Current Surgical Management of Pancreatic Cancer

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 12541

Special Issue Editors


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Guest Editor
Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
Interests: hepatopancreatobiliary surgery; organ transplantation; pancreatic surgery; liver transplantation; liver surgery
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Guest Editor
Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
Interests: liver transplantation; hepatectomy; pancreaticoduodenectomy; pancreatic surgery; pancreatic cancer
Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
Interests: hepatobiliary surgery; organ transplantation; pancreatic surgery; liver transplantation; liver surgery; hepatectomy

Special Issue Information

Dear Colleagues,

We invite your participation in the current Special Issue of JCM on “Current Surgical Management of Pancreatic Cancer”. Pancreatic cancer has a poor prognosis following its diagnosis. Altough the progress of treatment for pancreatic cancer is remarkable, surgery is the only treatment with the potential for curing it. Since neoadjuvant and adjuvant therapies used for pancreatic cancer have been recently developed, the role of surgery for pancreatic cancer has changed. Furthermore, minimally invasive surgery, including laparoscopic and robotic surgeries, is becoming mainstream even in hepato-pancreatico-biliary surgery. Minimally invasive surgery for pancreatic cancer might be safe and feasible; however, further research is required. In the current Special Issue, we aim to discuss the current surgical management of pancreatic cancer, focusing on open and minimally invasive surgery, neoadjuvant and adjuvant therapies, and the outcomes. The translational research conducted on this topic is also invited for submission. In addition, multimedia manuscripts are welcomed.

We anticipate receiving your submissions to this Special Issue.

Dr. Kosei Takagi
Dr. Ryuuichi Yoshida
Dr. Yuzo Umeda
Guest Editors

Manuscript Submission Information

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Keywords

  • pancreatic cancer
  • pancreatectomy
  • minimally invasive surgery
  • neoadjuvant therapy
  • adjuvant therapy
  • conversion surgery
  • outcomes

Published Papers (7 papers)

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Editorial

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3 pages, 193 KiB  
Editorial
Role of Surgery for Pancreatic Ductal Adenocarcinoma in the Era of Multidisciplinary Treatment
by Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Takahito Yagi and Toshiyoshi Fujiwara
J. Clin. Med. 2023, 12(2), 465; https://doi.org/10.3390/jcm12020465 - 06 Jan 2023
Cited by 2 | Viewed by 1061
Abstract
The incidence and mortality rates of pancreatic ductal adenocarcinoma (PDAC) have increased in recent years worldwide [...] Full article
(This article belongs to the Special Issue Current Surgical Management of Pancreatic Cancer)

