Annals of Surgical Oncology

, Volume 20, Issue 13, pp 4338–4347

Borderline Resectable/Locally Advanced Pancreatic Adenocarcinoma: Improvements Needed in Population-Based Registries

  • John T. Miura
  • Douglas B. Evans
  • Sam G. Pappas
  • T. Clark Gamblin
  • Kiran K. Turaga
Pancreatic Tumors

Abstract

Background

Management of patients with borderline resectable/locally advanced (BR/LA) pancreatic adenocarcinoma is based on knowledge of natural history and patterns of treatment failure, information of great importance to large data registries. Using the SEER database, we examined the survival for patients with BR/LA tumors and critically evaluated the utility of the data.

Methods

T3/T4 tumors from 2004 to 2007 were divided into those that involved the portal vein/superior mesenteric vein/gastroduodenal artery/hepatic artery and those that involved the superior mesenteric artery (SMA) or celiac axis. The control group (CG) included patients who were recommended surgery but did not undergo it. Multivariate disease-specific survival analyses were performed using the Cox proportional hazards model.

Results

Of 3,837 patients, 571 patients (15 %) were recommended surgery, and 323 (8 %) underwent surgical resection. We were unable to separate patients into BR/LA based on current NCCN guidelines. We were able to identify vascular involvement but not those who actually underwent vascular resection. Median survival of patients who underwent surgery with SMA and celiac involvement was 12 and 8 months compared with 7 and 6 months, respectively, in the CG (p = .01). Patients who underwent surgical resection with venous involvement had a longer survival than those with arterial involvement (18 vs 12 months, p = .001).

Conclusions

Analysis of patients with BR/LA pancreatic adenocarcinoma who underwent pancreatic resection in the SEER database yielded limited information. New manuals must focus on obtaining information consistent with current advances in the field; our recommendations for optimizing the SEER database are included.

Supplementary material

10434_2013_3237_MOESM1_ESM.docx (39 kb)
Supplementary material 1 (DOCX 38 kb)

