Surgical strategies for locally advanced pancreatic cancer following gemcitabine plus S-1-based chemoradiotherapy.

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2025-07-18 DOI:10.1016/j.suronc.2025.102269

Aoi Hayasaki, Shugo Mizuno, Benson Kaluba, Yuki Segi, Haruna Komatsubara, Tatsuya Sakamoto, Koki Maeda, Toru Shinkai, Takahiro Ito, Kazuyuki Gyoten, Takehiro Fujii, Yusuke Iizawa, Akihiro Tanemura, Yasuhiro Murata, Naohisa Kuriyama, Masashi Kishiwada

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引用次数: 0

Abstract

Background: In this study, we present our institution's treatment outcomes and surgical strategies for patients with localized pancreatic ductal adenocarcinoma (PDAC).

Methods: The study retrospectively reviewed clinical data of 397 patients with localized PDAC who were enrolled in a gemcitabine and S-1 based chemoradiotherapy (GS-CRT) protocol between September 2011 and March 2023. Following GS-CRT, pancreatectomy was performed and concomitant vascular resection with subsequent reconstruction was done, if required, in order to achieve R0 resection margins.

Result: From the 397 patients, 366 (92.2 %) completed the GS-CRT. A total of 359 patients were adequately re-evaluated after GS-CRT and categorized as having resectable (R; n = 77), borderline resectable with superior mesenteric vein/portal vein involvement (BR-PV; n = 40), borderline resectable with arterial involvement (BR-A; n = 94), or unresectable locally advanced (UR-LA; n = 148) tumors, respectively. From these, 202 patients with R (n = 63), BR-PV (n = 31), BR-A (n = 56) and UR-LA (n = 52) PDAC underwent curative-intent pancreatectomy. The R0 resection rates and median survival times for disease-specific survival (DSS) according to resectability were favorable: 98.4 %, 93.5 %, 92.9 %, and 80.8 %, and 62.7, 66.1, 41.8, and 36.2 months, respectively. Prognostic factors for DSS among the 202 resected patients included performance status, pre-operative carbohydrate antigen 19-9 and carcinoembryonic antigen serum levels, pre-operative tumor resectability, pathological T factor and receipt of adjuvant chemotherapy. In the resected UR-LA patients, adjuvant chemotherapy was a significant prognostic factor of survival outcomes.

Conclusions: GS-CRT followed by pancreatectomy is feasible and a beneficial treatment strategy for PDAC. Therefore, a safe and reliable surgical approach that ensures R0 resection margins and enables subsequent adjuvant chemotherapy is essential.

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吉西他滨加s -1基础放化疗后局部晚期胰腺癌的手术策略。

背景：在本研究中，我们介绍了本院对局限性胰腺导管腺癌（PDAC）患者的治疗结果和手术策略。方法：本研究回顾性回顾了2011年9月至2023年3月期间397例局部PDAC患者的临床资料，这些患者均接受吉西他滨和S-1为基础的放化疗（GS-CRT）方案。GS-CRT术后，行胰切除术，如有需要，行血管切除术并重建，以达到R0切除边缘。结果：397例患者中，366例（92.2%）完成了GS-CRT。共有359例患者在GS-CRT后进行了充分的重新评估，并被分类为可切除(R；n = 77)，边缘可切除，累及肠系膜上静脉/门静脉(BR-PV；n = 40)，边缘可切除伴动脉受累(BR-A；n = 94)或无法切除的局部晚期(UR-LA；N = 148)例肿瘤。其中，202例R型（63例）、BR-PV型（31例）、BR-A型（56例）和UR-LA型（52例）PDAC患者接受了治愈性胰腺切除术。根据可切除性，R0切除率和疾病特异性生存（DSS）的中位生存时间是有利的：分别为98.4%,93.5%，92.9%和80.8%,62.7,66.1,41.8和36.2个月。202例DSS患者预后因素包括运动状态、术前碳水化合物抗原19-9、癌胚抗原血清水平、术前肿瘤可切除性、病理T因子、是否接受辅助化疗。在切除的UR-LA患者中，辅助化疗是影响生存结果的重要预后因素。结论：GS-CRT联合胰管切除术是治疗PDAC的一种可行且有益的治疗策略。因此，一个安全可靠的手术方法，确保R0切除边缘，并使后续的辅助化疗是必不可少的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.