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Update on Management Periampullary/Pancreatic Head Cancer

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Abstract

Management of pancreatic head (ductal adenocarcinoma) and periampullary cancer is difficult owing to its insidious onset and hence late diagnosis, lack of significant diagnostic, predictive and prognostic biomarkers, and the inherent tumor biology of being relatively resistant to chemotherapy and radiotherapy. Surgery of this deep-seated gland is technically challenging and the procedure is called pancreaticoduodenectomy (PD). It involves removal of pancreatic head, duodenum, bile duct and gallbladder ± distal stomach. The reconstruction involves pancreatoenteric anastomosis (pancreaticojejunostomy or pancreaticogastrostomy), hepaticojejunostomy, and gastro/duodenojejunostomy. At times, vascular resection and adjacent organ resection are required for complete extirpation (R0) of the cancer. Over the years, surgical procedures used in the management of pancreatic cancer (PC) have been refined and with better anesthesia and perioperative and postoperative care, the operative mortality has dropped to < 5% but morbidity still remains close to 40%. The most common cause of severe morbidity is occurrence of postoperative pancreatic fistula. Post pancreatectomy hemorrhage and delayed gastric emptying are the other two major morbidities extending hospital stay and are at times life-threatening. New classification systems, better imaging, and new chemotherapeutic/targeted drug combinations for neoadjuvant/adjuvant treatment with/without refined radiotherapy techniques and centralization of treatment have helped in selecting the best patients for aggressive treatment with the aim of improving abysmally low overall survival. The present review highlights recent updates in the management of PC.

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References

  1. Venkatesh B, Anand L, Padamavathi VK, Balachandar V (2016) Review on clinical and molecular diagnosis of periampullary carcinoma. Int J Adv Res Biol Sci 3(9):210–216

    Article  CAS  Google Scholar 

  2. Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley JW, Kamel I, Nio Y, Schulick RS, Bassi C, Kluijt I, Levy MJ, Chak A, Fockens P, Goggins M, Bruno M, International Cancer of Pancreas Screening (CAPS) Consortium (2013) International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 62(3):339–347. https://doi.org/10.1136/gutjnl-2012-303108

    Article  PubMed  Google Scholar 

  3. Schultz NA, Dehlendorff C, Jensen BV, Bjerregaard JK, Nielsen KR, Bojesen SE, Calatayud D, Nielsen SE, Yilmaz M, Holländer NH, Andersen KK, Johansen JS (2014) MicroRNA biomarkers in whole blood for detection of pancreatic cancer. Jama 311:392–404

    Article  CAS  PubMed  Google Scholar 

  4. Liggett T, Melnikov A, Yi QL et al (2010) Differential methylation of cell- free circulating DNA among patients with pancreatic cancer versus chronic pancreatitis. Cancer 116:1674–1680

    Article  CAS  PubMed  Google Scholar 

  5. Tewari M (2015) Pancreatic cancer: a challenge to cure, Indian J Surg. 77(5):350–357. https://doi.org/10.1007/s12262-015-1369-6

  6. O'Brien DP, Sandanayake NS, Jenkinson C, Gentry-Maharaj A, Apostolidou S, Fourkala EO, Camuzeaux S, Blyuss O, Gunu R, Dawnay A, Zaikin A, Smith RC, Jacobs IJ, Menon U, Costello E, Pereira SP, Timms JF (2015) Serum CA19-9 is significantly upregulated up to 2 years before diagnosis with pancreatic cancer: implications for early disease detection. Clin Cancer Res 21(3):622–631. https://doi.org/10.1158/1078-0432.CCR-14-0365

    Article  PubMed  Google Scholar 

  7. Verma A, Shukla S, Verma N (2015) Diagnosis, preoperative evaluation, and assessment of resectability of pancreatic and periampullary cancer. Indian J Surg 77(5):362–370