Research

Jump to: Editorial

12 pages, 1001 KiB  
Article
Short- and Long-Term Outcomes of Neoadjuvant Chemoradiotherapy Followed by Pancreatoduodenectomy in Elderly Patients with Resectable and Borderline Resectable Pancreatic Cancer: A Retrospective Study
by Hironobu Suto, Takuro Fuke, Hiroyuki Matsukawa, Yasuhisa Ando, Minoru Oshima, Mina Nagao, Shigeo Takahashi, Toru Shibata, Hiroki Yamana, Hideki Kamada, Hideki Kobara, Hiroyuki Okuyama, Kensuke Kumamoto and Keiichi Okano
J. Clin. Med. 2024, 13(5), 1216; https://doi.org/10.3390/jcm13051216 - 21 Feb 2024
Viewed by 525
Abstract
Background: The efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by pancreatoduodenectomy (PD) in elderly patients with pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods: This retrospective analysis of prospectively collected data examined the effect of NACRT followed by PD in elderly patients with [...] Read more.
Background: The efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by pancreatoduodenectomy (PD) in elderly patients with pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods: This retrospective analysis of prospectively collected data examined the effect of NACRT followed by PD in elderly patients with PDAC. A total of 112 patients with resectable (R-) and borderline resectable (BR-) PDAC, who were planned for PD and received NACRT between 2009 and 2022, were assessed. Changes induced by NACRT, surgical outcomes, nutritional status, renal and endocrine functions, and prognosis were compared between elderly (≥75 years, n = 43) and non-elderly (<75 years, n = 69) patients over two years following PD. Results: Completion and adverse event rates during NACRT, nutritional status, renal function, endocrine function over two years postoperatively, and prognosis did not significantly differ between the two groups. Low prognostic index after NACRT and the absence of postoperative adjuvant chemotherapy may be adverse prognostic indicators for elderly patients undergoing NACRT for R- and BR-PDAC. Conclusions: Despite a higher incidence of postoperative complications, NACRT followed by PD can be safely performed in elderly patients, resulting in a prognosis similar to that in non-elderly patients. Full article
(This article belongs to the Special Issue Current Surgical Management of Pancreatic Cancer)
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11 pages, 826 KiB  
Article
Optimal Lymphadenectomy in Patients with Well-Differentiated Nonfunctioning Pancreatic Neuroendocrine Neoplasms
by Ryuta Shintakuya, Kenichiro Uemura, Tatsuaki Sumiyoshi, Kenjiro Okada, Kenta Baba, Takumi Harada, Yoshiaki Murakami, Masahiro Serikawa, Yasutaka Ishii, Koji Arihiro and Shinya Takahashi
J. Clin. Med. 2023, 12(21), 6778; https://doi.org/10.3390/jcm12216778 - 26 Oct 2023
Viewed by 679
Abstract
This study aimed to evaluate the optimal extent of lymphadenectomy in patients with nonfunctioning pancreatic neuroendocrine neoplasms. We retrospectively analyzed the clinicopathological data of patients with nonfunctioning pancreatic neuroendocrine neoplasms who underwent surgical resection. We investigated the frequency of metastases at each lymph [...] Read more.
This study aimed to evaluate the optimal extent of lymphadenectomy in patients with nonfunctioning pancreatic neuroendocrine neoplasms. We retrospectively analyzed the clinicopathological data of patients with nonfunctioning pancreatic neuroendocrine neoplasms who underwent surgical resection. We investigated the frequency of metastases at each lymph node station according to tumor location and analyzed the factors contributing to poor overall survival (OS) and disease-free survival (DFS). Overall, data of 84 patients were analyzed. Among patients with pancreatic head tumors, metastases at stations 8, 13, and 17 were found in one (3.1%), four (12.5%), and three (9.3%) patients, respectively. However, none of the other stations showed metastases. For pancreatic body and tail tumors, metastases only at station 11 were found in two (5.1%) patients. Additionally, multivariate DFS and OS analyses showed that lymph node metastasis was the only independent prognostic factor. In conclusion, lymph node metastasis near the primary tumor was the only independent factor of poor prognosis in patients with nonfunctioning pancreatic neuroendocrine neoplasms after undergoing curative surgery. Peri-pancreatic lymphadenectomy might be recommended for nonfunctioning pancreatic neuroendocrine neoplasms. Full article
(This article belongs to the Special Issue Current Surgical Management of Pancreatic Cancer)
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11 pages, 830 KiB  
Article
Utility of Covered Self-Expanding Metal Stents for Biliary Drainage during Neoadjuvant Chemotherapy in Patients with Borderline Resectable Pancreatic Cancer
