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Strategy for the borderline resectable pancreatic cancer using neo-adjuvant chemoradiation therapy
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Abstracts / Pancreatology 13 (2013) S1–S80
group (1 yr; 85.8%, 3 yrs; 56.7%) and ODP group (1 yr; 79.3%, 3 yrs; 44.5%). (P ¼ 0.079) Conclusions: There seems to be increasing evidence that LDP is equivalent to ODP for Pancreatic cancer in terms of oncologic outcome. However, long term oncologic result will be required and further randomized prospective studies should be performed to support the validity of LDP for Pancreatic cancer. Keywords: Pancreatic cancer, Laparoscopic distal pancreatectomy, Opend distal pancreatectomy, RAMPS
[O 21]. Pancreas-preserving total duodenectomy: A preferable alternative to high-risk pancreaticoduodenectomy for premalignant duodenal lesions €rd, Marco Del Chiaro, Lars Lundell, Elena Rangelova Ralf Segersva Dept of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden Background/aim: Pancreaticojejunal anastomosis sutured to a normal pancreas - with small duct and soft texture, reflects an increased risk for development of pancreatic fistula (PF) and overall morbidity, particularly in overweight patients. Performing pancreas-preserving total duodenectomy (PPTD) and avoiding the transection of the gland for pre- or lowgrade malignant duodenal tumors, where pancreas is normal, could be a safer alternative to high-risk pancreaticoduodenectomy (HR-PD). Methods: All patients operated with PPTD and HR-PD between 2006– 2011 at Karolinska University Hospital were retrieved from a prospective registry. The demographics, length of stay (LOS), postoperative morbidity and mortality and hospital costs were analyzed. Results: Twenty patients operated with PPTD and 81 with HR-PD were identified. Patients who underwent PPTD were younger than those with HR-PD (50 vs 62.4 yrs; p¼0.0003). The percentage of obese patients was no different in the two groups (60 vs 45.7%; p¼0.2). No differences were found in overall morbidity and surgery-specific complications. However, PPTD patients had less and less severe post-operative PF (15% vs 37.3%; p¼0.06), fewer severe (Clavien grade3b) complications (20% vs 31%), less ICU stay (5% vs 12.4%), lower reoperation rate (10% vs 21%), lower mortality (0 vs 6.2%), and shorter LOS (16.9 days vs 24.6 days), but the numbers were too small to reach statistical significance. PPTD was performed with shorter operative time (319 min vs 418 min; p<0.0001) and less intra-operative blood loss than HR-PD (521 ml vs 1027 ml; p¼0.003). The hospital costs for performing PPTD were significantly lower than HR-PD (29,170 vs 53,080 Euro, p¼0.03). Conclusions: PPTD for resection of pre- and low-grade malignant duodenal lesions in this small series shows to be an equivalent alternative to HR-PD, as it can be performed with shorter operative time, less intraoperative blood loss, comparable, even slightly better, postoperative outcome and with lower costs. Keywords: Duodenectomy, High-risk pancreaticoduodenectomy, Premalignant lesions
[O 22]. Strategy for the borderline resectable pancreatic cancer using neoadjuvant chemoradiation therapy Takashi Hatori 1, Shuji Suzuki 1, Nana Ooshima 1, Ryuji Suzuki 1, Akira Kimijima 1, Wataru Izumo 1, Toru Furukawa 2, Norio Mitsuhashi 3, Keiko Shiratori 4, Masakazu Yamamoto 1 1 Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan 2 Institute for Integrated Medical Sciences, Tokyo Women’s Medical University, Tokyo, Japan
3
Department of Radiation Oncology, Tokyo Women’s Medical University, Tokyo, Japan 4 Department of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan Background/aim: In case of the borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC), the strategy of the treatment is controversial. The aim of this study is to evaluate the treatment using the neoadjuvant chemoradiation therapy (NACRT) for the BR-PDAC. Methods: A group of 93 patients who were treated for BR-PDAC between 2000 and 2012 was examined retrospectively. In this study, the BRPDAC was defined according to the NCCN clinical practice guidelines 2012 except for the venous involvement of the SMV/portal vein. The patients were divided into 2 groups according to the initial treatment; 63 patients underwent surgical resection at the initial treatment (Surgery group) and 30 patients received chemotherapy with S-1 (80 mg/m2) while concurrent radiation therapy (1.8 Gy/f, total 50.4 Gy/28 fractions) was given to the tumor including regional lymph nodes at the initial treatment (CRT group). Results: In the Surgery group, the rate of R0 resection was 62% and 43 patients (83%) underwent adjuvant chemotherapy. The overall median survival time (MST), 5-year survival rate were 18.6 months, 12.9%. In the CRT group, 6 patients (20%) obtained a partial response (PR), 23 patients (77%) obtained a stable disease (SD) and progression disease (PD) was recognized in one patients (3%). No severe adverse events were observed. 10 patients (33%) underwent laparotomy. Highly selected 7 patients achieved surgical resection with R0 resection and the MST, 3-year survival rate were 33.0 months, 41.7%. However, the remaining 23 patients could not undergo surgical resection due to the distant metastases, and the MST, 3year survival rate were 14.9 months, 23.0%. Conclusions: The NACRT with adjuvant surgery for the BR-PDAC could make an opportunity for a long-term survival. Keywords: Pancreatic cancer, Borderline resectable, Chemoradiation therapy