    Article  PubMed  PubMed Central  Google Scholar 

  8. De Angelis C, Brizzi RF, Pellicano R (2013) Endoscopic ultrasonography for pancreatic cancer: current and future perspectives. J Gastrointest Oncol 4(2):220–230

    PubMed  PubMed Central  Google Scholar 

  9. Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16(7):1727–1733

    Article  PubMed  Google Scholar 

  10. Varadhachary GR (2011) Preoperative therapies for resectable and borderline resectable pancreatic cancer. J Gastrointest Oncol 2(3):136–142

    PubMed  PubMed Central  Google Scholar 

  11. National Comprehensive Cancer Network (NCCN) v2. 2017

  12. Katz MH, Marsh R, Herman JM, Shi Q, Collison E, Venook AP, Kindler HL, Alberts SR, Philip P, Lowy AM, Pisters PW, Posner MC, Berlin JD, Ahmad SA (2013) Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol 20(8):2787–2795

    Article  PubMed  PubMed Central  Google Scholar 

  13. Allen VB, Gurusamy KS, Takwoingi Y, Kalia A, Davidson BR (2016) Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev 7:CD009323. https://doi.org/10.1002/14651858.CD009323.pub3

    Article  PubMed  Google Scholar 

  14. Chun YS, Pawlik TM, Vauthey JN (2017) 8th edition of the AJCC Cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol. https://doi.org/10.1245/s10434-017-6025-x

  15. Allen PJ, Kuk D, Castillo CF, Basturk O, Wolfgang CL, Cameron JL, Lillemoe KD, Ferrone CR, Morales-Oyarvide V, He J, Weiss MJ, Hruban RH, Gönen M, Klimstra DS, Mino-Kenudson M (2017) Multi-institutional validation study of the American Joint Commission on Cancer (8th edition) changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg 265(1):185–191

    Article  PubMed  Google Scholar 

  16. Layfield LJ, Dodd L, Factor R, Schmidt RL (2014) Malignancy risk associated with diagnostic categories defined by the Papanicolaou Society of Cytopathology pancreaticobiliary guidelines. Cancer Cytopathol 122:420–427

    Article  PubMed  Google Scholar 

  17. Lai EC, Lau SH, Lau WY (2014) The current status of preoperative biliary drainage for patients who receive pancreaticoduodenectomy for periampullary carcinoma: a comprehensive review. Surgeon 12(5):290–296

    Article  PubMed  Google Scholar 

  18. van der Gaag NA, Rauws EAJ, van Eijck CHJ, Bruno MJ, van der Harst E, Kubben FJGM, Gerritsen JJGM, Greve JW, Gerhards MF, de Hingh IHJT, Klinkenbijl JH, Nio CY, de Castro SMM, Busch ORC, van Gulik TM, Bossuyt PMM, Gouma DJ (2010) Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 362:129–137

    Article  PubMed  Google Scholar 

  19. Codivilla A (1898) Rendiconto statistico della sezione chirurgica dell’ospedale di lmola

  20. Sauve L (1908) Des pancréatectomies et spécialement de la pancreatectomy céphalique. Rev Chir 37:113–152 335–85

    Google Scholar 

  21. Kawai M, Yamaue H (2010) Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today 40:1011–1017

    Article  PubMed  Google Scholar 

  22. Winter JW, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J et al (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10:1199–1211

    Article  PubMed  Google Scholar 

  23. Muller MW, Friess H, Beger HG, Kleeff J, Lauterburg B, Glasbrenner B, Riepl RL, Buchler MW (1997) Gastric emptying following pylorus-preserving Whipple and duodenum-preserving pancreatic head resection in patients with chronic pancreatitis. Am J Surg 173(4):257–263. https://doi.org/10.1016/S0002-9610(96)00402-3

    Article  CAS  PubMed  Google Scholar 

  24. van Berge Henegouwen MI, van Gulik TM, DeWit LT, Allema JH, Rauws EA, Obertop H, Gouma DJ (1997) Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg 185(4):373–379

    Article  PubMed  Google Scholar 

  25. Jimenez RE, Fernandez-del Castillo C, Rattner DW, Chang Y, Warshaw AL (2000) Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg 231(3):293–300

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C (2001) Ten-year experience with 733 pancreatic resec- tions: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136(4):391–398

    Article  PubMed  Google Scholar 

  27. Sadowski CUW, Baer HU, Reber P, Seiler C, Büchler M (1997) Delayed gastric emptying after classic and pylorus-preserving Whipple procedure: a prospective study. Dig Surg 14:159–164

    Article  Google Scholar 

  28. Horstmann O, Becker H, Post S, Nustede R (1999) Is delayed gastric emptying following pancreaticoduodenectomy related to pylorus preservation? Langenbecks Arch Surg / Deutsch Gesellschaft Chir 384(4):354–359

    Article  CAS  Google Scholar 

  29. Niedergethmann M, Shang E, Farag Soliman M, Saar J, Berisha S, Willeke F, Post S (2006) Early and enduring nutritional and functional results of pylorus preservation vs classic Whipple procedure for pancreatic cancer. Langenbecks Arch Surg / Deutsch Gesellschaft Chir 391(3):195–202. https://doi.org/10.1007/s00423-005-0015-3

  30. Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, Yamaue H (2011) Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg 253(3):495–501. https://doi.org/10.1097/SLA.0b013e31820d98f1

    Article  PubMed  Google Scholar 

  31. Kurahara H, Shinchi H, Maemura K, Mataki Y, Iino S, Sakoda M, Ueno S, Takao S, Natsugoe S (2011) Delayed gastric emptying after pancreatoduodenectomy. J Surg Res 171(2):e187–e192. https://doi.org/10.1016/j.jss.2011.08.002

    Article  PubMed  Google Scholar 

  32. Hayashibe A, Kameyama M, Shinbo M, Makimoto S (2007) The surgical procedure and clinical results of subtotal stomach preserving pancreaticoduodenectomy (SSPPD) in comparison with pylorus preserving pancreaticoduodenectomy (PPPD). J Surg Oncol 95(2):106–109

    Article  PubMed  Google Scholar 

  33. Matsumoto I, Shinzeki M, Asari S, Goto T, Shirakawa S, Ajiki T, Fukumoto T, Suzuki Y, Ku Y (2014) A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status. J Surg Oncol 109(7):690–696

    Article  PubMed  Google Scholar 

  34. Hartwig W, Hackert T, Hinz U, Hassenpflug M, Strobel O, Bùchler MW et al (2009) Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 250:81–87

    Article  PubMed  Google Scholar 

  35. Burdelski CM, Reeh M, Bogoevski D, Gebauer F, Tachezy M, Vashist YK, Cataldegirmen G, Yekebas E, Izbicki JR, Bockhorn M (2011) Multivisceral resections in pancreatic cancer: identification of risk factors. World J Surg 35:2756–2763

    Article  PubMed  Google Scholar 

  36. Hartwig W, Gluth A, Hinz U, Koliogiannis D, Strobel O, Hackert T, Werner J, Büchler MW (2016) Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer. Br J Surg 103(12):1683–1694. https://doi.org/10.1002/bjs.10221

    Article  CAS  PubMed  Google Scholar 

  37. Tewari M (2016) Significance of pathological positive superior mesenteric/portal venous invasion in pancreatic cancer. Hepatobiliary Pancreat Dis Int 15(6):572–578

    Article  PubMed  Google Scholar 

  38. Thilo Hackert T, Schneider L, Büchler MW (2015) Current state of vascular resections in pancreatic cancer surgery. Gastroenterol Res Pract 2015:120207. https://doi.org/10.1155/2015/120207

