title: Adjuvant surgical therapy for patients with initially-unresectable pancreatic cancer with long-term favorable responses to chemotherapy.
abstract: BACKGROUND
  To evaluate the prognostic impact of surgical intervention for initially-unresectable pancreatic ductal adenocarcinomas with long-term favorable responses to chemotherapy.
  
  
  METHODS
  Twelve patients with initially-unresectable pancreatic ductal carcinomas who underwent radical surgery after a favorable response to chemotherapy for six months or longer in principle were enrolled in this study. We retrospectively reviewed the charts of these 12 patients and performed a survival analysis.
  
  
  RESULTS
  Initially, the included patients were unable to undergo resection secondary to locally-advanced disease in eight patients and metastatic disease in four patients. The length of preoperative therapy was five to 44 months (median 12). The operative procedure included resection of the area initially involved by tumor and regional major vessels. The postoperative mortality and morbidity rates were 0% for patients with locally-advanced disease and 50% in those with metastatic disease. R0 resection was achieved in nine patients (75%) and pathological CR was seen in one patient. Estimated overall five-year survival from initial therapy was 50.0%. The survival rate (0% at 5 years) of the four patients with metastatic disease as the cause of initial unresectability was significantly worse than that (100% at 5 years) of the eight patients with locally-advanced disease (P = 0.0014).
  
  
  CONCLUSIONS
  Surgical intervention should be considered for patients with initially-unresectable pancreatic cancers who demonstrate long-term favorable responses to chemotherapy. R0 resection may significantly contribute to cure, especially in patients with initially locally-advanced disease. Large cohort prospective studies will be necessary to demonstrate the efficacy of this strategy.
authors: Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Kita 15 nishi 7, Kita-ku, Sapporo 060-8638, Japan. katoken@med.hokudai.ac.jp
authors: Kentaro
authors: K
authors: Kato
authors: Satoshi
authors: S
authors: Kondo
authors: Satoshi
authors: S
authors: Hirano
authors: Eiichi
authors: E
authors: Tanaka
authors: Toshiaki
authors: T
authors: Shichinohe
authors: Takahiro
authors: T
authors: Tsuchikawa
authors: Joe
authors: J
authors: Matsumoto
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents