Back
 SS  Vol.6 No.12 , December 2015
Stage II Pancreatic Cancer: Radical, Palliative Surgery or Stenting?
Abstract: Background: Pancreatic ductal adenocarcinoma is the fourth most common reason of death among oncological diseases with ever increasing mortality. At the time of diagnosis, patients are usually suitable for three ways of treatment: radical, palliative surgery or stenting. Deciding the best option depends on clinical situation, but is still a matter of debate. Methods: We performed a retrospective research of patients with stage II pancreatic head cancer treated in our clinic between years 2002-2014. Four groups were formed according to the used treatment method: group A: radical surgery with R0 (microscopic tumour clearance) margin; group B: radical surgery with R1 (presence of tumour cells within 1 mm of the resection margin) margin; group C: biliary tract stenting; group D: biliodigestive anastomosis. Clinical data and most importantly the survival of these patients were compared. Results: 200 patients were involved in the final analysis, 82 (41%) of them were IIA and 118 (59%) were IIB. Group A consisted of 113 patients; group B consisted of 28 patients; group C consisted of 33 patients; group D consisted of 26 patients. In patients with IIA stage, group A had the highest survival rate compared with other groups, mean survival was 3.242 versus 1.600; 0.454; 0.652 years. Patients with IIB stage of cancer similarly had longer survival in group A versus other groups, 1.720 versus 0.931; 0.713; 0.957 years. Conclusions: Patients with IIA and IIB stage of pancreatic cancer benefit the most from radical surgery with R0 margin. However, for patients with lymph node involvement (stage IIB) and when achieving R0 margin is hardly possible, neoadjuvant treatment seems promising, but we need further randomized controlled trials to fully confirm its effectiveness.
Cite this paper: Šileikis, A. , Kurlinkus, B. , Kryžauskas, M. and Strupas, K. (2015) Stage II Pancreatic Cancer: Radical, Palliative Surgery or Stenting?. Surgical Science, 6, 555-561. doi: 10.4236/ss.2015.612079.
References

[1]   Bosetti, C., Bertuccio, P., Malvezzi, M., Levi, F., Chatenoud, L., et al. (2013) Cancer Mortality in Europe, 2005-2009, and an Overview of Trends since 1980. Annals of Oncology, 24, 2657-2671.
http://dx.doi.org/10.1093/annonc/mdt301

[2]   Raimondi, S., Maisonneuve, P. and Lowenfels, A.B. (2009) Epidemiology of Pancreatic Cancer: An Overview. Nature reviews. Gastroenterology & Hepatology, 6, 699-708.
http://dx.doi.org/10.1038/nrgastro.2009.177

[3]   Sohn, T.A., Yeo, C.J., Cameron, J.L., Koniaris, L., Kaushal, S., et al. (2000) Resected Adenocarcinoma of the Pancreas-616 Patients: Results, Outcomes, and Prognostic Indicators. Journal of Gastrointestinal Surgery, 4, 567-579.
http://dx.doi.org/10.1016/S1091-255X(00)80105-5

[4]   Yadav, D. and Lowenfels, A.B. (2013) The Epidemiology of Pancreatitis and Pancreatic Cancer. Gastroenterology, 144, 1252-1261.
http://dx.doi.org/10.1053/j.gastro.2013.01.068

[5]   Zuckerman, D.S. and Ryan, D.P. (2008) Adjuvant Therapy for Pancreatic Cancer: A Review. Cancer, 112, 243-249.
http://dx.doi.org/10.1002/cncr.23174

[6]   Assfalg, V., Hüser, N., Michalski, C., Gillen, S., Kleeff, J., et al. (2011) Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer. Cancers, 3, 652-661.
http://dx.doi.org/10.3390/cancers3010652

[7]   Hüser, N., Michalski, C.W., Schuster, T., Friess, H. and Kleeff, J. (2009) Systematic Review and Meta-Analysis of Prophylactic Gastroenterostomy for Unresectable Advanced Pancreatic Cancer. British Journal of Surgery, 96, 711-719.
http://dx.doi.org/10.1002/bjs.6629

[8]   Tol, J.A.M.G, Eshuis, W.J., Besselink, M.G.H., van Gulik, T.M., Busch, O.R.C., et al. (2015) Non-Radical Resection versus Bypass Procedure for Pancreatic Cancer—A Consecutive Series and Systematic Review. European Journal of Surgical Oncology, 41, 220-227.
http://dx.doi.org/10.1016/j.ejso.2014.11.041

