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NCI CANCERLIT® Search: Therapy of Pancreatic Cancer - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 11383684
AU - Barber MD; Fearon KC
TI -
Tolerance and incorporation of a high-dose eicosapentaenoic acid diester
emulsion by patients with pancreatic cancer cachexia.
SO - Lipids 2001 Apr;36(4):347-51
AD - University Department of Surgery, Royal Infirmary of Edinburgh,
Scotland, United Kingdom.
Chemotherapy and radiotherapy offer little benefit to patients with
advanced pancreatic cancer. Eicosapentaenoic acid (EPA) has anticancer
effects both in vitro and in animal models. The dose of EPA that can be
administered to cancer patients has previously been limited by the low
purity of available preparations and the tolerability of large capsules.
A high-purity preparation of EPA as a 20% oil-in-water diester emulsion
allowed a small study of the tolerance, incorporation, and effects of
EPA in high doses in five patients with advanced pancreatic cancer.
Patients underwent assessment at baseline and every 4 wk thereafter. All
patients managed to tolerate a dose providing 18 g EPA per day, with
doses between 9 and 27 g daily being taken for at least a month. Dosage
was limited by a sensation of fullness, cramping abdominal pain,
steatorrhea, and nausea. All such symptoms were controlled by dose
reduction or pancreatic enzyme supplements. No other adverse effects
attributable to the trial agent were observed. Plasma phospholipid EPA
content increased from around 1% at baseline to 10% at 4 wk and 20% at 8
wk. Incorporation of EPA into red blood cell phospholipids reached
levels of around 10%. The present study has shown that a novel,
high-purity, EPA diester emulsion can be tolerated at a dose providing
around 18 g EPA per day with side-effects being easily controlled. The
acceptibility of large doses of oral EPA should allow larger controlled
clinical studies into potential anticancer effects of EPA.
2
UI - 11432627
AU - Louvet C; Andre T; Hammel P; Selle F; Landi B; Cattan S; Fonck M; Flesch
TI -
M; Colin P; Balosso J; Ruszniewski P; de Gramont A
Phase II trial of bimonthly leucovorin, 5-fluorouracil and gemcitabine
for advanced pancreatic adenocarcinoma (FOLFUGEM).
SO - Ann Oncol 2001 May;12(5):675-9
AD - Service l'Oncologie, Hjpital Saint-Antoine, Paris, France.
christophe.louvet@sat.ap-hop-paris.fr
BACKGROUND: Gemcitabine alone or 5-fluorouracil (5-FU) according to
several schedules are used for palliation of metastatic and locally
advanced (LA) pancreatic adenocarcinoma. This study was designed to test
the efficacy of the leucovorin 5-FU and gemcitabine combination.
PATIENTS AND METHODS: This phase II trial combined a simplified
bimonthly LV5FU2 with gemcitabine: leucovorin 400 mg/m2 in a two-hour
infusion, followed by 5-fluorouracil 400 mg/m2 bolus and 2 or 3 g/m2
continuous infusion over 46 hours; gemcitabine 1 g/m2 was infused over
30 min on day 3 after 5-FU. Treatment was repeated every two weeks.
Gemcitabine dose could be increased (250 mg/m2 every two cycles up to
1500 mg/m2) in the absence of NCI-CTC toxicity > 2. RESULTS: Among the
62 patients included in this study, 22 had LA and 40 had metastatic
disease. Objective response rate for the 54 patients with measurable
disease was 25.9% (95% confidence interval (CI): 14%-37.8%) and 22.6%
(95% CI: 12%-33.2%) in the intent-to-treat population: the clinical
benefit rate for the 59 assessable patients was 49.2%. Median
progression-free survival and median overall survival were 4.8 and 9
months, respectively, with 32.3% of patients alive at 1 year. The most
frequent toxicity (grade 3-4) was neutropenia (56.5%) usually
asymptomatic (1.1% febrile neutropenia), but requiring decreases of 5-FU
and gemcitabine doses. Unexpected complete alopecia occurred in 97% of
patients. CONCLUSIONS: Palliative effects, response rate and survival
observed in this multicenter study seem to be superior to those obtained
with gemcitabine or 5-FU alone, despite a limiting hematological
toxicity.
3
UI - 11432628
AU - Penberthy DR; Rich TA; Shelton CH 3rd; Adams R; Minasi JS; Jones RS
TI -
A pilot study of chronomodulated infusional 5-fluorouracil
chemoradiation for pancreatic cancer.
SO - Ann Oncol 2001 May;12(5):681-4
AD - Department of Radiation Oncology, University of Virginia Health Sciences
Center, Charlottesville 22901, USA.
BACKGROUND: Dose limiting acute toxicity from chemoradiation for
pancreatic cancer occurs in 15% -20% of patients treated with
post-operative adjuvant therapy. Reported here is a pilot study using
chronomodulated infusional 5-fluorouracil (5-FU) chemoradiation (CIC)
for pancreatic cancer, a treatment designed to reduce normal tissue
toxicity and maintain efficacy, with specific evaluation of acute and
late morbidity, patterns of disease progression, and survival. PATIENTS
AND METHODS: Twenty-three patients with adenocarcinoma of the pancreas
median age was 64, and there were 9 males and 14 females. Six patients
were considered unresectable and seventeen others were treated
post-operatively. The median external beam irradiation dose was 50.4 Gy.
