The management of pancreatic cancer. Current expert opinion and recommendations derived from the 8th World Congress on Gastrointestinal Cancer, Barcelona, 2006

Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium.
Annals of Oncology (Impact Factor: 7.04). 07/2007; 18 Suppl 7(suppl 7):vii1-vii10. DOI: 10.1093/annonc/mdm210
Source: PubMed

ABSTRACT This article summarizes the expert discussion on the management of pancreatic cancer, which took place during the 8th World Congress on Gastrointestinal Cancer in June 2006 in Barcelona. A multidisciplinary approach to a patient with pancreatic cancer is essential, in order to guarantee an optimal staging, surgery, selection of the appropriate (neo-)adjuvant strategy and chemotherapeutic choice management. Moreover, optimal symptomatic management requires a dedicated team of health care professionals. Quality control of surgery and pathology is especially important in this disease with a high locoregional failure rate. There is now solid evidence in favour of chemotherapy in both the adjuvant and palliative setting, and gemcitabine combined with erlotinib, capecitabine or platinum compounds seems to be slightly more active than gemcitabine alone in advanced pancreatic cancer. There is a place for chemoradiotherapy in selected patients with locally advanced disease, while the role in the adjuvant setting remains controversial. Those involved in the care for patients with pancreatic cancer should be encouraged to participate in well-designed clinical trials, in order to increase the evidence-based knowledge and to make further progress.

