title: Clinical Significance of Adjuvant Surgical Resection for Initially Unresectable Pancreatic Cancer Responsive to Arterial Infusion Chemotherapy.
abstract: OBJECTIVE
  We have reported a clinically meaningful local-control effect and a hepatic metastatic tumor-regression effect of transcatheter peripancreatic arterial embolization-hepatic and splenic arterial infusion chemotherapy (TPPAE-HSAIC) for unresectable advanced pancreatic cancer. The aim of this study was to evaluate the clinical significance, of adjuvant surgical resection after TPPAE-HSAIC.
  
  
  METHODS
  We assessed histopathological findings and outcomes of 6 patients who underwent surgical resection of tumors judged to be radically resectable after attaining tumor down-staging or long-term tumor control following TPPAE-HSAIC for pancreatic cancer initially diagnosed as unresectable.
  
  
  RESULTS
  Clinical stage at the initial diagnosis was T4N0M0 Stage III in 4 patients and T4N0M1 Stage IV in 2 patients. The durations of TPPAE-HSAIC ranged from 5 to 46 months with a median of 19 months. An R0 resection was performed in 5 of the 6 patients (83%) and pathological down-staging, from the viewpoint of clinical stage, was observed in 4 patients. Of the 5 patients with R0 resection, one died from a postoperative complication at 7 months and another from pulmonary metastasis at 30 months post-operatively, while the other 3 patients have survived for 45 to 83 months to date.
  
  
  CONCLUSIONS
  If surgical resection of pancreatic cancer initially diagnosed as unresectable can be carried out in patients responding favorably to TPPAE-HSAIC, the likelihood of long-term survival might be increased.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Doi
authors.forename: Hisato
authors.initials: H
authors.lastname: Homma
authors.forename: Takehide
authors.initials: T
authors.lastname: Akiyama
authors.forename: Shinichi
authors.initials: S
authors.lastname: Mezawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Takahashi
authors.forename: Motoo
authors.initials: M
authors.lastname: Ohi
authors.forename: Shingo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Morii
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Kogawa
authors.forename: Motoya
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Kenichirou
authors.initials: K
authors.lastname: Hirata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine