Clinical Implications of Conversion Surgery for Initially Unresectable, Locally Advanced Pancreatic Adenocarcinoma. A Single Center Experiences

Yasutoshi Kimura, Masafumi Imamura, Minoru Nagayama, Hiroshi Yamaguchi, Masayo Motoya, Makoto Yoshida, Naoki Hirokawa, Toru Mizuguchi, Junji Kato, Hiroshi Nakase, Koichi Sakata and Ichiro Takemasa

Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Japan
Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Japan
Medical Oncology, Sapporo Medical University School of Medicine, Japan
Radiation Oncology and Medical Physics, Sapporo Medical University School of Medicine, Japan

^*Correspondance to: Yasutoshi Kimura 

 PDF  Full Text DOI: 10.25107/2474-1647.1994

Abstract

Background: Recent advances in anticancer treatment for unresectable Pancreatic Adenocarcinoma (PDAC) facilitate good disease control, and considering who might benefit from Conversion Surgery (CS) among those with a favorable response to induction treatment remains controversial.Objectives: The aim of this study was to evaluate patients’ outcomes and identify indicators for selecting conversion surgery after multidisciplinary induction treatment for initially unresectable and locally advanced (UR-LA) pancreatic adenocarcinoma.Methods: Among 727 patients in a hospital-based PDAC database from 1997 to 2016, 93 who were clinically diagnosed as UR-LA on imaging were included in this retrospective cohort. Treatment regimens and overall survival (OS) were analyzed in relation to CS. Univariate and multivariate analyses were undertaken to determine predictors for OS. Prognostic scores, such as the highsensitivity modified Glasgow prognostic score (HS-mGPS) and the prognostic nutritional index (PNI), were also evaluated.
Results: For the 93 UR-LA PDAC cases, chemotherapy (CT) with or without chemoradiotherapy (CRT) was given as 1st and 2nd line treatment. CS was completed in 15 (16.1%) patients at 10.7 months after induction treatment, with all cases achieving R0. OS was significantly better in the CS group (32.9 vs. 15.6 months, p=0.0008). Independent predictors for OS were CS (HR 0.23, 95% CI 0.09-0.63, p=0.004) and pre-treatment HS-mGPS [2-3; HR 1.96, 95% CI 1.09-3.52, p=0.024].Conclusions: CS following a favorable response to induction therapy for UR-LA PDAC may be a good option to prolong survival. The preoperative HS-mGPS was significantly related to the prognosis of UR-LA PDAC patients.

Keywords

Pancreatic adenocarcinoma; Unresectable; Locally advanced; Radical surgery; Conversion

Cite the article

Kimura Y, Imamura M, Nagayama M, Yamaguchi H, Motoya M, Yoshida M, et al. Clinical Implications of Conversion Surgery for Initially Unresectable, Locally Advanced Pancreatic Adenocarcinoma. A Single Center Experiences. Clin Surg. 2018; 3: 1994.