References

  1. 1.
    Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–15.PubMedCrossRefGoogle Scholar
  2. 2.
    Cleary SP, Gryfe R, Guindi M, et al. Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am Coll Surg. 2004;198:722–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg. 2003;237:74–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247:456–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Evans DB, Varadhachary GR, Crane CH, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3496–502.PubMedCrossRefGoogle Scholar
  6. 6.
    Evans DB, Erickson BA, Ritch P. Borderline resectable pancreatic cancer: definitions and the importance of multimodality therapy. Ann Surg Oncol. 2010;17:2803–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.PubMedCrossRefGoogle Scholar
  8. 8.
    Evans DB, Farnell MB, Lillemoe KD, Vollmer C Jr, Strasberg SM, Schulick RD. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1736–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Katz MH, Pisters PW, Evans DB, et al. (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 206:833–46 (Discussion 846–8).PubMedCrossRefGoogle Scholar
  10. 10.
    Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403–13.PubMedGoogle Scholar
  11. 11.
    Allendorf JD, Lauerman M, Bill A, et al. Neoadjuvant chemotherapy and radiation for patients with locally unresectable pancreatic adenocarcinoma: feasibility, efficacy, and survival. J Gastrointest Surg. 2008;12:91–100.PubMedCrossRefGoogle Scholar
  12. 12.
    Al-Haddad M, Martin JK, Nguyen J, et al. Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg. 2007;11:1168–74.PubMedCrossRefGoogle Scholar
  13. 13.
    Bold RJ, Charnsangavej C, Cleary KR, et al. Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative, and pathologic analysis. J Gastrointest Surg. 1999;3:233–43.PubMedCrossRefGoogle Scholar
  14. 14.
    Carrere N, Sauvanet A, Goere D, et al. Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg. 2006;30:1526–35.PubMedCrossRefGoogle Scholar
  15. 15.
    Fuhrman GM, Leach SD, Staley CA, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric–portal vein confluence. Pancreatic tumor study group. Ann Surg. 1996;223:154–62.PubMedCrossRefGoogle Scholar
  16. 16.
    Illuminati G, Carboni F, Lorusso R, et al. Results of a pancreatectomy with a limited venous resection for pancreatic cancer. Surg Today. 2008;38:517–23.PubMedCrossRefGoogle Scholar
  17. 17.
    Toomey P, Hernandez J, Morton C, et al. Resection of portovenous structures to obtain microscopically negative margins during pancreaticoduodenectomy for pancreatic adenocarcinoma is worthwhile. Am Surg. 2009;75:804–9 (Discussion 809–10).PubMedGoogle Scholar
  18. 18.
    Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8:935–49 (Discussion 949–50).PubMedCrossRefGoogle Scholar
  19. 19.
    Nakao A, Takeda S, Inoue S, et al. (2006) Indications and techniques of extended resection for pancreatic cancer. World J Surg. 30:976–82.PubMedCrossRefGoogle Scholar
  20. 20.
    Fortner JG. Regional resection of cancer of the pancreas: a new surgical approach. Surgery. 1973;73:307–20.PubMedGoogle Scholar
  21. 21.
    Fortner JG, Kim DK, Cubilla A, Turnbull A, Pahnke LD, Shils ME. Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection. Ann Surg. 1977;186:42–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Bachellier P, Rosso E, Lucescu I, et al. Is the need for an arterial resection a contraindication to pancreatic resection for locally advanced pancreatic adenocarcinoma? A case-matched controlled study. J Surg Oncol. 2011;103:75–84.PubMedCrossRefGoogle Scholar
  23. 23.
    Bockhorn M, Burdelski C, Bogoevski D, Sgourakis G, Yekebas EF, Izbicki JR. Arterial en bloc resection for pancreatic carcinoma. Br J Surg. 2011;98:86–92.PubMedCrossRefGoogle Scholar
  24. 24.
    Hirano S, Kondo S, Hara T, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results. Ann Surg. 2007;246:46–51.PubMedCrossRefGoogle Scholar
  25. 25.
    Stitzenberg KB, Watson JC, Roberts A, et al. Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol. 2008;15:1399–406.PubMedCrossRefGoogle Scholar
  26. 26.
    Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg. 2008;247:300–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Wu X, Tao R, Lei R, et al. Distal pancreatectomy combined with celiac axis resection in treatment of carcinoma of the body/tail of the pancreas: a single-center experience. Ann Surg Oncol. 2010;17:1359–66.PubMedCrossRefGoogle Scholar
  28. 28.
    Amano H, Miura F, Toyota N, et al. Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepatobiliary Pancreat Surg. 2009;16:850–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Wu YL, Yan HC, Chen LR, Gao SL, Chen J, Dong X. (2007) Extended Appleby’s operation for pancreatic cancer involving celiac axis. J Surg Oncol. 96:442–6 (Discussion 447).PubMedCrossRefGoogle Scholar
  30. 30.
    Chua TC, Saxena A. Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg. 2010;14:1442–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Martin RC 2nd, Scoggins CR, Egnatashvili V, Staley CA, McMasters KM, Kooby DA. Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg. 2009;144:154–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Mollberg N, Rahbari NN, Koch M, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg. 2011;254:882–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Sasson AR, Hoffman JP, Ross EA, Kagan SA, Pingpank JF, Eisenberg BL. (2002) En bloc resection for locally advanced cancer of the pancreas: is it worthwhile? J Gastrointest Surg. 6:147–57 (Discussion 157–8).PubMedCrossRefGoogle Scholar
  34. 34.
    National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program. http://www.seer.cancer.gov. Accessed 13 June 2012.
  35. 35.
    National Comprehensive Cancer Network. Pancreatic Adenocarcinoma (Version 2.2012) March 29, 2012. http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed 13 June 2012.
  36. 36.
    Raut CP, Tseng JF, Sun CC, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246:52–60.PubMedCrossRefGoogle Scholar
  37. 37.
    Katz MH, Varadhachary GR, Fleming JB, et al. Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation. Ann Surg Oncol. 2010;17:1794–801.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • John T. Miura
    • 1
  • Douglas B. Evans
    • 1
  • Sam G. Pappas
    • 1
  • T. Clark Gamblin
    • 1
  • Kiran K. Turaga
    • 1
  1. 1.Division of Surgical OncologyMedical College of WisconsinMilwaukeeUSA

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