5-FU infusion was given five days per week (300 mg/m2/d) and the median
total dose was 8.4 g/m2. The chronomodulated 5-FU infusion consists of a
low basal infusion rate for 16 hours followed by an eight-hour
escalating-deescalating infusion peaking at 10 p.m. All patients were
followed from the time of initial diagnosis until last follow-up or
death; the median follow-up was 16 months. RESULTS: No RTOG grade 3 or 4
hematologic toxicity occurred. Twelve of seventeen patients treated
postoperatively have been controlled locally, and seven patients have no
evidence of disease. The median survival is 28 months and one-year
actuarial survival is 88% in the group of resected patients. The 6
patients treated for unresectable disease have a median survival of 13
months. CONCLUSIONS: Acute toxicity of 5-FU CIC appears to be less
frequent and less severe than that reported with flat infusional or
bolus 5-FU based chemoradiation used for adjuvant post-operative therapy
for pancreatic cancer. This method may warrant further examination, as
it may be attractive for the elderly or those who cannot tolerate the
toxicity associated with standard post-operative treatment protocols.
4
UI - 11482200
AU - Basheev VKh; Ladur AI; Donets VL; Bogdanov VA
TI -
[Combined palliative subtotal pancreatectomy with resection of two
hollow organs in cancer surgery]
SO - Klin Khir 2001 Apr;(4):57-8
5
UI - 11452816
AU - Molino D; Perrotti P; Antropoli C; Bottino V; Napoli V; Fioretto R
TI -
[Central segmental pancreatectomy in benign and borderline neoplasms of
the pancreatic isthmus and body]
SO - Chir Ital 2001 May-Jun;53(3):319-25
AD - Divisione VII, Chirurgia Gastroenterologica Azienda Ospedaliera di
Rilievo Nazionale A. Cardarelli, Napoli.
We report our experience with middle segment pancreatectomy for benign,
cystic and borderline tumours of the neck and body of the pancreas. The
guidelines for management of these tumours are unclear. Formerly they
were usually resected with a pancreatico-duodenectomy or distal
pancreatectomy including the spleen. However, such operations may cause
high morbidity, a notable wastage of normal tissue and an unnecessary
risk of diabetes mellitus and splenic loss. Four patients (age range:
34-72 years) with tumours of the neck or body of the pancreas underwent
a middle segmental pancreatectomy. The cephalic stump was sutured with
duct ligation. The distal stump was anastomosed with a Roux-en-Y jejunal
loop. Neither pancreatic fistulas nor operative death occurred in any of
the patients. In 3 patients with serous cystadenoma and in one with
mucinous cystadenoma, the tumours measured 3.5 to 7 cm in size. These
were located in the neck and body of the pancreas and could not be
safely enucleated without compromising the pancreatic duct. All tumours
were resected with clear margins. The mean operative time was 230
minutes and the median postoperative hospital stay 14 days (range: 10-23
days). The patients have been followed up for five years after surgery
and all are disease-free. None of the patients became diabetic or
presented exocrine insufficiency. Middle segment pancreatectomy may be
an appropriate technique for selected benign or borderline pancreatic
tumours in the neck and body of the pancreas. This procedure has an
acceptable surgical risk when compared to that of major pancreatic
resections and preserves pancreatic function and the spleen.
6
UI - 11464498
AU - Napolitano L; Francomano F; Gargano E; Francione T; Angelucci D;
TI -
Napolitano AM
[Our experience regarding biologically inactive gastroenteropancreatic
neuroendocrine tumors]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):61-4; discussion 65
AD - Dipartimento di Scienze Chirurgiche Universita di Chieti.
The Authors present 9 cases of gastro-enteropancreatic neuro-endocrine
biologically inactive tumors. In 5 cases the tumor site was
appendicular. In 4 patients an appendectomy was performed, in one
patient a right hemicolectomy and the patients after a period of 3-9
years are well and disease free. In a patient with a gastric carcinoid
and a single hepatic metastasis a total gastrectomy with an hepatic
metastasectomy were performed but the patient died 16 months thereafter.
In a case localized to the right colon with a single hepatic metastasis
a right hemicolectomy was performed with a metastasectomy but the
patient died after 12 months. In a case localized to an ileal loop a
segmental resection was performed followed by a medical therapy with
octreotide and the patient is well and disease free after 3 years. In a
case localized to the pancreas with widespread lymphatic metastasis it
was performed a simple biliary diversion (coledocho-duodenostomy)
followed by medical therapy with octreotide. Surprisingly after 4 years
the patient is alive and a TC control shows a decrease of the pancreatic
tumor and of the lympho glandular tumefactions.
