Impact of Borderline Resectability in Pancreatic Head Cancer on Patient Survival: Biology Matters According to the New I
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Impact of Borderline Resectability in Pancreatic Head Cancer on Patient Survival: Biology Matters According to the New International Consensus Criteria Friedrich Anger, MD1, Anna Do¨ring, MD1, Jacob van Dam, MD2, Johan Friso Lock1, Ingo Klein1, Max Bittrich, MD3, Christoph-Thomas Germer, MD1,4, Armin Wiegering, MD1,4, Volker Kunzmann, MD3,4, Casper van Eijck, MD2, and Stefan Lo¨b, MD1 1
Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Julius Maximilians University Wuerzburg, Wu¨rzburg, Germany; 2Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; 3Department of Internal Medicine II, Julius Maximilians University Wuerzburg, Wu¨rzburg, Germany; 4Comprehensive Cancer Centre Mainfranken, Julius Maximilians University Wuerzburg, Wu¨rzburg, Germany
ABSTRACT Background. International consensus criteria (ICC) have redefined borderline resectability for pancreatic ductal adenocarcinoma (PDAC) according to three dimensions: anatomical (BR-A), biological (BR-B), and conditional (BR-C). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumour and vessels but that biological and conditional dimensions also are important. Methods. Patients’ tumours were retrospectively defined borderline resectable according to ICC. The study cohort was grouped into either BR-A or BR-B and compared with patients considered primarily resectable (R). Differences in postoperative complications, pathological reports, overall (OS), and disease-free survival were assessed. Results. A total of 345 patients underwent resection for PDAC. By applying ICC in routine preoperative assessment, 30 patients were classified as stage BR-A and 62 patients as stage BR-B. In total, 253 patients were considered R. The cohort did not contain BR-C patients. No
Casper van Eijck and Stefan Lo¨b have contributed equally to this work. Ó The Author(s) 2020 First Received: 30 April 2020 Accepted: 18 August 2020 S. Lo¨b, MD e-mail: [email protected]
differences in postoperative complications were detected. Median OS was significantly shorter in BR-A (15 months) and BR-B (12 months) compared with R (20 months) patients (BR-A vs. R: p = 0.09 and BR-B vs. R: p \ 0.001). CA19-9, as the determining factor of BR-B patients, turned out to be an independent prognostic risk factor for OS. Conclusions. Preoperative staging defining surgical resectability in PDAC according to ICC is crucial for patient survival. Patients with PDAC BR-B should be considered for multimodal neoadjuvant therapy even if considered anatomically resectable.
Ductal adenocarcinoma of the pancreas (PDAC) remains an aggressive gastrointestinal malignancy with a poor prognosis.1 Surgical resection, in combination with systemic chemotherapy, offers the only option for longterm survival or even cure for patients with pancreatic cancer. However, modern multimodal treatment approaches still result in 5-year survival rates of 20–30%.2 Only 1
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