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

University of Toronto, Toronto, Ontario, Canada
Annals of Oncology (Impact Factor: 7.04). 07/2007; 18 Suppl 7(suppl 7):vii1-vii10. DOI: 10.1093/annonc/mdm210
Source: PubMed


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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    • "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.
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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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    • "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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