7
UI - 11490821
AU - Burcharth F; Olsen SD; Trillingsgaard J; Federspiel B; Moesgaard F;
TI -
Struckmann JR
Pancreaticoduodenectomy for periampullary cancer in patients more than
70 years of age.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1149-52
AD - Department of Surgical Gastroenterology, Herlev Hospital, University of
Copenhagen, Denmark. flbu@herlevhosp.kbhamt.dk
BACKGROUND/AIMS: To assess the indications for and results of
pancreaticoduodenectomy in patients more than 70 years old with
periampullary cancer. METHODOLOGY: Thirty-four consecutive patients
older than 70 years with periampullary cancer. The surgical procedure
was pancreaticoduodectomy (Whipple's operation) with an extensive
dissection of lymph nodes and the connective tissue in the
peripancreatic region. Main outcome measures were postoperative
morbidity and mortality, median and 5-year survival rates. RESULTS:
Postoperative medical complications occurred in 24% and surgical
complications in 53% of the patients. Four patients (12%) died in the
postoperative period (within 30 days), and 3 patients (9%) died later in
the postoperative course. The cumulative and age corrected 5-year
survival rate for the remaining patients was 26%. Fifteen patients died
of recurrence, and 7 patients of other causes. Five patients are still
alive more than 5 years after surgery. In patients with noncurative
operation the median survival time was 1 1/2 years, which is longer than
would be expected from other palliative procedures. Apart from a
moderately increased postoperative mortality the results were similar to
those reported for younger patients. CONCLUSIONS:
Pancreaticoduodenectomy should be considered in patients older than 70
years with resectable periampullary cancer. A 5-year survival rate of
20-35% can be obtained. Palliative resection may be indicated in
patients in good general condition, as resection gives the best
palliation and longer survival than other palliative methods.
8
UI - 11490822
AU - Yoshizawa K; Nagai H; Kurihara K; Sata N; Kawai T; Saito K
TI -
Long-term survival after surgical resection for pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1153-6
AD - Department of Surgery, Jichi Medical School, 3311-1 Yakushiji,
Minami-Kawachi, Tochigi 329-0498, Japan. k-yoshi@jichi.ac.jp
BACKGROUND/AIMS: Pancreatic cancer remains one of the most formidable
tumors defying early detection and effective treatment. Long-term
survivors, however, do exist after resection. We investigated the
clinicopathologic features of patients with pancreatic cancer who
survived more than 5 years to draw out some suggestions concerning the
indication of surgical treatment. METHODOLOGY: We studied the
clinicopathologic features of 13 patients with pancreatic cancer who
survived more than 5 years after resection. We reviewed their clinical
records to investigate preoperative symptoms, serum tumor markers,
operative findings, postoperative adjuvant therapy, and modes of
recurrence and survival periods. Information on the location, size,
histology and spread of the primary tumors were mainly obtained from
pathology reports. RESULTS: Histologic types of the long survivors
included ductal adenocarcinoma of common type in 4 patients, mucinous
noncystic adenocarcinoma in 2, intraductal papillary-mucinous carcinoma
(invasive) in 4, undifferentiated carcinoma in 1, endocrine tumor (islet
cell carcinoma) in 1 and acinar cell carcinoma in 1. All 4 cases of
ductal adenocarcinoma of the common type showed a moderate invasion
either to the retroperitoneum, the portal vein or the duodenum. Two
patients with mucinous noncystic carcinoma attained a long survival
despite extensive invasion of the pancreatic stroma, although one died
of peritoneal carcinomatosis. Two of 4 patients with intraductal
papillary-mucinous cancer (invasive) died of peritoneal dissemination 6
and 11 years after resection, respectively. Three patients with cancer
of other special histologic types, i.e., undifferentiated,
well-differentiated endocrine carcinoma and acinar cell carcinoma,
showed invasion of the portal vein and splenic artery, involvement of
the retroperitoneum and a metastatic tumor in the liver, respectively.
CONCLUSIONS: Whereas special histologic types including ductal variants
tended to predispose to long-term survival, ductal adenocarcinoma of the
common type had some chance of long survival even with invasion of the
surrounding tissues.
9
UI - 11490823
AU - Fujino Y; Suzuki Y; Ajiki T; Tanioka Y; Kuroda Y
TI -
Surgical treatment for mucin-producing tumors of the pancreas.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1157-61
AD - First Department of Surgery, Kobe University School of Medicine, 7-5-2
Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. yasu120@med.kobe-u.ac.jp
BACKGROUND/AIMS: Our objectives in this study were to evaluate the
surgical treatment for mucin-producing tumor of the pancreas from the
clinicopathological and imaging features. METHODOLOGY: Thirty-one
patients with mucin-producing tumor of the pancreas were examined based
on clinicopathological analyses to determine the appropriate surgical
treatment. RESULTS: The clinical and imaging features easily
distinguished the main duct type of intraductal papillary lesions (type
Ia), branch type of intraductal papillary lesions (type Ib) and mucinous
cystic neoplasms (type II). From pathological examinations, a dilated
main pancreatic duct had the malignant potentiality and multicentric
development. CONCLUSIONS: Pancreatic segments containing a dilated main
pancreatic duct should be resected in type Ia. Type Ib is sufficient for
partial resection without lymphadenectomy. Type II also requires partial
resection of the cystic neoplasm. A standard lymphadenectomy may be an
option when type Ia and II show invasive features.
10
UI - 11490825
AU - Yoshida T; Aramaki M; Matsumoto T; Morii Y; Bandah T; Kai T; Kawano K;
TI -
Kitano S
Right hepatic artery interruption and prostaglandin E1 in total or
proximal pancreatectomy for pancreatobiliary malignancy.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1166-9
AD - Department of Surgery I, Oita Medical University, 1-1 Idaigaoka, Hasama,
Oita 879-5593, Japan.