[O 23]. Prediction of response to adjuvant chemotherapy by response in a patient-derived pancreatic cancer xenograft model Ross Smith, Aiqun Xue, Sohel Julovi, Jaswinder Samra, Anthony Gill, Matthew Wong Cancer Surgery, Kolling Institute, NSW, Australia Background/aim: To establish and evaluate the patient-derived subrenal capsule (SRC) xenografts in non-obese diabetic/severe combined immunodeficient mice (NOD/SCID) mice as a novel pre-clinical model for predicting gemcitabine responses in pancreatic ductal adenocarcinoma (PDAC). Methods: The cancers from twenty patients undergoing resection of PDAC were grafted under each renal capsule in ten NOD/SCID mice. After 4 weeks, the mice were randomly assigned to receive either gemicitabine or saline (control) treatment. After 8 weeks, the tumour grafts were harvested and compared with the original tumour tissues. Gemcitabine responses were determined by; change in mean post-graft area (mm2), histological morphology, immunohistochemical (IHC) scores using several markers and correlation with clinical outcome. Results: Eighty-five precent of xenografts were successfully established. Histopathological and immunostaining features of graft tissue was similar to the Original tumour with >90% concordance. Xenografts from 5 patients who have not had recurrence of their cancer responded to gemcitabine by reduction in tumour volume (P < 0.05) and by the expressions of CK7, CK20 and Ki-67 compared to the control mice. Moreover, the xenografts from two who developed early metastasis were also unresponsive to gemcitabine. Conclusions: The SRC xenografts of patient-derived pancreatic cancer in NOD/SCID mice can retain major histopathological and immunohistochemical characteristics of the original tumour. The high engraftment rate allows the use of such xenografts as a potential tool to assess an individual patient’s response to gemcitabine treatment within 8 weeks after pancreatic tumour resection.
Abstracts / Pancreatology 13 (2013) S1–S80
group (1 yr; 85.8%, 3 yrs; 56.7%) and ODP group (1 yr; 79.3%, 3 yrs; 44.5%). (P ¼ 0.079) Conclusions: There seems to be increasing evidence that LDP is equivalent to ODP for Pancreatic cancer in terms of oncologic outcome. However, long term oncologic result will be required and further randomized prospective studies should be performed to support the validity of LDP for Pancreatic cancer. Keywords: Pancreatic cancer, Laparoscopic distal pancreatectomy, Opend distal pancreatectomy, RAMPS
[O 21]. Pancreas-preserving total duodenectomy: A preferable alternative to high-risk pancreaticoduodenectomy for premalignant duodenal lesions €rd, Marco Del Chiaro, Lars Lundell, Elena Rangelova Ralf Segersva Dept of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden Background/aim: Pancreaticojejunal anastomosis sutured to a normal pancreas - with small duct and soft texture, reflects an increased risk for development of pancreatic fistula (PF) and overall morbidity, particularly in overweight patients. Performing pancreas-preserving total duodenectomy (PPTD) and avoiding the transection of the gland for pre- or lowgrade malignant duodenal tumors, where pancreas is normal, could be a safer alternative to high-risk pancreaticoduodenectomy (HR-PD). Methods: All patients operated with PPTD and HR-PD between 2006– 2011 at Karolinska University Hospital were retrieved from a prospective registry. The demographics, length of stay (LOS), postoperative morbidity and mortality and hospital costs were analyzed. Results: Twenty patients operated with PPTD and 81 with HR-PD were identified. Patients who underwent PPTD were younger than those with HR-PD (50 vs 62.4 yrs; p¼0.0003). The percentage of obese patients was no different in the two groups (60 vs 45.7%; p¼0.2). No differences were found in overall morbidity and surgery-specific complications. However, PPTD patients had less and less severe post-operative PF (15% vs 37.3%; p¼0.06), fewer severe (Clavien grade3b) complications (20% vs 31%), less ICU stay (5% vs 12.4%), lower reoperation rate (10% vs 21%), lower mortality (0 vs 6.2%), and shorter LOS (16.9 days vs 24.6 days), but the numbers were too small to reach statistical significance. PPTD was performed with shorter operative time (319 min vs 418 min; p<0.0001) and less intra-operative blood loss than HR-PD (521 ml vs 1027 ml; p¼0.003). The hospital costs for performing PPTD were significantly lower than HR-PD (29,170 vs 53,080 Euro, p¼0.03). Conclusions: PPTD for resection of pre- and low-grade malignant duodenal lesions in this small series shows to be an equivalent alternative to HR-PD, as it can be performed with shorter operative time, less intraoperative blood loss, comparable, even slightly better, postoperative outcome and with lower costs. Keywords: Duodenectomy, High-risk pancreaticoduodenectomy, Premalignant lesions