[9]   Nordby, T., Ikdahl, T., BowitzLothe, I.M., Fagerland, M.W., Heiberg, T., et al. (2013) Improved Survival and Quality of Life in Patients Undergoing R1 Pancreatic Resection Compared to Patients with Locally Advanced Unresectable Pancreatic Adenocarcinoma. Pancreatology, 13, 180-185.
http://dx.doi.org/10.1016/j.pan.2013.01.003

[10]   Wang, S., Shyr, Y., Su, C., Chen, T. and Wu, C. (2012) Palliative Pancreaticoduodenectomy in Pancreatic and Periampullary Adenocarcinomas. Pancreas, 41, 882-887.
http://dx.doi.org/10.1097/MPA.0b013e31823c9d46

[11]   Smith, A.C., Dowsett, J.F., Russell, R.C., Hatfield, A.R. and Cotton, P.B. (1994) Randomised Trial of Endoscopic Stenting versus Surgical Bypass in Malignant Low Bileduct Obstruction. The Lancet, 344, 1655-1660.
http://dx.doi.org/10.1016/S0140-6736(94)90455-3

[12]   Taylor, M.C., McLeod, R.S. and Langer, B. (2000) Biliary Stenting versus Bypass Surgery for the Palliation of Malignant Distal Bile Duct Obstruction: A Meta-Analysis. Liver Transplantation, 6, 302-308.
http://dx.doi.org/10.1053/lv.2000.5196

[13]   Ball, C.G., Dixon, E., Vollmer, C.M. and Howard, T.J. (2015) The View from 10,000 Procedures: Technical Tips and Wisdom from Master Pancreatic Surgeons to Avoid Hemorrhage during Pancreaticoduodenectomy. BMC Surgery, 15, 122.
http://dx.doi.org/10.1186/s12893-015-0109-y

[14]   Kantor, O., Talamonti, M.S., Stocker, S.J., Wang, C., Winchester, D.J., et al. (2015) A Graded Evaluation of Outcomes Following Pancreaticoduodenectomy with Major Vascular Resection in Pancreatic Cancer. Journal of Gastrointestinal Surgery, in press.
http://dx.doi.org/10.1007/s11605-015-2957-2

[15]   Okano, K., Hirao, T., Unno, M., Fujii, T., Yoshitomi, H., et al. (2015) Postoperative Infectious Complications after Pancreatic Resection. British Journal of Surgery, 102, 1551-1560.
http://dx.doi.org/10.1002/bjs.9919

[16]   Neoptolemos, J.P., Stocken, D.D., Dunn, J.A., Almond, J., Beger, H.G., et al. (2001) Influence of Resection Margins on Survival for Patients with Pancreatic Cancer Treated by Adjuvant Chemoradiation and/or Chemotherapy in the ESPAC-1 Randomized Controlled Trial. Annals of Surgery, 234, 758-768.
http://dx.doi.org/10.1097/00000658-200112000-00007

[17]   Jamieson, N.B., Denley, S.M., Logue, J., MacKenzie, D.J., Foulis, A.K., et al. (2011) A Prospective Comparison of the Prognostic Value of Tumor- and Patient-Related Factors in Patients Undergoing Potentially Curative Surgery for Pancreatic Ductal Adenocarcinoma. Annals of Surgical Oncology, 18, 2318-2328.
http://dx.doi.org/10.1245/s10434-011-1560-3

[18]   Pang, T.C.Y., Wilson, O., Argueta, M.A., Hugh, T.J., Chou, A., Jaswinder, S.S. and Anthony, J.G. (2014) Frozen Section of the Pancreatic Neck Margin in Pancreatoduodenectomy for Pancreatic Adenocarcinoma Is of Limited Utility. Pathology, 46, 188-192.
http://dx.doi.org/10.1097/PAT.0000000000000072

[19]   Menon, K.V., Gomez, D., Smith, A.M., Anthoney, A. and Verbeke, C.S. (2009) Impact of Margin Status on Survival Following Pancreatoduodenectomy for Cancer: The Leeds Pathology Protocol (LEEPP). HPB, 11, 18-24.
http://dx.doi.org/10.1111/j.1477-2574.2008.00013.x

[20]   Verbeke, C.S. and Menon, K.V. (2009) Redefining Resection Margin Status in Pancreatic Cancer. HPB, 11, 282-289.
http://dx.doi.org/10.1111/j.1477-2574.2009.00055.x

