Surgery Today

, Volume 43, Issue 1, pp 33–39

Portal vein infusion chemotherapy with gemcitabine after surgery for pancreatic cancer

  • Chi-e Kitami
  • Isao Kurosaki
  • Yasuyuki Kawachi
  • Koei Nihei
  • Yoshiaki Tsuchiya
  • Tatsuya Nomura
  • Masahiro Minagawa
  • Kabuto Takano
  • Katsuyoshi Hatakeyama
  • Niigata study group of pancreatic cancer
Original Article

Abstract

Purposes

Pancreatic cancer still has a poor prognosis even after curative resection because of the high incidence of postoperative liver metastasis. This study prospectively evaluated the feasibility and tolerability of portal vein infusion chemotherapy of gemcitabine (PVIG) as an adjuvant setting after pancreatic resection.

Methods

Thirteen patients enrolled in this study received postoperative chemotherapy with PVIG. The patients received intermittent administration of gemcitabine (800 mg/m2) via the portal vein on days 1, 8, and 15 after surgery. The tolerability and the toxicity of PVIG were closely monitored.

Results

The PVIG was started on an average of 3.1 days after surgery. Complete doses of chemotherapy (three sessions of portal infusion) were accomplished in 11 of the 13 patients. Grade 3 or 4 leukocytopenia was observed in three patients (23 %), and liver dysfunction was found in one patient (7.7 %). Grade 2 sepsis developed in two cases due to bloodstream infection. Liver metastasis was the first site of recurrence in only two patients.

Conclusions

PVIG can be administered to the liver with acceptable toxicity, but myelosuppression is similar to the systemic use of gemcitabine. Careful observation is required even for locoregional chemotherapy.

Keywords

Portal vein infusion chemotherapy Gemcitabine Adjuvant chemotherapy Pancreatic cancer Liver metastasis 

References

  1. 1.
    Amikura K, Kobari M, Matsuno S. The time of occurrence of liver metastasis in carcinoma of the pancreas. Int J Pancreatol. 1995;17:139–246.PubMedGoogle Scholar
  2. 2.
    Ishikawa O, Ohigashi H, Sasaki Y, Furukawa H, Kabuto T, Kameyama M, et al. Liver perfusion chemotherapy via both the hepatic artery and portal vein to prevent hepatic metastasis after extended pancreatectomy for adenocarcinoma of the pancreas. Am J Surg. 1994;168:361–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Ishikawa O, Ohhigashi H, Sasaki Y, Furukawa H, Imaoka S. Extended pancreatectomy and liver perfusion chemotherapy for resectable adenocarcinoma of the pancreas. Digestion. 1999;60(Suppl 1):135–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Kurosaki I, Kawachi Y, Nihei K, Tsuchiya Y, Aono T, Yokoyama N, et al. Liver perfusion chemotherapy with 5-fluorouracil followed by systemic gemcitabine administration for resected pancreatic cancer: preliminary results of a prospective phase 2 study. Pancreas. 2009;38:161–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Takahashi S, Ogata Y, Miyazaki H, Maeda D, Murai S, Yamataka K, et al. Aggressive surgery for pancreatic duct cell cancer: feasibility, validity, limitations. World J Surg. 1995;19:653–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Nakayama S, Takeda S, Kawase Y, Inoue S, Kaneko T, Nakao A. Clinical significance of dihydropyrimidine dehydrogenase in adjuvant 5-fluorouracil liver perfusion chemotherapy for pancreatic cancer. Ann Surg. 2004;240:840–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Ohigashi H, Ishikawa O, Eguchi H, Sasaki Y, Yamada T, Noura S, et al. Feasibility and efficacy of combination therapy with preoperative and postoperative chemoradiation, extended pancreatectomy, and postoperative liver perfusion chemotherapy for locally advanced cancers of the pancreatic head. Ann Surg Oncol. 2005;12:629–36.PubMedCrossRefGoogle Scholar
  8. 8.
    Ohigashi H, Ishikawa O, Eguchi H, Takahashi H, Gotoh K, Yamada T, et al. Feasibility and efficacy of combination therapy with preoperative full-dose gemcitabine, concurrent three-dimensional conformal radiation, surgery, and postoperative liver perfusion chemotherapy for T3-pancreatic cancer. Ann Surg. 2009;250:88–95.PubMedCrossRefGoogle Scholar
  9. 9.
    Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs. observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.PubMedCrossRefGoogle Scholar
  10. 10.
    Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, et al. A randomized phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer. 2009;101:908–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Onoue M, Terada T, Okuda M, Fujimoto K, Doi R, Imamura M, et al. Surgical resection deteriorates gemcitabine-induced leucopenia in pancreatic cancer. Int J Clin Oncol. 2004;9:174–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2012

Authors and Affiliations

  • Chi-e Kitami
    • 1
  • Isao Kurosaki
    • 1
  • Yasuyuki Kawachi
    • 2
  • Koei Nihei
    • 3
  • Yoshiaki Tsuchiya
    • 4
  • Tatsuya Nomura
    • 4
  • Masahiro Minagawa
    • 1
  • Kabuto Takano
    • 1
  • Katsuyoshi Hatakeyama
    • 1
  • Niigata study group of pancreatic cancer
  1. 1.Division of Digestive and General SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
  2. 2.Department of SurgeryNagaoka Chuo General HospitalNagaokaJapan
  3. 3.Department of SurgeryTsuruoka Municipal Shonai HospitalTsuruokaJapan
  4. 4.Department of SurgeryNiigata Cancer Center Niigata HospitalNiigataJapan

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