[O 22]. Strategy for the borderline resectable pancreatic cancer using neoadjuvant chemoradiation therapy Takashi Hatori 1, Shuji Suzuki 1, Nana Ooshima 1, Ryuji Suzuki 1, Akira Kimijima 1, Wataru Izumo 1, Toru Furukawa 2, Norio Mitsuhashi 3, Keiko Shiratori 4, Masakazu Yamamoto 1 1 Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan 2 Institute for Integrated Medical Sciences, Tokyo Women’s Medical University, Tokyo, Japan
3
Department of Radiation Oncology, Tokyo Women’s Medical University, Tokyo, Japan 4 Department of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan Background/aim: In case of the borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC), the strategy of the treatment is controversial. The aim of this study is to evaluate the treatment using the neoadjuvant chemoradiation therapy (NACRT) for the BR-PDAC. Methods: A group of 93 patients who were treated for BR-PDAC between 2000 and 2012 was examined retrospectively. In this study, the BRPDAC was defined according to the NCCN clinical practice guidelines 2012 except for the venous involvement of the SMV/portal vein. The patients were divided into 2 groups according to the initial treatment; 63 patients underwent surgical resection at the initial treatment (Surgery group) and 30 patients received chemotherapy with S-1 (80 mg/m2) while concurrent radiation therapy (1.8 Gy/f, total 50.4 Gy/28 fractions) was given to the tumor including regional lymph nodes at the initial treatment (CRT group). Results: In the Surgery group, the rate of R0 resection was 62% and 43 patients (83%) underwent adjuvant chemotherapy. The overall median survival time (MST), 5-year survival rate were 18.6 months, 12.9%. In the CRT group, 6 patients (20%) obtained a partial response (PR), 23 patients (77%) obtained a stable disease (SD) and progression disease (PD) was recognized in one patients (3%). No severe adverse events were observed. 10 patients (33%) underwent laparotomy. Highly selected 7 patients achieved surgical resection with R0 resection and the MST, 3-year survival rate were 33.0 months, 41.7%. However, the remaining 23 patients could not undergo surgical resection due to the distant metastases, and the MST, 3year survival rate were 14.9 months, 23.0%. Conclusions: The NACRT with adjuvant surgery for the BR-PDAC could make an opportunity for a long-term survival. Keywords: Pancreatic cancer, Borderline resectable, Chemoradiation therapy
[O 23]. Prediction of response to adjuvant chemotherapy by response in a patient-derived pancreatic cancer xenograft model Ross Smith, Aiqun Xue, Sohel Julovi, Jaswinder Samra, Anthony Gill, Matthew Wong Cancer Surgery, Kolling Institute, NSW, Australia Background/aim: To establish and evaluate the patient-derived subrenal capsule (SRC) xenografts in non-obese diabetic/severe combined immunodeficient mice (NOD/SCID) mice as a novel pre-clinical model for predicting gemcitabine responses in pancreatic ductal adenocarcinoma (PDAC). Methods: The cancers from twenty patients undergoing resection of PDAC were grafted under each renal capsule in ten NOD/SCID mice. After 4 weeks, the mice were randomly assigned to receive either gemicitabine or saline (control) treatment. After 8 weeks, the tumour grafts were harvested and compared with the original tumour tissues. Gemcitabine responses were determined by; change in mean post-graft area (mm2), histological morphology, immunohistochemical (IHC) scores using several markers and correlation with clinical outcome. Results: Eighty-five precent of xenografts were successfully established. Histopathological and immunostaining features of graft tissue was similar to the Original tumour with >90% concordance. Xenografts from 5 patients who have not had recurrence of their cancer responded to gemcitabine by reduction in tumour volume (P < 0.05) and by the expressions of CK7, CK20 and Ki-67 compared to the control mice. Moreover, the xenografts from two who developed early metastasis were also unresponsive to gemcitabine. Conclusions: The SRC xenografts of patient-derived pancreatic cancer in NOD/SCID mice can retain major histopathological and immunohistochemical characteristics of the original tumour. The high engraftment rate allows the use of such xenografts as a potential tool to assess an individual patient’s response to gemcitabine treatment within 8 weeks after pancreatic tumour resection.