BACKGROUND/AIMS: Advanced hepato-biliary-pancreatic malignancy can
frequently involve the hepatic artery. We evaluated the use of
prostaglandin E1 in total or proximal pancreatectomy with the right
hepatic artery interruption. METHODOLOGY: A Consecutive seven of 117
patients (6.0%) in whom the right hepatic artery was interrupted and not
reconstructed were reviewed retrospectively. Four of them received
prostaglandin E1 (10-20 ng/kg/min) until the fifth postoperative day,
while, the remaining three did not. The effect of prostaglandin E1 was
compared concerning complication and hepatic function. RESULTS: The
right hepatic artery was intentionally resected because of cancer
invasion in five patients with biliary tract carcinoma, while,
accidentally transected in two with pancreatic carcinoma. Operative
deaths did not occur. The biliary leakage was identified in one patient
treated without prostaglandin E1. Although a marked rise in glutamic
oxaloacetic transaminase, glutamic pyruvic transaminase, and lactate
dehydrogenase levels was observed, hepatic dysfunction was successfully
treated conservatively in all patients. The glutamic oxaloacetic
transaminase and lactate dehydrogenase values were significantly lower
(P < 0.05) in patients treated with prostaglandin E1 compared with those
without prostaglandin E1. CONCLUSIONS: The prostaglandin E1 infusion can
be helpful for biliary anastomosis and hepatic function in radical
hepato-biliary-pancreatic surgery with the right hepatic artery
interruption.
11
UI - 11490839
AU - Nakao A
TI -
Recent advances in diagnosis and treatment of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):914-5
12
UI - 11490846
AU - Nakao A; Kaneko T; Takeda S; Inoue S; Harada A; Nomoto S; Ekmel T;
TI -
Yamashita K; Hatsuno T
The role of extended radical operation for pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):949-52
AD - Department of Surgery II, Nagoya University School of Medicine, 65
Tsurumaicho, Showa-ku, Nagoya 466-8550, Japan.
nakaoaki@tsuru.med.nagoya-u.ac.jp
BACKGROUND/AIMS: To clarify the indication of extended operation for
pancreatic carcinoma, a clinical study was carried out. METHODOLOGY:
carcinoma underwent resection of the tumor. Portal vein resection was
performed in 145 of these 196 (74.0%) resected cases. The postoperative
survival rate was studied according to the operative and
histopathological findings. RESULTS: In spite of the aggressive surgery,
there was no patient who survived over 3 years after operation in the
group carcinoma-positive on the surgical margins. Patients who survived
over 3 years postoperatively were observed in the group of
carcinoma-free surgical margins. CONCLUSIONS: The most important
indication of extended operation combined with portal vein resection for
pancreatic cancer is to obtain surgical cancer-free margins. There is no
indication of extended operation for cases in which surgical margins
will become cancer-positive, if such an operation is employed.
13
UI - 11490847
AU - Takeda S; Inoue S; Kaneko T; Harada A; Nakao A
TI -
The role of adjuvant therapy for pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):953-6
AD - Department of Surgery II, Nagoya University School of Medicine, 65
Tsurumai-Cho, Showa-Ku, Nagoya 466-8550, Japan.
shinta@med.nagoya-u.ac.jp
BACKGROUND/AIMS: In spite of radical pancreatectomy with lymphadenectomy
for adenocarcinoma of the pancreas, survival remains poor. We add two
forms of adjuvant therapy, i.e., intraoperative radiotherapy and liver
perfusion chemotherapy, to the radical resection. The aim of this study
is to investigate the utility of these two forms of adjuvant therapy
prospectively and to review their effectiveness. METHODOLOGY: One
hundred and ninety-six patients with pancreatic cancer who underwent
radical pancreatectomy in our institute were enrolled. We conducted
intraoperative radiation therapy 30 Gy against the retroperitoneal
connective tissues around the superior mesenteric artery during surgery.
Adjuvant liver perfusion chemotherapy was added immediately after
operation via the portal vein using 5-fluorouracil (250 mg/body/day) for
3 to 4 weeks continuously. Overall survival analyses were done by the
method of Kaplan and Meier. RESULTS: Intraoperative radiation therapy
did not influence the prognoses directly. However, the patients who
received adjuvant liver perfusion chemotherapy had better prognoses (P <
0.05). CONCLUSIONS: Although adjuvant therapy after radical resection
with wide lymphadenectomy improves prognoses, the results are still not
satisfactory. We should develop a new and more efficacious treatment.
14
UI - 11490850
AU - Kanazumi N; Nakao A; Kaneko T; Takeda S; Harada A; Inoue S; Nagasaka T;
TI -
Nakashima N
Surgical treatment of intraductal papillary-mucinous tumors of the
pancreas.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):967-71
AD - Department of Surgery II, Nagoya University School of Medicine, Nagoya,
Japan.
BACKGROUND/AIMS: IPMT (Intraductal papillary-mucinous tumor of the
pancreas) is increasingly recognized. The aim of this study was to
investigate the appropriate surgical treatment for these tumors.
IPMT underwent surgery. We retrospectively examined the
clinicopathological features and surgical outcomes of the patients.