    Article  PubMed  PubMed Central  Google Scholar 

  39. Duffas JP, Suc B, Msika S, Fourtanier G, Muscari F, Hay JM et al (2005) A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg 189:720–729

    Article  PubMed  Google Scholar 

  40. Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N et al (2005) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy. Results of a comparative study. Ann Surg 242:767–773

    Article  PubMed  PubMed Central  Google Scholar 

  41. Fernandez-Cruz L, Cosa R, Blanco L, Lopez-Boado MA, Astudillo E (2008) Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann Surg 248:930–938

    Article  PubMed  Google Scholar 

  42. Topal B, Fieuws S, Aerts R, Weerts J, Feryn T, Roeyen G, Bertrand C, Hubert C, Janssens M, Closset J, Belgian Section of Hepatobiliary and Pancreatic Surgery (2013) Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol 14:655–662

    Article  PubMed  Google Scholar 

  43. Figueras J, Sabater L, Planellas P, Muñoz-Forner E, Lopez-Ben S, Falgueras L, Sala-Palau C, Albiol M, Ortega-Serrano J, Castro-Gutierrez E (2013) Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg 100:1597–1605

    Article  CAS  PubMed  Google Scholar 

  44. El Nakeeb A, Hamdy E, Sultan AM et al (2014) Isolated roux loop pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a prospective randomized study. HPB (Oxford) 16:713–722

    Article  Google Scholar 

  45. Tewari M, Hazrah P, Kumar V, Shukla HS (2010) Options of restorative pancreaticoenteric anastomosis following pancreaticoduodenectomy: a review. Surg Oncol 19(1):17–26

    Article  PubMed  Google Scholar 

  46. Cheng Y, Briarava M, Lai M, Wang X, Tu B, Cheng N, Gong J, Yuan Y, Pilati P, Mocellin S (2017) Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy. Cochrane Database Syst Rev 9:CD012257. https://doi.org/10.1002/14651858.CD012257.pub2

    Article  PubMed  Google Scholar 

  47. Zhao Z, Yin Z, Hang Z, Ji G, Feng Q, Zhao Q (2017) A systemic review and an updated meta-analysis: minimally invasive vs open pancreaticoduodenectomy. Sci Rep 7(1):2220. https://doi.org/10.1038/s41598-017-02488-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Ricci C, Casadei R, Taffurelli G, Pacilio CA, Ricciardiello M, Minni F (2017) Minimally invasive pancreaticoduodenectomy: what is the best “choice”? A systematic review and network meta-analysis of non-randomized comparative studies. World J Surg. https://doi.org/10.1007/s00268-017-4180-7

  49. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  50. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768

    Article  PubMed  Google Scholar 

  51. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery.;142(1):20–5

  52. Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andrén-Sandberg A, Asbun HJ, Bockhorn M, Büchler MW, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM, International Study Group on Pancreatic Surgery (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600. https://doi.org/10.1016/j.surg.2014.06.016

    Article  PubMed  Google Scholar 

  53. Hartwig W, Vollmer CM, Fingerhut A, Yeo CJ, Neoptolemos JP, Adham M, Andrén-Sandberg A, Asbun HJ, Bassi C, Bockhorn M, Charnley R, Conlon KC, Dervenis C, Fernandez-Cruz L, Friess H, Gouma DJ, Imrie CW, Lillemoe KD, Milićević MN, Montorsi M, Shrikhande SV, Vashist YK, Izbicki JR, Büchler MW, International Study Group on Pancreatic Surgery (2014) Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS). Surgery 156(1):1–14. https://doi.org/10.1016/j.surg.2014.02.009

    Article  PubMed  Google Scholar 

  54. Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic Surgery (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155(6):977–988. https://doi.org/10.1016/j.surg.2014.02.001

    Article  PubMed  Google Scholar 

  55. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591. https://doi.org/10.1016/j.surg.2016.11.014

