TY - JOUR
T1 - Aggressive surgery for borderline resectable pancreatic cancer
T2 - Evaluation of national comprehensive cancer network guidelines
AU - Yamada, Suguru
AU - Fujii, Tsutomu
AU - Sugimoto, Hiroyuki
AU - Nomoto, Shuji
AU - Takeda, Shin
AU - Kodera, Yasuhiro
AU - Nakao, Akimasa
PY - 2013/8
Y1 - 2013/8
N2 - OBJECTIVES: The objective of this study was to evaluate the relevance of defining borderline resectable (BR) pancreatic cancer as a distinct entity in the treatment scheme of pancreatic cancer as proposed by the National Comprehensive Cancer Network. METHODS: Among 375 patients with pancreatic cancer, 137 patients were deemed to have resectable disease (R) by preoperative imaging studies, whereas 96 were found to have an unresectable disease during surgery. The remaining 142 patients fulfilled the definition of BR and were further classified into 3 subgroups based on the National Comprehensive Cancer Network guidelines: portal vein invasion (PV[+]), common hepatic artery invasion (CHA[+]), and superior mesenteric artery invasion (SMA[+]). PV(+) was subdivided into types B, C, and D according to the degree of portal vein invasion. RESULTS: Patients in the R group had significantly better survival than those in the PV(+) group (P = 0.0038), who in turn survived significantly longer than those classified as SMA(+) (P = 0.041). Type B patients survived significantly longer than did types C and D patients (P = 0.013 and P = 0.030, respectively). In PV(+) patients, compliance with postoperative chemotherapy at 3 and 6 months was 56.9% and 44.6%, respectively, substantially inferior to patients with resectable disease (72.6% and 54.7%, respectively). CONCLUSIONS: The optimal treatment strategy may differ among various subgroups within the BR category.
AB - OBJECTIVES: The objective of this study was to evaluate the relevance of defining borderline resectable (BR) pancreatic cancer as a distinct entity in the treatment scheme of pancreatic cancer as proposed by the National Comprehensive Cancer Network. METHODS: Among 375 patients with pancreatic cancer, 137 patients were deemed to have resectable disease (R) by preoperative imaging studies, whereas 96 were found to have an unresectable disease during surgery. The remaining 142 patients fulfilled the definition of BR and were further classified into 3 subgroups based on the National Comprehensive Cancer Network guidelines: portal vein invasion (PV[+]), common hepatic artery invasion (CHA[+]), and superior mesenteric artery invasion (SMA[+]). PV(+) was subdivided into types B, C, and D according to the degree of portal vein invasion. RESULTS: Patients in the R group had significantly better survival than those in the PV(+) group (P = 0.0038), who in turn survived significantly longer than those classified as SMA(+) (P = 0.041). Type B patients survived significantly longer than did types C and D patients (P = 0.013 and P = 0.030, respectively). In PV(+) patients, compliance with postoperative chemotherapy at 3 and 6 months was 56.9% and 44.6%, respectively, substantially inferior to patients with resectable disease (72.6% and 54.7%, respectively). CONCLUSIONS: The optimal treatment strategy may differ among various subgroups within the BR category.
KW - borderline resectable
KW - chemotherapy
KW - pancreatic cancer
UR - http://www.scopus.com/inward/record.url?scp=84880698644&partnerID=8YFLogxK
U2 - 10.1097/MPA.0b013e31827b2d7c
DO - 10.1097/MPA.0b013e31827b2d7c
M3 - 学術論文
C2 - 23532000
AN - SCOPUS:84880698644
SN - 0885-3177
VL - 42
SP - 1004
EP - 1010
JO - Pancreas
JF - Pancreas
IS - 6
ER -