RESULTS: The types of IPMT were as follows: hyperplasia (20); adenoma
(31); and carcinoma, both invasive (5) and noninvasive (6). Lymph node
metastasis was found in 36% of the carcinomas. The size of mural nodules
was more than 3 mm in all adenoma or carcinoma cases, while the
percentage of hyperplasia less than 3 mm was 75%. Intraoperative
pancreatoscopy and annular array ultrasonography were very useful,
because they detected 10 lesions that could not be found by preoperative
examinations, such as computed tomography, endoscopic retrograde
pancreatography, and endoscopic ultrasonography. All patients underwent
surgical resection, including 10 pancreaticoduodenectomies (Whipple's
procedure), 10 pylorus-preserving pancreaticoduodenectomies, 13
pancreatic head resections with segmental duodenectomies, 17 distal
pancreatectomies, 9 segmental resections of the pancreas, 2
duodenum-preserving pancreatic head resections, and 1 total
pancreatectomy. No operative or hospital death was observed. The
postoperative survival rate at 5 years was 71.6% for carcinoma in IPMT.
All of the cases with hyperplasia, adenoma and noninvasive carcinoma
survived. Only two of the patients with invasive carcinoma died.
CONCLUSIONS: IPMT had a favorable prognosis, as compared with pancreatic
duct carcinoma. When selecting a surgical procedure for treating these
tumors, it is important to confirm the tumor extent, as well as the
diagnosis of invasion or noninvasion. In cases with invasion, radical
resection is required. On the other hand, organ-function-preserving
procedures should be selected for diseases without invasion.
15
UI - 11499693
AU - Jacobson SD; Alberts SR; O'Connell MJ
TI -
Pancreatic cancer in the older patient.
SO - Oncology (Huntingt) 2001 Jul;15(7):926-32; discussion 935-7
AD - Mayo Graduate School of Medicine, Rochester, Minnesota 55905, USA.
Pancreatic cancer is a disease seen predominantly in elderly patients.
Compared to younger patients, older patients are more likely to present
with early-stage disease and, therefore, may be candidates for
aggressive local treatment. Little published information exists on
treatment outcomes for elderly patients with potentially resectable
disease or those with locally advanced or metastatic pancreatic cancer.
The limited information available suggests that elderly patients are as
likely to benefit from surgery, radiation, and chemotherapy as younger
patients. Despite this apparent benefit, elderly patients appear to have
a worse long-term outcome. This may be due to the failure to offer them
aggressive treatment or to comorbid conditions. Nevertheless, further
studies need to be conducted in this area, and greater emphasis needs to
be placed on including elderly patients in clinical trials. For elderly
patients with terminal disease, there should be better use of palliative
measures that may be of benefit. Each of these issues is discussed in
detail.
16
UI - 11504284
AU - Wayne JD; Wolff RA; Pisters PW; Evans DB
TI -
Multimodality management of localized pancreatic cancer.
SO - Cancer J 2001 Jul-Aug;7 Suppl 1():S35-46
AD - Department of Surgical Oncology, The University of Texas MD Anderson
Cancer Center, Houston 77030, USA.
Despite improvements in surgical management, only a minority of patients
enjoy long-term survival following pancreaticoduodenectomy for
adenocarcinoma of the pancreas. Adjuvant therapy consisting of
5-fluorouracil and irradiation has improved median and 5-year survival
rates; however, at least one third of eligible patients do not receive
postoperative adjuvant therapy because of delayed recovery following
pancreaticoduodenectomy. This has led to the development of treatment
schedules incorporating the delivery of systemic therapy and/or
chemoradiation prior to surgery. This article briefly outlines the
history of adjuvant therapy for adenocarcinoma of the pancreas and
reviews the available literature on neoadjuvant therapy for localized
pancreatic cancer including investigational therapies under clinical
trial evaluation.
17
UI - 11504292
AU - Mullan MH; Gauger PG; Thompson NW
TI -
Endocrine tumours of the pancreas: review and recent advances.
SO - ANZ J Surg 2001 Aug;71(8):475-82
AD - Department of Surgery, Division of Endocrine Surgery, University of
Michigan Hospital, Ann Arbor 48109-0331, USA.
Pancreatic endocrine tumours (PET) are rare but nonetheless important to
recognize and treat in a timely fashion. Significant morbidity occurs
due to excess secretion of hormones, with all of the PET having some
degree of malignant potential. Surgeons must plan directed operative
strategies to deal with these tumours and be prepared to undertake
aggressive palliative debulking resections if indicated. Somatostatin
receptor scintigraphy and endoscopic ultrasound have been particularly
helpful in both localizing and staging patients with PET. Other
important advances in management include the use of long-acting
somatostatin analogues to inhibit hormonal secretion and tumour growth.
The possibility of multiple endocrine neoplasia type 1 (MEN-1) should be
considered in any patient with a PET. The present article will review
the various classes of PET, describe MEN-1 in relation to PET and
examine advances in imaging and localization. The role of surgery for
PET is also discussed in the present review.
18
UI - 11520088
AU - van Geenen RC; van Gulik TM; Offerhaus GJ; de Wit LT; Busch OR; Obertop
TI -
H; Gouma DJ
Survival after pancreaticoduodenectomy for periampullary adenocarcinoma:
an update.
SO - Eur J Surg Oncol 2001 Sep;27(6):549-57
AD - Department of Surgery, Academic Medical Center, Amsterdam, The
Netherlands.
