scholarly journals Current and Future Intraoperative Imaging Strategies to Increase Radical Resection Rates in Pancreatic Cancer Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Henricus J. M. Handgraaf ◽  
Martin C. Boonstra ◽  
Arian R. Van Erkel ◽  
Bert A. Bonsing ◽  
Hein Putter ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Surgery ◽  
Near Infrared ◽  
Frozen Section ◽  
Intraoperative Imaging ◽  
Meta Analysis ◽  
Survival Rates ◽  
Radical Resection ◽  
Resection Margins ◽  
Curative Intent

Prognosis of patients with pancreatic cancer is poor. Even the small minority that undergoes resection with curative intent has low 5-year survival rates. This may partly be explained by the high number of irradical resections, which results in local recurrence and impaired overall survival. Currently, ultrasonography is used during surgery for resectability assessment and frozen-section analysis is used for assessment of resection margins in order to decrease the number of irradical resections. The introduction of minimal invasive techniques in pancreatic surgery has deprived surgeons from direct tactile information. To improve intraoperative assessment of pancreatic tumor extension, enhanced or novel intraoperative imaging technologies accurately visualizing and delineating cancer cells are necessary. Emerging modalities are intraoperative near-infrared fluorescence imaging and freehand nuclear imaging using tumor-specific targeted contrast agents. In this review, we performed a meta-analysis of the literature on laparoscopic ultrasonography and we summarized and discussed current and future intraoperative imaging modalities and their potential for improved tumor demarcation during pancreatic surgery.

scholarly journals Development of a MUC16-Targeted Near-Infrared Fluorescent Antibody Conjugate for Intraoperative Imaging of Pancreatic Cancer

2020 ◽  
Vol 19 (8) ◽  
pp. 1670-1681 ◽  
Author(s):  
Madeline T. Olson ◽  
Nicholas E. Wojtynek ◽  
Geoffrey A. Talmon ◽  
Thomas C. Caffrey ◽  
Prakash Radhakrishnan ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Near Infrared ◽  
Intraoperative Imaging ◽  
Fluorescent Antibody ◽  
Antibody Conjugate

scholarly journals Prognostic Roles of Inflammatory Markers in Pancreatic Cancer: Comparison between the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Dongwook Oh ◽  
Jung-Soo Pyo ◽  
Byoung Kwan Son
Keyword(s):  
Pancreatic Cancer ◽  
Inflammatory Markers ◽  
Inflammatory Marker ◽  
Meta Analysis ◽  
Survival Rates ◽  
Tumor Stage ◽  
Neutrophil To Lymphocyte Ratio ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Tumor Stages

Background/Objectives. This meta-analysis is aimed at investigating the prognostic roles of the inflammatory markers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with pancreatic cancer.Methods. The correlations between high inflammatory marker expression levels and prognosis in 7105 patients with pancreatic cancer from 34 eligible studies were investigated. Additionally, subgroup analyses based on study location, tumor stage, treatment, and value cutoffs were performed.Results. High NLR and PLR values were considered to be 2.0–5.0 and 150–200, respectively. Using a random-effects model, the estimated rates of high NLR and PLR were 0.379 (95% confidence interval [CI] 0.310–0.454) and 0.490 (95% CI 0.438–0.543), respectively. High NLRs were frequently found in patients with lower tumor stages and in those who underwent surgery. There were significant correlations between high NLR and PLR and poor survival rates (hazard ratio [HR] 1.737, 95% CI 1.502–2.009 and HR 1.143, 95% CI 1.037–1.259, resp.). Interestingly, the NLR and PLR had no prognostic value in patients who underwent chemoradiotherapy.Conclusion. Taken together, our results showed that inflammatory markers are useful for predicting prognosis in patients with pancreatic cancer. The NLR is a more suitable parameter for predicting prognosis regardless of the patient’s condition.

scholarly journals Oligometastatic Pancreatic Cancer to the Liver in the Era of Neoadjuvant Chemotherapy: Which Role for Conversion Surgery? A Systematic Review and Meta-Analysis

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3402
Author(s):  
Ottavia De Simoni ◽  
Marco Scarpa ◽  
Marco Tonello ◽  
Pierluigi Pilati ◽  
Francesca Tolin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Potential Role ◽  
Retrospective Studies ◽  
Meta Analysis ◽  
Survival Rates ◽  
Analysis Data ◽  
Conversion Surgery ◽  
Definition Of

Background: the improved survival rates achieved using new polychemotherapy regimens in patients with metastatic pancreatic cancer (mPDAC) have suggested a potential role for surgery following a favorable response to initial chemotherapy (IC). The purpose of this systematic review is to summarize the available evidence on the role of surgery following IC in mPDAC, focusing on oligometastatic disease to the liver (lmPDAC). Methods: studies reporting on patients with lmPDAC undergoing surgery after IC were included. The main outcome was overall survival (OS). Results: six observational retrospective studies were included in the qualitative analysis. Data were retrieved on 2087 patients. The most common IC regimen in patients undergoing surgery was FOLFIRINOX (N 84, 73%). Only three studies reported survival comparison among patients treated with IC+surgery vs. IC alone. Median OS varied from 23 to 56 months after conversion surgery vs. 11 to 16.4 months after IC alone. Conclusions: despite wide heterogeneity of chemotherapy regimens, different downstaging criteria and potential selection biases, patients with oligometastatic lmPDAC undergoing surgery after IC have significantly higher survival rates compared to patients treated with IC alone. Future trials are needed for definition of univocal criteria of downstaging, oligometastatic definition and indications for surgery.

