post-neoadjuvant imaging) to assess propensity for surgical exploration if resection status is not known. RESULTS: A total of 153 eligible responses were received from 4 continents. Median duration of practice is 12 years (interquartile range 6-20) and 77% work in a university setting. Most surgeons (86%) are considered high volume (>10 resections/yr), 33% offer a minimally-invasive approach, and 50% offer arterial resections in select patients. Most (72%) always recommend neoadjuvant chemotherapy, and 65% prefer FOLFIRINOX. Preferences for the duration of chemotherapy varied widely: 39% prefer ≥2 months, 43% prefer ≥4 months, and 11% prefer ≥6 months. Forty-one percent frequently recommend neoadjuvant radiotherapy, and 53% prefer 5 to 6 weeks of chemoradiation. The proportion of surgeons favoring exploration following neoadjuvant varied extensively across 5 vignettes of LAPC, from 14% to 53%. In a vignette of oligometastatic liver metastases, 31% would offer exploration if a favorable therapy response is observed. CONCLUSIONS: In an international cohort of pancreas surgeons, there is substantial variation in management preferences, perceived contraindications to surgery, and the propensity to consider exploration in LAPC. These results emphasize the importance of a robust and nuanced multidisciplinary discussion for each patient, and suggest an evolving concept of "resectability."
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: Citadel J Cabasag; Melina Arnold; Mark Rutherford; Aude Bardot; Jacques Ferlay; Eileen Morgan; Alana Little; Prithwish De; Elijah Dixon; Ryan R Woods; Nathalie Saint-Jacques; Sue Evans; Gerda Engholm; Mark Elwood; Neil Merrett; David Ransom; Dianne L O'Connell; Freddie Bray; Isabelle Soerjomataram Journal: Br J Cancer Date: 2022-03-02 Impact factor: 9.075
Authors: Logan R McNeil; Alex B Blair; Robert W Krell; Chunmeng Zhang; Aslam Ejaz; Vincent P Groot; Georgios Gemenetzis; James C Padussis; Massimo Falconi; Christopher L Wolfgang; Matthew J Weiss; Chandrakanth Are; Jin He; Bradley N Reames Journal: Surg Open Sci Date: 2022-08-06