    Article  PubMed  Google Scholar 

  56. Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A et al (2016) Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 161(5):1221–1234. https://doi.org/10.1016/j.surg.2016.11.021

    Article  PubMed  Google Scholar 

  57. Jin K, Zhou H, Zhang J, Wang W, Sun Y, Ruan C, Hu Z, Wang Y (2015) Systematic review and meta-analysis of somatostatin analogues in the prevention of postoperative complication after pancreaticoduodenectomy. Dig Surg 32(3):196–207

    Article  CAS  PubMed  Google Scholar 

  58. Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641

    Article  PubMed  Google Scholar 

  59. Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt M, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH, Enhanced Recovery After Surgery (ERAS) Group (2009) Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144:961–969

    Article  PubMed  Google Scholar 

  60. Xiong J, Szatmary P, Huang W, de la Iglesia-Garcia D, Nunes QM, Xia Q, Hu W, Sutton R, Liu X, Raraty MG (2016) Enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 95(18):e3497. https://doi.org/10.1097/MD.0000000000003497

    Article  CAS  Google Scholar 

  61. Griffin JF, Smalley SR, Jewell W, Paradelo JC, Reymond RD, Hassanein RE, Evans RG (1990) Patterns of failure after curative resection of pancreatic carcinoma. Cancer 66:56–61. https://doi.org/10.1002/1097-0142(19900701)66

    Article  CAS  PubMed  Google Scholar 

  62. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD (2000) Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4(6):567–579

    Article  CAS  PubMed  Google Scholar 

  63. Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, Arnaud JP, Gonzalez DG, de Wit LT, HennipmanA WJ (1999) Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 230:776–782; discussion 782-4. https://doi.org/10.1097/00000658-199912000-00006

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Spitz FR, Abbruzzese JL, Lee JE, Pisters PW, Lowy AM, FenoglioCJ CKR, Janjan NA, Goswitz MS, Rich TA, Evans DB (1997) Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 15:928–937

    Article  CAS  PubMed  Google Scholar 

  65. Ohigashi H, Ishikawa O, Eguchi H, Takahashi H, GotohK YT, Yano M, Nakaizumi A, Uehara H, Tomita Y, Nishiyama K (2009) 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 250:88–95. https://doi.org/10.1097/SLA.0b013e3181ad65cc

    Article  PubMed  Google Scholar 

  66. Palmer DH, Stocken DD, Hewitt H, Markham CE, Hassan AB, Johnson PJ, Buckels JA, Bramhall SR (2007) A randomized phase 2 trial of neoadjuvant chemotherapy in resectable pancreatic cancer: gemcitabine alone versus gemcitabine combined with cisplatin. Ann Surg Oncol 14:2088–2096

    Article  PubMed  Google Scholar 

  67. Heinrich S, Schäfer M, Weber A, Hany TF, Bhure U, Pestalozzi BC, Clavien PA (2008) Neoadjuvant chemotherapy generates a significant tumor response in resectable pancreatic cancer without increasing morbidity: results of a prospective phase II trial. Ann Surg 248:1014–1022. https://doi.org/10.1097/SLA.0b013e318190a6da

  68. Stokes JB, Nolan NJ, Stelow EB, Walters DM, Weiss GR, de Lange EE, Rich TA, Adams RB, Bauer TW (2011) Preoperative capecitabine and concurrent radiation for borderline resectable pancreatic cancer. Ann Surg Oncol 18(3):619–627. https://doi.org/10.1245/s10434-010-1456-7

    Article  PubMed  Google Scholar 

  69. Yang A, O’Reilly EM (2015) Novel directions in neoadjuvant therapy for pancreas adenocarcinoma. Expert Rev Gastroenterol Hepatol 9:585–601

  70. Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleeff J (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7(4):e1000267

