Treatment of Pancreatic Cancer: Challenge of the Facts View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2003-08-21

AUTHORS

Hans G. Beger, Bettina Rau, Frank Gansauge, Bertram Poch, Karl-Heinz Link

ABSTRACT

Adenocarcinoma of the pancreas is associated with the worst survival of any form of gastrointestinal malignancy. In spite of the progress in surgical treatment, resulting in increasing resection rates and a decrease in treatment-related morbidity and mortality, the true figures of cure are even today below 3%. The dissemination of pancreatic cancer behind the local tissue compartments restricts the short-term (< 3 years) and long-term outcome for patients who have undergone resection. By histological evaluation, less than 15% of the patients undergoing R0 resection have a pN0 status, more than 60% suffer from lymph angiosis carcinomatosa, and more than 50% suffer extrapancreatic nerve plexus infiltration. Hematoxylin and eosin–negative lymph nodes were found to be cancer positive when reverse transcriptase polymerase chain reaction (RT- PCR) or immunostaining was applied to the HE-negative lymph nodes. Cancer of the uncinate process has a very poor prognosis because there are no early symptoms; vessel wall involvement occurs early and frequently; a high association of liver metastasis exists as well. Surgery offers a low success rate, but it provides the only chance of cure. Ductal pancreatic cancer is diagnosed in more than 95% of the cases in an advanced stage; potentially curative resection can be performed only in about 10%–15% of these patients. Major contributions of surgery to improved treatment results are the reduction of surgical morbidity—e.g., early postoperative local and systemic complications—and a decrease of hospital mortality below 3%–5%. In most recently published prospective trials, R0 resection has been reported to result in an increase in short-term survival beyond that recorded for patients with residual tumor. However, R0 resection fails to improve long-term survival. In many published R0 series, standard tissue resection of pancreatic head cancer with the Kausch-Whipple procedure failed to include remote cancer cell–positive tissues in the operative specimen; e.g., N2-lymph nodes, nerve plexus, and perivascular extrapancreatic and retropancreatic tissues were not excised. Cancer recurrence after so-called R0 resection with curative intent is frequently the consequence of cancer left behind. Thus, long-term survival (> 5 years) is observed in a very small group of patients, contradicting the published 5-year actuarial survival rates of 20%–45% for resected patients. The assessment of clinical benefit from surgical or medical cancer treatment should therefore be based on several end points, not only on actuarial survival. Publication of actuarial survival figures must include the number of observed (actual) survivals, the definition of the subset of patients followed after resection, and the total number of patients in the study group; anything less is misleading. In reporting pancreatic cancer treatment trial results after oncological resections, more convincing primary end points to evaluate treatment efficacy are median survival (in months), actual survival at 1–5 years, and progression-free survival (in months). In series with multimodality treatment, clinical benefit response as well as quality of life measurements using the EORTC Quality of Life index C30 (QLQ-C30) are of importance in evaluating survival data. Adjuvant treatment improves survival after oncological resection; however, the short-term and long-term benefit after adjuvant chemotherapy in R0 as well as in R1-2 resected patients has not yet been underscored by data from controlled clinical trials. The survival benefit (median survival time) of adjuvant chemotherapy or radiochemotherapy has been demonstrated to be 6–10 months. Therefore, after oncological resection of pancreatic cancer each patient should be offered adjuvant treatment. A neoadjuvant treatment protocol for pancreatic cancer, however, has not been established. More... »

PAGES

1075-1084

References to SciGraph publications

Journal

TITLE

World Journal of Surgery

ISSUE

10

VOLUME

27

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00268-003-7165-7

DOI

http://dx.doi.org/10.1007/s00268-003-7165-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1033806827

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/12925907


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81 hospital mortality
82 importance
83 increase
84 infiltration
85 intent
86 involvement
87 life measurements
88 liver metastases
89 long-term benefits
90 long-term outcomes
91 long-term survival
92 low success rate
93 lymph nodes
94 major contribution
95 malignancy
96 measurements
97 median survival
98 medical cancer treatment
99 metastasis
100 months
101 morbidity
102 mortality
103 multimodality treatment
104 neoadjuvant treatment protocols
105 nerve plexus
106 nodes
107 number
108 observed survival
109 oncological resection
110 only chance
111 operative specimen
112 outcomes
113 pN0 status
114 pancreas
115 pancreatic cancer
116 pancreatic head cancer
117 patients
118 plexus
119 point
120 polymerase chain reaction
121 poor prognosis
122 primary end point
123 procedure
124 process
125 prognosis
126 progress
127 progression-free survival
128 prospective trial
129 protocol
130 publications
131 quality
132 radiochemotherapy
133 rate
134 reaction
135 recurrence
136 reduction
137 resection
138 resection rate
139 residual tumor
140 response
141 results
142 retropancreatic tissue
143 reverse transcriptase-polymerase chain reaction
144 series
145 short-term survival
146 small group
147 specimen
148 spite
149 stage
150 status
151 study group
152 subset
153 subset of patients
154 success rate
155 surgery
156 surgical morbidity
157 surgical treatment
158 survival
159 survival benefit
160 survival data
161 survival figures
162 survival rate
163 symptoms
164 systemic complications
165 tissue
166 tissue compartments
167 tissue resection
168 today
169 total number
170 transcriptase-polymerase chain reaction
171 treatment
172 treatment efficacy
173 treatment protocol
174 treatment results
175 treatment trials
176 treatment-related morbidity
177 trials
178 true figure
179 tumors
180 uncinate process
181 vessel wall involvement
182 wall involvement
183 worse survival
184 years
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