by Masaru Furukawa, Yasutaka Ishii, Masahiro Serikawa, Tomofumi Tsuboi, Yumiko Tatsukawa, Tetsuro Hirano, Shinya Nakamura, Juri Ikemoto, Yusuke Kiyoshita, Sho Saeki, Yosuke Tamura, Sayaka Miyamoto, Kazuki Nakamura, Yumiko Yamashita, Noriaki Iijima, Kenichiro Uemura and Shiro Oka
J. Clin. Med. 2023, 12(19), 6245; https://doi.org/10.3390/jcm12196245 - 28 Sep 2023
Cited by 1 | Viewed by 909
Abstract
Objectives: We aimed to compare the utility of covered self-expanding metal stents (CSEMSs) with that of plastic stents (PSs) for biliary drainage during neoadjuvant chemotherapy in patients with borderline resectable pancreatic cancer. Methods: Forty patients with borderline resectable pancreatic cancer underwent biliary stenting [...] Read more.
Objectives: We aimed to compare the utility of covered self-expanding metal stents (CSEMSs) with that of plastic stents (PSs) for biliary drainage during neoadjuvant chemotherapy in patients with borderline resectable pancreatic cancer. Methods: Forty patients with borderline resectable pancreatic cancer underwent biliary stenting during neoadjuvant chemotherapy at Hiroshima University Hospital. PSs and CSEMSs were placed in 19 and 21 patients, respectively. Two gemcitabine-based regimens for chemotherapy were used. Treatment outcomes and postoperative complications were compared between both groups. Results: The incidence of recurrent biliary obstruction was significantly lower in the CSEMS group (0% vs. 47.4%, p < 0.001), and the median time to recurrent biliary obstruction in the PS group was 47 days. There was no difference in the incidence of other complications such as non-occlusive cholangitis, pancreatitis, and cholecystitis between the two groups. Delays in the chemotherapy schedule due to stent-related complications were significantly frequent in the PS group (52.6% vs. 4.8%, p = 0.001). There was no significant difference in the incidence of postoperative complications between the two groups. Conclusions: CSEMSs may be the best choice for safely performing neoadjuvant chemotherapy for several months in patients with borderline resectable pancreatic cancer with bile duct stricture. Full article
(This article belongs to the Special Issue Current Surgical Management of Pancreatic Cancer)
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16 pages, 3071 KiB  
Article
Does Surgical Resection Significantly Prolong the Long-Term Survival of Patients with Oligometastatic Pancreatic Ductal Adenocarcinoma? A Cross-Sectional Study Based on 18 Registries
by Zheng Li, Xiaojie Zhang, Chongyuan Sun, Zefeng Li, He Fei and Dongbing Zhao
J. Clin. Med. 2023, 12(2), 513; https://doi.org/10.3390/jcm12020513 - 08 Jan 2023
Cited by 4 | Viewed by 1290
Abstract
Background: Pancreatic ductal adenocarcinoma (PDAC) is a type of lethal gastrointestinal malignancy. It is mainly discovered at, and diagnosed with, an advanced stage of metastasis. As the only potentially curative treatment for PDAC, surgical resection has an uncertain impact on the survival of [...] Read more.
Background: Pancreatic ductal adenocarcinoma (PDAC) is a type of lethal gastrointestinal malignancy. It is mainly discovered at, and diagnosed with, an advanced stage of metastasis. As the only potentially curative treatment for PDAC, surgical resection has an uncertain impact on the survival of these patients. As such, we aimed to investigate if patients with metastatic PDAC (mPDAC) benefit from surgery. Methods: Patients with pancreatic cancer in 18 registries of the Surveillance, Epidemiology, and End Results database between 2000 and 2018 were reviewed retrospectively. According to the American Joint Committee on Cancer (AJCC), the eighth edition staging system was utilized. Propensity score matching was applied to strengthen the comparability of the study. The impact of surgery on survival was evaluated by restricted mean survival time (RMST) and Kaplan–Meier analysis. Results: A total of 210 well-matched mPDAC patients were included in the study. The 1 year, 3 year, and 5 year overall survival (OS) of patients undergoing surgery was 34.3%, 15.2%, and 11.0%, respectively. The 1 year, 3 year, and 5 year cancer-specific survival (CSS) of these patients was 36.1%, 19.7%, and 14.2%, respectively. RMST analysis revealed that mPDAC patients with surgery had better OS and CSS than those without (OS: 9.49 months vs. 6.45 months, p < 0.01; CSS: 9.76 months vs. 6.54 months, p < 0.01). Nevertheless, subgroup analysis demonstrated that such statistical significance especially existed in oligometastatic PDAC patients, which refers to those metastases that were limited in number and concentrated to a single organ in this study. Additionally, surgery was identified as a significant predictor for the long-term prognosis of patients (OS: [HR, hazard ratio] = 0.48, 95% CI: 0.36–0.65, p < 0.001; CSS: HR = 0.45, 95% CI: 0.33–0.63, p < 0.001). Lastly, a nomogram was established to predict whether an individual was suitable for surgical treatment in this study. Conclusions: Surgical resection significantly prolonged the long-term prognosis of oligometastatic PDAC patients. Such insights might broaden the management of patients with mPDAC to a large extent. However, a prospective clinical trial should be conducted before a recommendation of surgery in these patients. Full article