1055 SURGERY WITH CURATIVE INTENT IN OLIGOMETASTATIC PANCREATIC CANCER TO THE LIVER IN THE ERA OF FOLFIRINOX: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 158 (6) ◽  
pp. S-1550-S-1551
Author(s):  
Ottavia De Simoni ◽  
Marco Scarpa ◽  
Marco Tonello ◽  
Pierluigi Pilati ◽  
Francesca Tolin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Meta Analysis ◽  
Curative Intent

scholarly journals Impact of intraoperative margin clearance on survival following pancreatoduodenectomy for pancreatic cancer: a systematic review and meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Emrullah Birgin ◽  
Erik Rasbach ◽  
Patrick Téoule ◽  
Felix Rückert ◽  
Christoph Reissfelder ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Frozen Section ◽  
Meta Analysis ◽  
Tumor Biology ◽  
Surgical Techniques ◽  
Positive Margin ◽  
Residual Tumor ◽  
Permanent Section ◽  
Pancreatic Neck

AbstractThe use of intraoperative margin revision to achieve margin clearance in patients undergoing pancreatoduodenectomy for pancreatic cancer is controversial. We performed a systematic review and meta-analysis to summarize the evidence of intraoperative margin revisions of the pancreatic neck and its impact on overall survival (OS). Nine studies with 4501 patients were included. Patient cohort was stratified in an R0R0-group (negative margin on frozen and permanent section), R1R0-group (revised positive margin on frozen section which turned negative on permanent section), and R1R1-group (positive margin on frozen and permanent section despite margin revision). OS was higher in the R1R0-group (HR 0.83, 95% CI 0.72–0.96, P = 0.01) compared to the R1R1-group but lower compared to the R0R0-group (HR 1.20; 95% CI 1.05–1.37, P = 0.008), respectively. Subgroup analyses on the use of different margin clearance definitions confirmed an OS benefit in the R1R0-group compared to the R1R1-group (HR 0.81; 95% CI 0.65–0.99, P = 0.04). In conclusion, intraoperative margin clearance of the pancreatic neck margin is associated with improved OS while residual tumor indicates aggressive tumor biology. Consensus definitions on margin terminologies, clearance, and surgical techniques are required.

Role of Short-Term Neoadjuvant Chemoradiotherapy for Potentially Resectable Pancreatic Cancer

2021 ◽  
pp. 000313482199867
Author(s):  
Keiichi Okano ◽  
Hironobu Suto ◽  
Minoru Oshima ◽  
Yasuhisa Ando ◽  
Hiroyuki Matsukawa ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Lymphatic Invasion ◽  
Resection Margins ◽  
Short Term ◽  
Resectable Pancreatic Cancer ◽  
Curative Intent ◽  
R1 Resection ◽  
Recurrence Patterns

Although the efficacy of neoadjuvant therapies for pancreatic cancer (PDAC) is reported in recent years, ideal neoadjuvant treatment for patients with potentially resectable (R) PDAC remains uncertain. We conducted the retrospective study about the effect of short-term neoadjuvant chemoradiotherapy (sNACRT) on R PDAC. The 94 patients received curative intent pancreatectomy for R PDAC between 2000 and 2016. Among them, 31 patients received sNACRT (S1 60 mg/m2/day for 2w and RTx 30 Gy/2w). Clinical outcomes of the 31 patients with sNACRT were analyzed in comparison with 63 patients without sNACRT. The 1-, 3-, and 5-year overall survival (OS) rates were 93, 71, and 62% in the patients with sNACRT and 78, 35, and 26% in the patients without sNACRT ( P = .0007), respectively. Lymph node metastasis was found in 41.9% of patients with sNACRT and 56.5% of patients without sNACRT ( P = .09). Microscopic tumor infiltration at resection margins (R1) was found in no patient with sNACRT and 5 patients (7.9%) without sNACRT ( P=.042). Retropancreatic infiltration ( P = .04), lymphatic invasion ( P = .002), plexus invasion ( P = .042), and main pancreatic duct extension ( P = .004) were significantly fewer in patients with sNACRT than the patients without sNACRT. The recurrences were found in 64% of patients with sNACRT (39% distant, 16% local, and 10% mix pattern) and 68% in patients without sNACRT (28% distant, 21% local, and 19% mix pattern). The recurrence patterns were significantly different ( P = .008) between the groups. Short-term neoadjuvant chemoradiotherapy decreased R1 resection rate and improved OS. Short-term neoadjuvant chemoradiotherapy may provide ideal local control during the short term and improve clinical outcome of R PDAC.

scholarly journals Tuned near infrared fluorescent hyaluronic acid conjugates for delivery to pancreatic cancer for intraoperative imaging

Theranostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 3413-3429 ◽  
Author(s):  
Bowen Qi ◽  
Ayrianne J. Crawford ◽  
Nicholas E. Wojtynek ◽  
Geoffrey A. Talmon ◽  
Michael A. Hollingsworth ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Hyaluronic Acid ◽  
Near Infrared ◽  
Intraoperative Imaging
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