AIM: Survival after pancreaticoduodenectomy for periampullary tumours is
limited. Over the last decade peri-operative management has improved and
morbidity and mortality decreased. The aim of the study was to analyse
recent survival data after pancreaticoduodenectomy and to determine
1998, 204 patients with a ductal adenocarcinoma in the pancreatic head
(108), distal bile duct (32), and ampulla (64) who underwent standard
pancreaticoduodenectomy, were analysed with regard to histology and
tumour status. Survival was calculated by using the Kaplan-Meier method.
Risk factors were identified in a univariate and multivariate analysis.
RESULTS: Median survival after resection for carcinoma of the pancreatic
head, distal bile duct, and ampulla were 16, 25 and 24 months,
respectively (P=0.008). In the univariate analysis vein resection, blood
transfusion of more than four packed red cells, the presence of tumour
positive resection margins, lymph-node metastases and poor tumour
differentiation significantly decreased survival. In the multivariate
analysis positive resection margins, lymph-node metastases, and poor
tumour differentiation independently influenced survival. CONCLUSIONS:
Resection margins, lymph-node status and tumour differentiation are
independent prognostic factors. Survival after standard
pancreaticoduodenectomy for periampullary tumours has not improved.
Copyright 2001 Harcourt Publishers Limited.
19
UI - 11521183
AU - Maosheng D; Ohtsuka T; Ohuchida J; Inoue K; Yokohata K; Yamaguchi K;
TI -
Chijiiwa K; Tanaka M
Surgical bypass versus metallic stent for unresectable pancreatic
cancer.
SO - J Hepatobiliary Pancreat Surg 2001;8(4):367-73
AD - Department of Surgery and Oncology, Graduate School of Medical Sciences,
Kyushu University, Fukuoka 812-8582, Japan.
With the development of interventional radiology and endoscopy, the
practice of inserting expandable metallic stents for malignant jaundice
has become widespread. Many studies have compared surgical bypass with
polyethylene stents, or metallic stents with polyethylene stents.
However, few data are available on the comparison of surgical bypass and
metallic stents. The aim of this study was to compare the patient's
postprocedure course and the cost performance of surgical bypass and
metallic stents in patients with unresectable pancreatic cancer. The
parameters analyzed were the rates of procedural and therapeutic
success, duration of hospital stay, prevalence of early and late
complications, cost performance, and prognosis. The rates of procedural
and therapeutic success were excellent with both palliative treatments.
With surgical bypass, there was a low prevalence of late complications,
but duodenal obstruction sometimes occurred in patients without gastric
bypass. With metallic stents, there was shorter hospitalization and
lower cost, but a higher prevalence of late complications. Stent
occlusion tended to occur in patients with uncovered metallic stents.
There was no difference in the prognosis between the two palliative
treatments. Thus, in consideration of the poor prognosis of pancreatic
cancer, in patients with unresectable pancreatic cancer, insertion of
covered metallic stents would be preferable to surgical bypass, because
of the subsequent short hospitalization and the low cost. On the other
hand, in patients with a relatively long expected prognosis, or in those
with existing duodenal obstruction, biliary bypass with
gastrojejunostomy may provide an advantage.
20
UI - 11527256
AU - Smith RC
TI -
Pancreaticoenteric anastomotic leak following pancreaticoduodenectomy.
SO - ANZ J Surg 2001 Sep;71(9):505-6
21
UI - 11573042
AU - Conlon KC; Labow D; Leung D; Smith A; Jarnagin W; Coit DG; Merchant N;
TI -
Brennan MF
Prospective randomized clinical trial of the value of intraperitoneal
drainage after pancreatic resection.
SO - Ann Surg 2001 Oct;234(4):487-93; discussion 493-4
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York
Ave., New York, NY 10021, USA.
OBJECTIVE: To test the hypothesis that routine intraperitoneal drainage
is not required after pancreatic resection. SUMMARY BACKGROUND DATA: The
use of surgically placed intraperitoneal drains has been considered
routine after pancreatic resection. Recent studies have suggested that
for other major upper abdominal resections, routine postoperative
drainage is not required and may be associated with an increased
complication rate. METHODS: After informed consent, eligible patients
with peripancreatic tumors were randomized during surgery either to have
no drains placed or to have closed suction drainage placed in a
standardized fashion after pancreatic resection. Clinical, pathologic,
and surgical details were recorded. RESULTS: One hundred seventy-nine
patients were enrolled in the study, 90 women and 89 men. Mean age was
65.4 years (range 23-87). The pancreas was the tumor site in 142 (79%)
patients, with the ampulla (n = 24), duodenum (n = 10), and distal
common bile duct (n = 3) accounting for the remainder. A
pancreaticoduodenectomy was performed in 139 patients and a distal
pancreatectomy in 40 cases. Eighty-eight patients were randomized to
have drains placed. Demographic, surgical, and pathologic details were
similar between both groups. The overall 30-day death rate was 2% (n =
4). A postoperative complication occurred during the initial admission
in 107 patients (59%). There was no significant difference in the number
or type of complications between groups. In the drained group, 11
patients (12.5%) developed a pancreatic fistula. Patients with a drain
were more likely to develop a significant intraabdominal abscess,
collection, or fistula. CONCLUSION: This randomized prospective clinical
trial failed to show a reduction in the number of deaths or
complications with the addition of surgical intraperitoneal closed
suction drainage after pancreatic resection. The data suggest that the
presence of drains failed to reduce either the need for interventional
radiologic drainage or surgical exploration for intraabdominal sepsis.
