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Annals of Surgical Oncology

, Volume 24, Issue 8, pp 2397–2403 | Cite as

Downstaging in Stage IV Pancreatic Cancer: A New Population Eligible for Surgery?

  • Isabella FrigerioEmail author
  • Paolo Regi
  • Alessandro Giardino
  • Filippo Scopelliti
  • Roberto Girelli
  • Claudio Bassi
  • Stefano Gobbo
  • Paolo Tinazzi Martini
  • Paola Capelli
  • Mirko D’Onofrio
  • Giuseppe Malleo
  • Laura Maggino
  • Elena Viviani
  • Giovanni Butturini
Pancreatic Tumors

Abstract

Background

Recent papers consider surgery as an option for synchronous liver oligometastatic patients [metastatic pancreatic ductal adenocarcinoma (mPDAC)]. In this study, we present our series of resected mPDACs after neoadjuvant chemotherapy (nCT).

Patients and methods

All patients resected after downstaging of mPDAC were included in this study. Downstaging criteria were disappearance of liver metastasis and a decrease in cancer antigen (CA) 19-9. The type and duration of nCT, last nCT surgery interval, histology, morbidity, and mortality were recorded, and overall survival (OS) and disease-free survival (DFS) were analyzed.

Results

Overall, 24 of 535 patients (4.5%) observed with mPDAC were included. These patients received gemcitabine alone (5/24), gemcitabine + nanoparticle albumin-bound (nab)−paclitaxel (3/24), and FOLFIRINOX (16/24). Primary tumor size decreased from 31 to 19 mm (p < 0.001), and serum CA19-9 decreased from 596 to 18 U/mL (p < 0.001). In 14/24 patients, the tumor was located in the head. Median interval nCT surgery was 2 months, there were no mortalities, and the postoperative course was uneventful in 34% of cases. Grade B/C pancreatic fistula, postoperative bleeding, and sepsis occurred in 17/4, 4, and 12% of cases, respectively, and reoperation rate was 4%. R0 resection was achieved in 88% of cases, with 17% complete pathological response. Positive nodes were found in 9/24 patients with a median node ratio of 0.37, and OS and DFS was 56 and 27 months, respectively.

Conclusions

Patients with mPDAC who were fully responsive to nCT may be cautiously considered for surgery, with potential benefit in survival compared with palliative chemotherapy alone. This is supported by results of our retrospective study, which is the largest ever reported.

Keywords

Overall Survival Liver Metastasis Gemcitabine Pancreatic Fistula Pancreatic Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

Special thanks goes to Professor Paolo Pederzoli, ‘Maestro’ of surgery for all of us.

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Isabella Frigerio
    • 1
    Email author
  • Paolo Regi
    • 1
  • Alessandro Giardino
    • 1
  • Filippo Scopelliti
    • 1
  • Roberto Girelli
    • 1
  • Claudio Bassi
    • 2
  • Stefano Gobbo
    • 3
  • Paolo Tinazzi Martini
    • 4
  • Paola Capelli
    • 3
  • Mirko D’Onofrio
    • 5
  • Giuseppe Malleo
    • 2
  • Laura Maggino
    • 2
  • Elena Viviani
    • 2
  • Giovanni Butturini
    • 1
  1. 1.HPB Surgical UnitPederzoli HospitalVeronaItaly
  2. 2.General Surgery B, The Pancreas InstituteUniversity of Verona Hospital TrustVeronaItaly
  3. 3.Department of PathologyPederzoli HospitalVeronaItaly
  4. 4.Department of RadiologyPederzoli HospitalVeronaItaly
  5. 5.Department of Radiology, G.B. Rossi HospitalUniversity of VeronaVeronaItaly

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