Laurent Sulpice1, Olivier Turrini2, Jonathan Garnier3, Fabien Robin1, Jacques Ewald4, Ugo Marchese4, Damien Bergeat1, Karim Boudjema1, Jean-Robert Delpero4. 1. Department of Hepato-Biliary and Digestive Surgery, CHU Rennes, Université Rennes 1, Rennes, France. 2. Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille University, CRCM, Marseille, France. 3. Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France. garnierj@ipc.unicancer.fr. 4. Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
Abstract
BACKGROUND: Experienced pancreatic surgeons, for whom complexity is not an issue, must decide at the end of neoadjuvant therapy whether to continue or discontinue surgery, when pancreatectomy with vascular resection is planned in patients with pancreatic ductal adenocarcinoma (PDAC). OBJECTIVE: Our study aimed to determine preoperative factors that can predict short postoperative survival in such situations. METHODS: Overall, 105 patients with borderline or locally advanced PDAC received neoadjuvant FOLFIRINOX (followed by chemoradiation in 22% of patients) and underwent pancreatectomy with segmental venous and/or arterial resection at two high-volume centers. The primary endpoint was overall survival (OS) of < 1 year after surgery for patients who did not die from the surgery. RESULTS: Tumors were classified as borderline in 78% of cases and locally advanced in 22% of cases. Mean CA19-9 at diagnosis was 934 U/mL, which significantly decreased to 213 U/mL (p < 0.01) after a median of six cycles of FOLFIRINOX. Pancreaticoduodenectomy was performed most often (76%). The vast majority of patients underwent venous resection (92%), and a simultaneous arterial resection was performed in 16 patients (15%). The severe morbidity rate and 30- and 90-day mortality rates were 21%, 8.5%, and 10.4%, respectively. The median OS after surgery was 23 months. In the multivariate analysis, preoperative CA19-9 ≥ 450 U/mL was the only preoperative factor independently associated with OS of < 1 year (p = 0.044). CONCLUSION: The preoperative CA19-9 value should be considered in the clinical decision-making process when complex vascular resection is required.
BACKGROUND: Experienced pancreatic surgeons, for whom complexity is not an issue, must decide at the end of neoadjuvant therapy whether to continue or discontinue surgery, when pancreatectomy with vascular resection is planned in patients with pancreatic ductal adenocarcinoma (PDAC). OBJECTIVE: Our study aimed to determine preoperative factors that can predict short postoperative survival in such situations. METHODS: Overall, 105 patients with borderline or locally advanced PDAC received neoadjuvant FOLFIRINOX (followed by chemoradiation in 22% of patients) and underwent pancreatectomy with segmental venous and/or arterial resection at two high-volume centers. The primary endpoint was overall survival (OS) of < 1 year after surgery for patients who did not die from the surgery. RESULTS:Tumors were classified as borderline in 78% of cases and locally advanced in 22% of cases. Mean CA19-9 at diagnosis was 934 U/mL, which significantly decreased to 213 U/mL (p < 0.01) after a median of six cycles of FOLFIRINOX. Pancreaticoduodenectomy was performed most often (76%). The vast majority of patients underwent venous resection (92%), and a simultaneous arterial resection was performed in 16 patients (15%). The severe morbidity rate and 30- and 90-day mortality rates were 21%, 8.5%, and 10.4%, respectively. The median OS after surgery was 23 months. In the multivariate analysis, preoperative CA19-9 ≥ 450 U/mL was the only preoperative factor independently associated with OS of < 1 year (p = 0.044). CONCLUSION: The preoperative CA19-9 value should be considered in the clinical decision-making process when complex vascular resection is required.
Authors: Thilo Hackert; Milena Sachsenmaier; Ulf Hinz; Lutz Schneider; Christoph W Michalski; Christoph Springfeld; Oliver Strobel; Dirk Jäger; Alexis Ulrich; Markus W Büchler Journal: Ann Surg Date: 2016-09 Impact factor: 12.969
Authors: Thierry Conroy; Françoise Desseigne; Marc Ychou; Olivier Bouché; Rosine Guimbaud; Yves Bécouarn; Antoine Adenis; Jean-Luc Raoul; Sophie Gourgou-Bourgade; Christelle de la Fouchardière; Jaafar Bennouna; Jean-Baptiste Bachet; Faiza Khemissa-Akouz; Denis Péré-Vergé; Catherine Delbaldo; Eric Assenat; Bruno Chauffert; Pierre Michel; Christine Montoto-Grillot; Michel Ducreux Journal: N Engl J Med Date: 2011-05-12 Impact factor: 91.245
Authors: Eva Versteijne; Mustafa Suker; Karin Groothuis; Janine M Akkermans-Vogelaar; Marc G Besselink; Bert A Bonsing; Jeroen Buijsen; Olivier R Busch; Geert-Jan M Creemers; Ronald M van Dam; Ferry A L M Eskens; Sebastiaan Festen; Jan Willem B de Groot; Bas Groot Koerkamp; Ignace H de Hingh; Marjolein Y V Homs; Jeanin E van Hooft; Emile D Kerver; Saskia A C Luelmo; Karen J Neelis; Joost Nuyttens; Gabriel M R M Paardekooper; Gijs A Patijn; Maurice J C van der Sangen; Judith de Vos-Geelen; Johanna W Wilmink; Aeilko H Zwinderman; Cornelis J Punt; Casper H van Eijck; Geertjan van Tienhoven Journal: J Clin Oncol Date: 2020-02-27 Impact factor: 44.544
Authors: Eran van Veldhuisen; Jantien A Vogel; Sjors Klompmaker; Olivier R Busch; Hanneke W M van Laarhoven; Krijn P van Lienden; Johanna W Wilmink; Hendrik A Marsman; Marc G Besselink Journal: HPB (Oxford) Date: 2018-02-21 Impact factor: 3.647
Authors: Francis I Macedo; Emily Ryon; Shishir K Maithel; Rachel M Lee; David A Kooby; Ryan C Fields; William G Hawkins; Greg Williams; Ugwuji Maduekwe; Hong J Kim; Syed A Ahmad; Sameer H Patel; Daniel E Abbott; Patrick Schwartz; Sharon M Weber; Charles R Scoggins; Robert C G Martin; Vikas Dudeja; Dido Franceschi; Alan S Livingstone; Nipun B Merchant Journal: Ann Surg Date: 2019-09 Impact factor: 12.969
Authors: Cristina R Ferrone; Giovanni Marchegiani; Theodore S Hong; David P Ryan; Vikram Deshpande; Erin I McDonnell; Francesco Sabbatino; Daniela Dias Santos; Jill N Allen; Lawrence S Blaszkowsky; Jeffrey W Clark; Jason E Faris; Lipika Goyal; Eunice L Kwak; Janet E Murphy; David T Ting; Jennifer Y Wo; Andrew X Zhu; Andrew L Warshaw; Keith D Lillemoe; Carlos Fernández-del Castillo Journal: Ann Surg Date: 2015-01 Impact factor: 12.969