Based on these results, closed suction drainage should not be considered
mandatory or standard after pancreatic resection.
22
UI - 11573043
AU - Norton JA; Alexander HR; Fraker DL; Venzon DJ; Gibril F; Jensen RT
TI -
Comparison of surgical results in patients with advanced and limited
disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison
syndrome.
SO - Ann Surg 2001 Oct;234(4):495-505; discussion 505-6
AD - Department of Surgery, University of California, San Francisco, CA, USA.
OBJECTIVE: To determine the role of surgery in patients with
Zollinger-Ellison syndrome (ZES) and multiple endocrine neoplasia type 1
(MEN1) with either limited or advanced pancreatic endocrine tumors
(PETs). SUMMARY BACKGROUND DATA: The role of surgery in patients with
MEN1 and ZES is controversial. There have been numerous previous studies
of surgery in patients with PETs; however, there are no prospective
studies on the results of surgery in patients with advanced disease.
METHODS: Eighty-one consecutive patients with MEN1 and ZES were assigned
to one of four groups depending on the results of imaging studies. Group
1 (n = 17) (all PETs smaller than 2.5 cm) and group 3 (n = 8) (diffuse
liver metastases) did not undergo surgery. All patients in group 2A (n =
17; single PET 2.5-6 cm [limited disease]) and group 2B (n = 31; two or
more lesions, 2.5 cm in diameter or larger, or one lesion larger than 6
cm) underwent laparotomy. Tumors were preferably removed by simple
enucleation, or if not feasible resection. Patients were reevaluated
yearly. RESULTS: Pancreatic endocrine tumors were found in all patients
at surgery, with groups 2A and 2B having 1.7 +/- 0.4 and 4.8 +/- 1 PETs,
respectively. Further, 35% of the patients in group 2A and 88% of the
patients in group 2B had multiple PETs, 53% and 84% had a pancreatic
PET, 53% and 68% had a duodenal gastrinoma, 65% and 71% had lymph node
metastases, and 0% and 12% had liver metastases. Of the patients in
groups 2A and 2B, 24% and 58% had a distal pancreatectomy, 0% and 13%
had a hepatic resection, 0% and 6% had a Whipple operation, and 53% and
68% had a duodenal resection. No patient was cured at 5 years. There
were no deaths. The early complication rate, 29%, was similar for groups
2A and 2B. Mean follow-up from surgery was 6.9 +/- 0.8 years, and during
follow-up liver metastases developed in 6% of the patients in groups 2A
and 2B. Groups 1, 2A, and 2B had similar 15-year survival rates
(89-100%); they were significantly better than the survival rate for
group 3 (52%). CONCLUSIONS: Almost 40% of patients with MEN1 and ZES
have advanced disease without diffuse distant metastases. Despite
multiple primaries and a 70% incidence of lymph node metastases, tumor
can be removed with no deaths and complication rates similar to those in
patients with limited disease. Further, despite previous studies showing
that patients with advanced disease have decreased survival rates, in
this study the patients with advanced tumor who underwent surgical
resection had the same survival as patients with limited disease and
patients without identifiable tumor. This suggests that surgical
resection should be performed in patients with MEN1 who have ZES and
advanced localized PET.
23
UI - 11574081
AU - Bachellier P; Nakano H; Oussoultzoglou PD; Weber JC; Boudjema K; Wolf
TI -
PD; Jaeck D
Is pancreaticoduodenectomy with mesentericoportal venous resection safe
and worthwhile?
SO - Am J Surg 2001 Aug;182(2):120-9
AD - Centre de Chirurgie Viscerale et de Transplantation, Hopital
Universitaire de Hautepierre, Avenue Moliere, 67098 Cedex, Strasbourg,
France.
BACKGROUND: Whether or not superior mesentericoportal venous resection
(SM-PVR) associated with pancreaticoduodenectomy (PD) is safe and
worthwhile has not been fully confirmed. The aim of the present study
was to investigate results of this surgical procedure performed for
pancreatic head and periampullary neoplasms. METHODS: As a first
analysis, postoperative morbidity and mortality after PD with (n = 31)
or without SM-PVR (n = 119) were investigated in 150 patients with
pancreatic head and periampullary neoplasms. As a second analysis, rates
of margin-negative resection and survival after SM-PVR (n = 21) and
without SM-PVR (n = 66) were compared in 87 patients with pancreatic
ductal adenocarcinoma of the pancreatic head. In these patients
undergoing SM-PVR (n = 21), survival rate was investigated in patients
who did (n = 13) and did not (n = 8) undergo a margin-negative
resection. RESULTS: In the first analysis, duration of surgery and
volume of blood transfused perioperatively were higher in patients
undergoing SM-PVR. However, mortality, morbidity rates, and mean
hospital stay did not differ between patients who did undergo SM-PVR (31
patients, 3.2%, 48.4%, and 22.2 days, respectively) and who did not (119
patients, 2.5%, 47.1%, 25.9 days, respectively). No postoperative death
occurred in the recent part of the present study, since 1994, in
patients undergoing SM-PVR. In the second analysis of pancreatic ductal
adenocarcinoma, rates of margin-negative resection and 2-year survival
did not significantly differ between patients who did and did not
undergo SM-PVR (62% and 22%, respectively, versus 73% and 24%). In
patients undergoing SM-PVR, survival rate was significantly higher for
patients undergoing a margin-negative resection (n = 13) than for
patients undergoing a macroscopic or microscopic margin-positive
resection (n = 8, 2-year survival = 57.1% versus 0%, P <0.05).
