セッション情報 JDDW International Debate Session(Featured Lecture)4(JDDW)

JDDW International Debate Session 「Treatment of borderline resectable pancreatic cancer (Surgery first vs Neoadjuvant therapy first)」

タイトル IS1-4-1:

Treatment of borderline resectable pancreatic cancer: Surgery first vs neoad juvant therapy first

演者 H. Friess(Department of Surgery, Klinikum rechts der Isar)
共同演者
抄録  Pancreatic cancer is still a devastating disease with poor prognosis. In resectable tumors treatment of choice is radical tumor resection with adequate lymphadenectomy and adjuvant chemotherapy. Although a R0 resection is always intended in this situation, standardized histopathological analysis revealed a R0 resection in only half of the patients and less. Especially if the tumors are large and in close contact to the venous and arterial vessels (borderline resectable tumors) R0 resection rates are often lower because of limitations to exceed the resection margins, without increasing morbidity and mortality. Therefore, there is still controversial discussion whether by a neoadjuvant therapy the R0 resection rate and long term survival can be improved. The concept of neoadjuvant therapy has been established in a number of other locally advanced (T3/N+) GI malignancies in Europe: esophageal cancer, gastric cancer and rectal cancer.A recent metaanalysis and systematic review on neoadjuvant therapy in pancreatic cancer revealed no difference in long term survival in patients with neoadjuvant therapy plus surgery versus surgery plus adjuvant therapy. Whether additional therapy is given before (neoadjuvant) or after (adjuvant) surgery seems not to influence survival. Therefore, the arguments against neoadjuvant therapy at the present time are:- most patients with pancreatic cancer are older than 70 years and they do not tolerate aggressive neoadjuvant therapy followed by extensive surgery- there is no defined neoadjuvant therapy regimen available which convincingly leads to downstaging of locally advanced tumors- tumors might progress during neoadjuvant therapy and turn from resectable to unresectable cancersThe controversy whether neoadjuvant therapy is beneficial in pancreatic cancer patients will never end until an adequately powered randomized controlled study will be performed. It is logical that such a study should be performed first in borderline resectable tumors to limit the potential disadvantages to the included patients. Data of such a study are needed and will define the future directions in treatment strategies to improve the prognosis of resectable pancreatic cancer patients.
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