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  71. Katz MH, Shi Q, Ahmad SA, Herman JM, Marsh Rde W, Collisson E, Schwartz L, Frankel W, Martin R, Conway W, Truty M, Kindler H, Lowy AM, Bekaii-Saab T, Philip P, Talamonti M, Cardin D, LoConte N, Shen P, Hoffman JP, Venook AP (2016) Preoperative Modified FOLFIRINOX treatment followed by capecitabine-based chemoradiation for borderline resectable pancreatic cancer: Alliance for Clinical Trials in Oncology Trial A021101. JAMA Surg 151(8):e161137. https://doi.org/10.1001/jamasurg.2016.1137

    Article  PubMed  PubMed Central  Google Scholar 

  72. Katz MH, Fleming JB, Bhosale P, Varadhachary G, Lee JE, Wolff R, Wang H, Abbruzzese J, Pisters PW, Vauthey JN, Charnsangavej C, Tamm E, Crane CH, Balachandran A (2012) Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 118(23):5749–5756. https://doi.org/10.1002/cncr.27636

    Article  PubMed  Google Scholar 

  73. Katz MHG, Ou FS, Herman JM, Ahmad SA, Wolpin B, Marsh R, Behr S, Shi Q, Chuong M, Schwartz LH, Frankel W, Collisson E, Koay EJ, Hubbard JM, Leenstra JL, Meyerhardt J, O'Reilly E (2017) Alliance for clinical trials in oncology (ALLIANCE) trial A021501: preoperative extended chemotherapy vs. chemotherapy plus hypofractionated radiation therapy for borderline resectable adenocarcinoma of the head of the pancreas. BMC Cancer 17(1):505. https://doi.org/10.1186/s12885-017-3441-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Breslin TM, Hess KR, Harbison DB, Jean ME, Cleary KR, Dackiw AP, Wolff RA, Abbruzzese JL, Janjan NA, Crane CH, Vauthey JN, Lee JE, Pisters PW, Evans DB (2001) Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: treatment variables and survival duration. Ann Surg Oncol 8:123–132

    Article  CAS  PubMed  Google Scholar 

  75. Tachezy M, Gebauer F, Petersen C, Arnold D, Trepel M, Wegscheider K, Schafhausen P, Bockhorn M, Izbicki JR, Yekebas E (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. https://doi.org/10.1186/1471-2407-14-411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. O’Reilly EM, Perelshteyn A, Jarnagin WR et al (2014) A single- arm, nonrandomized phase II trial of neoadjuvant gemcitabine and oxaliplatin in patients with resectable pancreas adenocarcinoma. Ann Surg 260(1):142–148

    Article  PubMed  Google Scholar 

  77. Lutz MP, Zalcberg JR, Ducreux M, Aust D, Bruno MJ, Büchler MW, Delpero JR, Gloor B, Glynne-Jones R, Hartwig W, Huguet F, Laurent-Puig P, Lordick F, Maisonneuve P, Mayerle J, Martignoni M, Neoptolemos J, Rhim AD, Schmied BM, Seufferlein T, Werner J, van Laethem JL, Otto F (2017) 3rd St. Gallen EORTC Gastrointestinal Cancer Conference: consensus recommendations on controversial issues in the primary treatment of pancreatic cancer. Eur J Cancer 79:41–49

    Article  PubMed  Google Scholar 

  78. Kalser MH, Ellenberg SS (1985) Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 120(8):899–903

    Article  CAS  PubMed  Google Scholar 

  79. Klinkenbijl JH, Jeekel J, Sahmoud T et al (1999) Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 230(6):776–782 discussion 782–4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, Beger H, Fernandez-Cruz L, Dervenis C, Lacaine F, Falconi M, Pederzoli P, Pap A, Spooner D, Kerr DJ, Büchler MW, European Study Group for Pancreatic Cancer (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350(12):1200–1210

