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. 2012 May;19(5):1663-9.
doi: 10.1245/s10434-011-2156-7. Epub 2011 Dec 1.

Downstaging in pancreatic cancer: a matched analysis of patients resected following systemic treatment of initially locally unresectable disease

K A Bickenbach  1 , M Gonen, Laura H Tang, Eileen O'Reilly, Karyn Goodman, M F Brennan, M I D'Angelica, R P Dematteo, Y Fong, W R Jarnagin, P J Allen
Affiliations

Downstaging in pancreatic cancer: a matched analysis of patients resected following systemic treatment of initially locally unresectable disease

K A Bickenbach et al. Ann Surg Oncol. 2012 May.

Abstract

Background: Patients with locally unresectable pancreatic cancer (AJCC stage III) have a median survival of 10-14 months. The objective of this study was to evaluate outcome of initially unresectable patients who respond to multimodality therapy and undergo resection.

Methods: Using a prospectively collected database, patients were identified who were initially unresectable because of vascular invasion and had sufficient response to nonoperative treatment to undergo resection. Overall survival (OS) was compared with a matched group of patients who were initially resectable. Case matching was performed using a previously validated pancreatic cancer nomogram.

Results: A total of 36 patients with initial stage III disease were identified who underwent resection after treatment with either systemic therapy or chemoradiation. Initial unresectability was determined by operative exploration (n = 15, 42%) or by cross-sectional imaging (n = 21, 58%). Resection consisted of pancreaticoduodenectomy (n = 31, 86%), distal pancreatectomy (n = 4, 11%), and total pancreatectomy (n = 1, 3%). Pathology revealed T3 lesions in 26 patients (73%), node positivity in 6 patients (16%), and a negative margin in 30 patients (83%). The median OS in this series was 25 months from resection and 30 months since treatment initiation. There was no difference in OS from time of resection between the initial stage III patients and those who presented with resectable disease (P = .35).

Conclusions: In this study, patients who were able to undergo resection following treatment of initial stage III pancreatic cancer experienced survival similar to those who were initially resectable. Resection is indicated in this highly select group of patients.

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Figures

FIG. 1
FIG. 1
Overall survival. a Since time of resection. b Overall survival since initiation of treatment
FIG. 2
FIG. 2
Comparison of disease-specific survival between initial stage III (dashed line) patients and case-matched control group (solid line)
See this image and copyright information in PMC

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