CONCLUSION: PD combined with SM-PVR can be performed safely. This
surgical procedure is followed by a promising survival rate and can be
recommended in order to obtain a margin-negative resection; however,
candidates for SM-PVR should be carefully selected.
24
UI - 11585973
AU - Twelves C
TI -
Vision of the future: capecitabine.
SO - Oncologist 2001;6 Suppl 4():35-9
AD - Cancer Research Campaign Department of Medical Oncology, University of
Glasgow, and Beatson Oncology Centre, Glasgow, United Kingdom.
c.twelves@beatson.gla.ac.uk
Capecitabine is a thymidine phosphorylase (TP)-activated oral
fluoropyrimidine, rationally designed to generate 5-fluorouracil (5-FU)
preferentially within tumors. This tumor selectivity is achieved through
exploitation of the significantly higher activity of TP in tumor
compared with healthy tissue. The high single-agent activity of
capecitabine in breast and colorectal cancer suggests that capecitabine
may have a role in the treatment of other tumor types that are sensitive
to 5-FU, such as pancreatic cancer. Tumor types known to have a high
level of TP activity, such as renal cancer, are especially attractive
targets for capecitabine therapy. Capecitabine has potential as
monotherapy in these tumor types, or as a combination partner for other
cytotoxic agents with different mechanisms of action and little overlap
of key toxicities. In particular, some cytotoxic drugs, such as the
taxanes and cyclophosphamide, are known to upregulate TP activity in
tumor tissue, offering the potential for synergistic action. The
combination of capecitabine and docetaxel has demonstrated significant
activity in women with anthracycline-pretreated breast cancer, and is
the only cytotoxic combination to significantly increase survival
compared with standard therapy in this setting. In addition,
capecitabine as monotherapy or in combination with other cytotoxic
agents has shown encouraging activity in pancreatic, ovarian, and renal
cell cancers. This article discusses recent data from clinical trials
investigating capecitabine in a range of tumor types, highlighting the
potential future role of capecitabine as an alternative to traditional
i.v. chemotherapy.
25
UI - 11587685
AU - Schwarz M; Pauls S; Sokiranski R; Brambs HJ; Glasbrenner B; Adler G;
TI -
Diederichs CG; Reske SN; Moller P; Beger HG
Is a preoperative multidiagnostic approach to predict surgical
resectability of periampullary tumors still effective?
SO - Am J Surg 2001 Sep;182(3):243-9
AD - Department of General Surgery, University of Ulm, Ulm, Germany.
BACKGROUND: Multimodality staging is recommended in patients with
periampullary tumors to optimize preoperative determination of
resectability. We investigated the potency of currently used diagnostic
procedures in order to determine resectability. METHODS: Ninety-five
consecutive patients with periampullary tumors prehospitally staged
resectable underwent preoperative diagnostic tests: helical-computed
tomography (CT) with maximum intensity projection of arterial vessels
(MIP), magnetic resonance imaging (MRI), magnetic resonance
cholangiopancreaticography (MRCP), endoscopic ultrasonography (EUS),
endoscopic retrograde cholangiopancreaticography (ERCP), digital
subtraction angiography (DSA), and positron emission tomography (PET).
Diagnoses were verified by surgery and histopathology. RESULTS: In 45
patients with benign and 50 patients with malignant periampullary tumors
sensitivity for tumor diagnosis was 89% to 96% in CT, MRI, EUS, and PET.
Small tumors were best diagnosed by EUS (100%). Diagnosis of malignancy
was made with 85% (EUS), 83% (CT), 82% (PET), and 72% (MRI) accuracy.
Arterial vessel infiltration was best predicted by CT/MIP with an
accuracy of 85%. For venous vessel infiltration MRI reached 85%
accuracy. Accuracy rates for local nonresectability were 93% (EUS), 92%
(MRI), and 90% (CT). Two and 4 of 8 patients with distant metastases
were identified by CT and PET, respectively. The correct diagnosis of
malignancy and determination of resectability was made by CT in 71% and
by MRI in 70%. Biliary stenting reduced accuracy of CT diagnosis of
malignancy from 88% to 73%. CONCLUSIONS: CT obtained before stenting was
the single most useful test, providing correct diagnosis in 88% and
resectability in 71% of patients. If no tumor is depicted in CT, EUS
should be added. Uncertain venous vessel infiltration can be verified by
MRI or EUS. Angiography should no longer be a routine diagnostic
procedure. Equivocal tumors or possible metastasis may be further
examined with PET.
26
UI - 11597816
AU - Boz G; De Paoli A; Innocente R; Rossi C; Tosolini G; Pederzoli P;
TI -
Talamini R; Trovo MG
Radiotherapy and continuous infusion 5-fluorouracil in patients with
nonresectable pancreatic carcinoma.
SO - Int J Ra
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