{"title":"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。","authors":"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","doi":"10.1016/j.suronc.2025.102269","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In this study, we present our institution's treatment outcomes and surgical strategies for patients with localized pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Methods: </strong>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.</p><p><strong>Result: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":" ","pages":"102269"},"PeriodicalIF":2.4000,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Surgical strategies for locally advanced pancreatic cancer following gemcitabine plus S-1-based chemoradiotherapy.\",\"authors\":\"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\",\"doi\":\"10.1016/j.suronc.2025.102269\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In this study, we present our institution's treatment outcomes and surgical strategies for patients with localized pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Methods: </strong>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.</p><p><strong>Result: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":51185,\"journal\":{\"name\":\"Surgical Oncology-Oxford\",\"volume\":\" \",\"pages\":\"102269\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgical Oncology-Oxford\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.suronc.2025.102269\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Oncology-Oxford","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.suronc.2025.102269","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Surgical strategies for locally advanced pancreatic cancer following gemcitabine plus S-1-based chemoradiotherapy.
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.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
