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Optimizing The Outcomes Of Pancreatic Cancer Surgery

Oliver Strobel, John P Neoptolemos, Dirk Jaeger, Markus W. Büchler
Published 2018 · Medicine
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Pancreatic cancer is likely to become the second most frequent cause of cancer-associated mortality within the next decade. Surgical resection with adjuvant systemic chemotherapy currently provides the only chance of long-term survival. However, only 10–20% of patients with pancreatic cancer are diagnosed with localized, surgically resectable disease. The majority of patients present with metastatic disease and are not candidates for surgery, while surgery remains underused even in those with resectable disease owing to historical concerns regarding safety and efficacy. However, advances made over the past decade in the safety and efficacy of surgery have resulted in perioperative mortality of around 3% and 5-year survival approaching 30% after resection and adjuvant chemotherapy. Furthermore, owing to advances in both surgical techniques and systemic chemotherapy, the indications for resection have been extended to include locally advanced tumours. Many aspects of pancreatic cancer surgery, such as the management of postoperative morbidities, sequencing of resection and systemic therapy, and use of neoadjuvant therapy followed by resection for tumours previously considered unresectable, are rapidly evolving. In this Review, we summarize the current status of and new developments in pancreatic cancer surgery, while highlighting the most important research questions for attempts to further optimize outcomes.Successful surgical resection offers patients with pancreatic cancer the best chance of survival. However, many patients do not have surgically resectable disease. In this Review, the authors describe recent improvements in pancreatic cancer surgery, which have increased survival and also enabled more patients to undergo surgery.Key pointsSurgical resection in combination with systemic chemotherapy offers the only hope for long-term survival or cure in patients with nonmetastatic pancreatic cancer.Surgical resection and adjuvant multi-agent chemotherapy (gemcitabine plus capecitabine or modified FOLFIRINOX) is the standard of care in patients with resectable pancreatic cancer.Both the safety and efficacy of pancreatic cancer surgery have improved considerably in the past decade, enabling perioperative mortality of around 3% and 5-year survival approaching 30–40% after resection and chemotherapy.Important criteria for assessing the quality of pancreatic cancer surgery include perioperative morbidity and mortality, oncologically determined pancreatic resection, the proportion of patients in fact receiving and completing adjuvant therapy and — above all — long-term survival.Relationships between hospital pancreatectomy volume and outcome quality have an important role in determining the success of pancreatic cancer surgery.Owing to advances in both surgery and systemic chemotherapy, the indications for surgical resections have been extended from stage I and II to locally advanced, previously unresectable pancreatic cancer.
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Prognostic Value of the C-Reactive Protein/Lymphocyte Ratio in Pancreatic Cancer
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K. F. Flick (2020)
10.7150/jca.44833
LncRNA H19-Derived miR-675-3p Promotes Epithelial-Mesenchymal Transition and Stemness in Human Pancreatic Cancer Cells by targeting the STAT3 Pathway
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10.1016/j.cej.2019.122949
Silica/gold nanoplatform combined with a thermosensitive gel for imaging-guided interventional therapy in PDX of pancreatic cancer
Ling-Xi Xing (2020)
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Pancreatic cancer incidence and survival and the role of specialist centres in resection rates in England, 2000 to 2014: A population-based study.
Aimilia Exarchakou (2020)
10.1002/jcb.29320
A potential prognostic marker and therapeutic target: SPOCK1 promotes the proliferation, metastasis, and apoptosis of pancreatic ductal adenocarcinoma cells.
Jinzhuo Li (2019)
10.3390/diagnostics10050305
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Lei Zhu (2020)
10.7717/peerj.8380
Identification of prognostic splicing factors and exploration of their potential regulatory mechanisms in pancreatic adenocarcinoma
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10.1158/1078-0432.CCR-19-1864
Neoadjuvant Therapy Remodels the Pancreatic Cancer Microenvironment via Depletion of Protumorigenic Immune Cells
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Proimmunogenic impact of MEK inhibition synergizes with agonist anti-CD40 immunostimulatory antibodies in tumor therapy
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Conversion surgery for initially unresectable pancreatic cancer: current status and unresolved issues
Hideyuki Yoshitomi (2019)
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Simultaneous resection of the primary tumour and liver metastases after conversion chemotherapy versus standard therapy in pancreatic cancer with liver oligometastasis: protocol of a multicentre, prospective, randomised phase III control trial (CSPAC-1)
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Diagnosing pancreatic ductal adenocarcinoma using plasma extracellular vesicle RNA profiles
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Inhibition of miR30a-3p by sulforaphane enhances gap junction intercellular communication in pancreatic cancer.
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