    Article  CAS  PubMed  Google Scholar 

  81. Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, Padbury R, Moore MJ, Gallinger S, Mariette C, Wente MN, Izbicki JR, Friess H, Lerch MM, Dervenis C, Olah A, Butturini G, Doi R, Lind PA, Smith D, Valle JW, Palmer DH, Buckels JA, Thompson J, McKay CJ, Rawcliffe CL, Buchler MW, European Study Group for Pancreatic Cancer (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304:1073–1081

    Article  CAS  PubMed  Google Scholar 

  82. Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, Carter R, Tebbutt NC, Dervenis C, Smith D, Glimelius B, Charnley RM, Lacaine F, Scarfe AG, Middleton MR, Anthoney A, Ghaneh P, Halloran CM, Lerch MM, Oláh A, Rawcliffe CL, Verbeke CS, Campbell F, Büchler MW, European Study Group for Pancreatic Cancer (2012) Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 308(2):147–156

    Article  CAS  PubMed  Google Scholar 

  83. Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, Faluyi O, O'Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ma YT, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Hackert T, Jackson R, Büchler MW, European Study Group for Pancreatic Cancer (2017) Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 389(10073):1011–1024

    Article  CAS  PubMed  Google Scholar 

  84. Regine WF, Winter KA, Abrams RA, Safran H, Hoffman JP, Konski A, Benson AB, Macdonald JS, Kudrimoti MR, Fromm ML, Haddock MG, Schaefer P, Willett CG, Rich TA (2008) Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 299:1019–1026

    Article  CAS  PubMed  Google Scholar 

  85. Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative- intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297(3):267–277

    Article  CAS  PubMed  Google Scholar 

  86. Seufferlein T, Bachet JB, Van Cutsem E, Rougier P (2012) ESMO Guidelines Working Group. Pancreatic adenocarcinoma: ESMO-ESDO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 23:33–40

    Article  Google Scholar 

  87. Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa-Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M, Groupe Tumeurs Digestives of Unicancer; PRODIGE Intergroup (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825. https://doi.org/10.1056/NEJMoa1011923

    Article  CAS  PubMed  Google Scholar 

  88. Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, Seay T, Tjulandin SA, Ma WW, Saleh MN, Harris M, Reni M, Dowden S, Laheru D, Bahary N, Ramanathan RK, Tabernero J, Hidalgo M, Goldstein D, Van Cutsem E, Wei X, Iglesias J, Renschler MF (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369(18):1691–1703

    Article  CAS  Google Scholar 

  89. Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, Au HJ, Murawa P, Walde D, Wolff RA, Campos D, Lim R, Ding K, Clark G, Voskoglou-Nomikos T, Ptasynski M, Parulekar W; National Cancer Institute of Canada Clinical Trials Group (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25(15):1960–1966

    Article  CAS  PubMed  Google Scholar 

  90. Adamska A, Domenichini A, Falasca M (2017) Pancreatic ductal adenocarcinoma: current and evolving therapies. Int J Mol Sci 18(7):E1338. https://doi.org/10.3390/ijms18071338

    Article  CAS  PubMed  Google Scholar 

  91. House MG, Choti MA (2005) Palliative therapy for pancreatic/biliary cancer. Surg Clin North Am 85:359–371

    Article  PubMed  Google Scholar 

  92. Yoon WJ, Ryu JK, Yang KY, Paik WH, Lee JK, Woo SM, Park JK, Kim Y, Yoon YB (2009) A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc 70:284–289

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Division of Hepato-Pancreato-Biliary and Gastrointestinal Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, 221005, India

    Mallika Tewari, Jyoti R. Swain & R. Mahendran

  2. Senior Consultant & Program Lead, Surgical Oncology, Wockhardt Hospitals, Mumbai, Maharashtra, India

    Mallika Tewari

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Tewari, M., Swain, J.R. & Mahendran, R. Update on Management Periampullary/Pancreatic Head Cancer. Indian J Surg 83 (Suppl 3), 654–664 (2021). https://doi.org/10.1007/s12262-019-02053-5

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