Vascular resection and reconstruction for pancreatic malignancy: a single center survival study.

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA.
Journal of Gastrointestinal Surgery (Impact Factor: 2.39). 10/2007; 11(9):1168-74. DOI: 10.1007/s11605-007-0216-x
Source: PubMed

ABSTRACT Pancreatic cancer is one of the leading causes of cancer-related death in the USA. Recently, several centers have introduced portal and superior mesenteric vein resection and reconstruction during extended pancreatectomy, rendering the previously inoperable cases resectable.
The aim of this study is to confirm whether patients with locally advanced pancreatic cancer and mesenteric vascular invasion can be cured with extended pancreatectomy with vascular reconstruction (VR) and to compare their survival to patients treated with pancreatectomy without VR and those treated without resection (palliation).
Survival of 22 patients who underwent pancreatectomy with VR was compared with two control groups: 54 patients who underwent pancreatectomy without the need for VR and 28 patients whose pre-operative imaging suggested resectability but whose laparotomy indicated inoperability.
A slight survival benefit was noted in patients who did not require VR (33.5%) compared to those who did require VR [20%, p = 0.18], although not reaching statistical significance. Despite a low 15% three-year survival in patients treated palliatively, this was not statistically different compared to survival after resection with VR (P = 0.23). The presence of nodal metastasis was associated with worse survival (p = 0.006), and the use of adjuvant therapy was associated with better survival (p = 0.001).
Pancreatic cancers that require VR to completely resect the tumor have a similar survival to those not requiring VR. Long-term survival was achievable in approximately 1 out 5 patients requiring VR, although we were not able to demonstrate statistically improved survival compared to palliative care.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic cancer (PC) is the fourth cause of cancer death in Western countries, the only chance for long term survival is an R0 surgical resection that is feasible in about 10%-20% of all cases. Five years cumulative survival is less than 5% and rises to 25% for radically resected patients. About 40% has locally advanced in PC either borderline resectable (BRPC) or unresectable locally advanced (LAPC). Since LAPC and BRPC have been recognized as a particular form of PC neoadjuvant therapy (NT) has increasingly became a valid treatment option. The aim of NT is to reach local control of disease but, also, it is recognized to convert about 40% of LAPC patients to R0 resectability, thus providing a significant improvement of prognosis for responding patients. Once R0 resection is achieved, survival is comparable to that of early stage PCs treated by upfront surgery. Thus it is crucial to look for a proper patient selection. Neoadjuvant strategies are multiples and include neoadjuvant chemotherapy (nCT), and the association of nCT with radiotherapy (nCRT) given as either a combination of a radio sensitizing drug as gemcitabine or capecitabine or and concomitant irradiation or as upfront nCT followed by nRT associated to a radio sensitizing drug. This latter seem to be most promising as it may select patients who do not go on disease progression during initial treatment and seem to have a better prognosis. The clinical relevance of nCRT may be enhanced by the application of higher active protocols as FOLFIRINOX.
  • Source
    Saudi medical journal 12/2014; 35(12):1529-1533. · 0.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic cancer is a serious threat to human life. Moreover, its treatment is complicated and its prognosis is very poor. Therefore, a new method for the diagnosis and treatment of pancreatic cancer is very essential. In this study, a eukaryotic expression plasmid targeting EphB4 was constructed and transfected into PANC-1 pancreatic cancer cells to investigate the inhibition of cell growth and the progression of iRNA against EphB4. This study provides the basis for the gene therapy of pancreatic cancer. The recombinant eukaryotic EphB4 expression plasmid, pSIREN-RetroQ-ZsGreen-EphB4 and a negative control plasmid, pSIREN-RetroQ-ZsGreen-N, were constructed. At 48 h after transfection, the relative messenger RNA (mRNA) and protein levels of EphB4 were measured by RT-PCR and western blot. The proliferation of the transfected cells was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, while cell migration ability was analyzed using the scratch migration assay. At 48 h after transient transfection, EphB4 mRNA expression was significantly decreased in transfected PANC-1 cells as compared to the control group (P < 0.01). In vitro, inhibition of EphB4 expression weakened the proliferation and cell migration ability of PANC-1 cells compared to the control group. The small interfering RNA (siRNA) eukaryotic expression plasmid vector targeting EphB4 was successfully constructed and effectively transfected into PANC-1 cells. The recombinant plasmid can inhibit the expression of EphB4 mRNA and protein in PANC-1 cells, as well as cell growth and migration.
    Tumor Biology 07/2014; 35(7):6855-9. DOI:10.1007/s13277-014-1937-6 · 2.84 Impact Factor