(This article belongs to the Special Issue Current Surgical Management of Pancreatic Cancer)
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6 pages, 2553 KiB  
Article
Surgical Strategies to Dissect around the Superior Mesenteric Artery in Robotic Pancreatoduodenectomy
by Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Jiro Kimura, Nanako Hata, Kento Mishima, Takahito Yagi and Toshiyoshi Fujiwara
J. Clin. Med. 2022, 11(23), 7112; https://doi.org/10.3390/jcm11237112 - 30 Nov 2022
Cited by 8 | Viewed by 1778
Abstract
The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among [...] Read more.
The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among the various approaches, our standard protocol for RPD included the right approach to the SMA, which can result in complete tumor resection in most cases. In patients with malignant diseases requiring lymphadenectomy around the SMA, we developed a novel approach by combining the left and right approaches in RPD. Using this approach, circumferential dissection around the SMA can be achieved through both the left and right sides. This approach can also be helpful in patients with obesity or intra-abdominal adhesions. The present study summarizes the advantages and disadvantages of both the approaches during RPD. To perform RPD safely, surgeons should understand the different surgical approaches and select the best approach or a combination of different approaches, depending on demographic, anatomical, and oncological factors. Full article
(This article belongs to the Special Issue Current Surgical Management of Pancreatic Cancer)
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12 pages, 1131 KiB  
Article
Possibility of Neoadjuvant Treatment for Radiologically Judged Resectable Pancreatic Cancer
by Takehiro Okabayashi, Kenta Sui, Motoyasu Tabuchi, Takahiro Murokawa, Shinichi Sakamoto, Jun Iwata, Sojiro Morita, Nobuto Okamoto, Tatsuo Iiyama, Yasuhiro Shimada and Toshiyoshi Fujiwara
J. Clin. Med. 2022, 11(22), 6792; https://doi.org/10.3390/jcm11226792 - 16 Nov 2022
Cited by 2 | Viewed by 5326
Abstract
Survival remains poor even after resection of pancreatic cancer and the postoperative recurrence rate is extremely high. Thus, neoadjuvant treatment may improve outcomes for resectable pancreatic cancer (RPC). This study evaluated the efficacy of neoadjuvant therapy for radiologically judged RPC. A prospectively maintained [...] Read more.
Survival remains poor even after resection of pancreatic cancer and the postoperative recurrence rate is extremely high. Thus, neoadjuvant treatment may improve outcomes for resectable pancreatic cancer (RPC). This study evaluated the efficacy of neoadjuvant therapy for radiologically judged RPC. A prospectively maintained institutional database was reviewed to identify patients who underwent potentially curative resection of radiologically judged RPC. Patient characteristics and intermediate-term outcomes were compared between groups that received neoadjuvant treatment or upfront surgery (UFS). We identified 353 eligible patients, including 55 patients who received neoadjuvant chemoradiotherapy (CRT group), 53 patients who received neoadjuvant gemcitabine plus nab-paclitaxel (GnP group), and 245 patients who underwent UFS (UFS group). The cumulative rates of pancreatic cancer recurrence at 2 years after pancreatic surgery were 49.5% in the UFS, 48.1% in the CRT group, and 52.7% in the GnP group. The recurrence rate tended to be improved after neoadjuvant treatment, although the difference was not significant at this follow-up point. While the clinical TNM classifications were noticeably different from the final pathological findings, the clinical and pathological TNM classifications were more similar in the groups that underwent neoadjuvant treatment. Neoadjuvant treatment can help identify good surgical candidates and avoid unnecessary laparotomy. Our results also suggest that neoadjuvant therapy might help improve the preoperative diagnostic accuracy for patients with RPC. Full article
(This article belongs to the Special Issue Current Surgical Management of Pancreatic Cancer)
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