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Available from: Mario Dicato, Sep 27, 2015
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    • "In the past, patients with locally advanced disease, vascular involvement (hepatic artery, superior mesenteric artery, or the superior mesenteric vein/portal vein axis) or metastases were traditionally referred to conservative palliative treatment approaches which include a wide range of medical, surgical, and other interventions [19]. However, in recent randomized prospective trials and meta-analysis patients benefit of classic palliative procedures with regard to quality of life and survival have been questioned [20, 21]. With improving safety and surgical expertise several authors have suggested more aggressive, curative-intended approaches in pancreatic surgery to improve long-term survival even in patients with advanced pancreatic adenocarcinoma [22]. "
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    ABSTRACT: Backround. Pancreas resection is the only curative treatment for pancreatic adenocarcinoma. In the event of unexpected incidental liver metastases during operative exploration patients were traditionally referred to palliative treatment arms. With continuous progress in the surgical expertise simultaneous pancreas and liver resections seem technically feasible nowadays. The aim of this study therefore was to analyze the impact of synchronous liver-directed therapy on operative outcome and overall survival in patients with hepatic metastasized pancreatic adenocarcinoma (HMPA). Methods. 22 patients who underwent simultaneous pancreas resection and liver-directed therapy for HMPA between January 1, 2004 and January 1, 2009 were compared to 22 patients who underwent classic pancreas resection for nonmetastasized pancreatic adenocarcinoma (NMPA) in a matched pair study design. Postoperative morbidity, preoperative, and operative data and overall survival were analyzed. Results. Overall survival was significantly decreased in the HMPA group. Postoperative morbidity and mortality and median operation time did not significantly differ between the groups. Conclusion. The results of our study showed that simultaneous pancreas resection and liver-directed therapy may safely be performed and may therefore be applied in individual patients with HMPA. However, a potential benefit of this radical surgical approach with regard to overall survival and/or quality of life remains to be proven.
    Gastroenterology Research and Practice 11/2012; 2012(6):939350. DOI:10.1155/2012/939350 · 1.75 Impact Factor
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    • "Sixty to eighty per cent of patients with periampullary cancer will have unresectable disease due to local invasion or metastases.1 Currently, most patients are palliated endoscopically but surgical bypass can provide good palliation in cases of failed stenting or when unresectable disease is discovered at the time of surgery (usually after a trial Whipple dissection).2 "
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    ABSTRACT: Hepaticojejunostomy is the standard biliary bypass technique for periampullary cancer when trial dissection reveals unresectable disease or endoscopic stent placement is not possible. This anastomosis can be technically demanding and potentially difficult. The simpler technique of hepaticocholecystoenterostomy (HCE) has only previously been reported in very limited numbers and without outcome data. All patients undergoing HCE for the management of periampullary cancer were identified from a prospectively maintained computerised database of a single surgeon and were reviewed retrospectively. The HCE technique achieves a biliary bypass by two anastomoses, using the gallbladder as a conduit. It involves an anastomosis of the infundibulum of the gallbladder to the common hepatic duct followed by a second anastomosis of the gallbladder fundus to the proximal small bowel. From 1996 to 2010, 30 patients with pancreatic adenocarcinoma required a biliary bypass after a failed trial of Whipple procedure (80%) or failed endoscopic stenting (20%). There were 19 men and 11 women with a mean age of 64.5 years. The mean operative time for HCE alone was 92 minutes. The mean length of hospital stay was nine days. There was a single grade 2 complication (readmission with gastric emptying delay) and a single grade 3 complication (bile leak requiring reoperation). Thirty-day mortality was zero and the mean survival was 12 months (with one patient still alive at the time of writing). There were no readmissions with recurrent biliary obstruction or cholangitis. One patient had developed an incisional hernia by the 24-month follow-up appointment. HCE in periampullary cancer is safe and effective in selected patients. It involves two simple anastomoses with good access rather than one more demanding anastomosis. Morbidity, patency and overall survival are comparable with contemporary published series of hepaticojejunostomy.
    Annals of The Royal College of Surgeons of England 10/2012; 94(7):472-5. DOI:10.1308/003588412X13171221592294 · 1.27 Impact Factor
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    • "Pancreatic duct adenocarcinoma (PDAC) is a lethal human cancer, with a five year survival rate of less than 5% [1], [2]. Even if PDAC is only the 10th most common cancer, the grim prognosis makes it the number four when it comes to cancer mortality [2], [3], [4]. No efficient treatment exists currently except for surgical resection, which only has a minor impact on the long term survival rate [5]. "
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    ABSTRACT: Much evidence exists regarding the fact that blood DCs, both myeloid DCs (MDCs) and plasmacytoid DCs (PDCs), are negatively affected in different types of cancer, with both reduced numbers and impaired functionality. Functional impairment of DCs in patients with pancreatic ductal adenocarcinoma (PDAC), may contribute to the poor clinical outcome. The aim of this study was to examine the effects PDAC had on blood DCs and elucidate the underlying mechanism responsible for the DC impairment. We examined the systemic influence PDAC exerted on blood DCs by ex vivo measuring numerous activation and maturation markers expressed on these cells. Furthermore, the effect patient plasma and the inflammatory factors CXCL8 and PGE(2) had on purified MDCs and PDCs from healthy donors was assessed and compared to the DCs existing in PDAC patients. We found a partial maturation of the blood MDCs and PDCs in PDAC patients with significantly enhanced expression of CD83, CD40, B7H3, PDL-1, CCR6, and CCR7 and decreased expression of ICOSL, and DCIR. These changes lead to impairment in their immunostimulatory function. Furthermore, chronic pancreatitis gave rise to DCs with similar semi-mature phenotype as seen in PDAC. Low expression of ICOSL was associated with poor prognosis. We found that the mechanism underlying this semi-maturation of DCs was inflammatory factors existing in the PDAC patients' plasma. Of note, PGE(2), which is elevated PDAC patient plasma, was one contributing factor to the changes seen in MDCs and PDCs phenotype. Our findings point to a role for the systemic inflammation in transforming blood MDCs and PDCs into semi-mature cells in PDAC patients and we show a correlation between maturation status and clinical outcome. Thus, means to preserve a functional blood DC compartment in PDAC patients by diminishing the inflammation could facilitate their ability to control the disease and improve survival.
    PLoS ONE 10/2010; 5(10):e13441. DOI:10.1371/journal.pone.0013441 · 3.23 Impact Factor
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