[21]   Esposito, I., Kleeff, J., Bergmann, F., Reiser, C., Herpel, E., et al. (2008) Most Pancreatic Cancer Resections Are R1 Resections. Annals of Surgical Oncology, 15, 1651-1660.
http://dx.doi.org/10.1245/s10434-008-9839-8

[22]   Merkow, R.P., Bilimoria, K.Y., Bentrem, D.J., Pitt, H.A., Winchester, D.P., Posner, M.C., Ko, C.Y. and Pawlik, T.M. (2014) National Assessment of Margin Status as a Quality Indicator after Pancreatic Cancer Surgery. Annals of Surgical Oncology, 21, 1067-1074.
http://dx.doi.org/10.1245/s10434-013-3338-2

[23]   Landry, J., Catalano, P.J., Staley, C., Harris, W., Hoffman, J., et al. (2010) Randomized Phase II Study of Gemcitabine plus Radiotherapy versus Gemcitabine, 5-Fluorouracil, and Cisplatin Followed by Radiotherapy and 5-Fluorouracil for Patients with Locally Sdvanced, Potentially Resectable Pancreatic Adenocarcinoma. Journal of Surgical Oncology, 101, 587-592.
http://dx.doi.org/10.1002/jso.21527

[24]   Golcher, H., Brunner, T.B., Witzigmann, H., Marti, L., Bechstein, W., et al. (2015) Neoadjuvant Chemoradiation Therapy with Gemcitabine/Cisplatin and Surgery versus Immediate Surgery in Resectable Pancreatic Cancer: Results of the First Prospective Randomized Phase II Trial. Strahlentherapie und Onkologie, 191, 7-16.
http://dx.doi.org/10.1007/s00066-014-0737-7

[25]   Tachezy, M., Gebauer, F., Petersen, C., Arnold, D., Trepel, M., et al. (2014) Sequential Neoadjuvant Chemoradiotherapy (CRT) Followed by Curative Surgery vs. Primary Surgery Alone for Resectable, Non-Metastasized Pancreatic Adenocarcinoma: NEOPA—A Randomized Multicenter Phase III Study (NCT01900327, DRKS00003893, ISRCTN82191749). BMC Cancer, 14, 411.
http://dx.doi.org/10.1186/1471-2407-14-411

[26]   Andersen, J.R., Sorensen, S.M., Kruse, A., Rokkjaer, M. and Matzen, P. (1989) Randomised Trial of Endoscopic Endoprosthesis versus Operative Bypass in Malignant Obstructive Jaundice. Gut, 30, 1132-1135.
http://dx.doi.org/10.1136/gut.30.8.1132

[27]   Shepherd, H.A., Royle, G., Ross, A.P., Diba, A., Arthur, M., et al. (1988) Endoscopic Biliary Endoprosthesis in the Palliation of Malignant Obstruction of the Distal Common Bile Duct: A Randomized Trial. The British Journal of Surgery, 75, 1166-1168.
http://dx.doi.org/10.1002/bjs.1800751207

[28]   Seshadri, R.M., Ali, N., Warner, S., Cochran, A., Vrochides, D., et al. (2015) Training and Practice of the Next Generation HPB Surgeon: Analysis of the 2014 AHPBA Residents’ and Fellows’ Symposium Survey. HPB, 17, 1096-1104.
http://dx.doi.org/10.1111/hpb.12498

[29]   Lohse, I., Borgida, A., Cao, P., Cheung, M., Pintilie, M., et al. (2015) BRCA1 and BRCA2 Mutations Sensitize to Chemotherapy in Patient-Derived Pancreatic Cancer Xenografts. British Journal of Cancer, 113, 425-432.
http://dx.doi.org/10.1038/bjc.2015.220

[30]   Shao, T.F., Zheng, Y.T., Zhao, B., Li, T., Cheng, K.G. and Cai, W.M. (2014) Recombinant Expression of Different Mutant K-Ras Gene in Pancreatic Cancer Bxpc-3 Cells and Its Effects on Chemotherapy Sensitivity. Science China Life Sciences, 57, 1011-1017.
http://dx.doi.org/10.1007/s11427-014-4724-0

[31]   Narayanan, R. (2015) Phenome-Genome Association Studies of Pancreatic Cancer: New Targets for Therapy and Diagnosis. Cancer Genomics & Proteomics, 12, 9-19.

 
 
Top