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. 2021 Apr;12(Suppl 1):S110-S117.
doi: 10.21037/jgo-20-243.

Conversion surgery in patients with pancreatic cancer and peritoneal metastasis

Suguru Yamada  1 , Tsutomu Fujii  2 , Tomohisa Yamamoto  3 , Hideki Takami  1 , Isaku Yoshioka  2 , So Yamaki  3 , Fuminori Sonohara  1 , Kazuto Shibuya  2 , Fuyuhiko Motoi  4 , Satoshi Hirano  5 , Yoshiak Murakami  6 , Hitoshi Inoue  7 , Masamichi Hayashi  1 , Daisuke Hashimoto  3 , Kenta Murotani  8 , Joji Kitayama  9 , Hideki Ishikawa  10 , Yasuhiro Kodera  1 , Mitsugu Sekimoto  3 , Sohei Satoi  3
Affiliations

Conversion surgery in patients with pancreatic cancer and peritoneal metastasis

Suguru Yamada et al. J Gastrointest Oncol. 2021 Apr.

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal malignancies globally. We have previously explored the clinical efficacy of intraperitoneal (IP) paclitaxel therapy for patients with PDAC and peritoneal metastasis, which demonstrated favourable response and disease control rates. However, the real implications of conversion surgery after IP therapy remain unclear.

Methods: We conducted two multicenter clinical trials of IP therapy with paclitaxel in patients with PDAC and peritoneal metastasis. We focused on patients who underwent conversion surgery and investigated the long-term outcomes, particularly, initial recurrence patterns and long-term survival.

Results: Seventy-nine patients with PDAC and peritoneal metastasis were treated, and 33 (41.8%) patients received SP (intravenous IP paclitaxel with S-1) and 46 (58.3%) were administered GAP (intravenous gemcitabine + nab-paclitaxel combined with IP paclitaxel) combination therapy. Of the 79 patients, 16 (20.3%) underwent conversion surgery. The median time to surgery was 9.0 (range, 4.1-13.0) months after the initiation of chemotherapy. Finally, 13 (81.3%) patients underwent R0 resection. Evans grade was IIA in nine patients, IIB in four patients, III in two patients, and IV in one patient. The median overall survival time in patients who underwent conversion surgery was 32.5 (range, 13.5-66.9) months. Twelve (75.0%) patients were found to have experienced recurrence after conversion surgery. Especially, peritoneal recurrence was observed in 50% of patients as the initial recurrence pattern. The median recurrence-free survival time was 9.2 (range, 5.1-32.8) months, and three patients have survived without recurrence to date.

Conclusions: Our IP therapy displays promising clinical efficacy with acceptable tolerability in patients with PDAC and peritoneal metastasis. Although we could observe some super-responders in the cohort, further improvements in IP therapy are warranted.

Keywords: Conversion surgery; intraperitoneal therapy (IP therapy); pancreatic cancer; peritoneal metastasis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-20-243). The focused issue was sponsored by the Peritoneal Surface Oncology Group International (PSOGI). The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Intra-abdominal findings on diagnostic laparoscopy. (A) Multiple peritoneal deposits were observed in the right subphrenic space before treatment introduction. (B) Withdrawal of peritoneal deposits was confirmed at second diagnostic laparoscopy, and pathological examination showed no evidence of malignancy. (C) Intra-abdominal findings at the time of conversion surgery.
Figure 2
Figure 2
Computed tomography findings during treatment. (A) The tumour located in pancreatic tail was observed before treatment introduction. (B) The peritoneal deposits were also found in peritoneal cavity. (C) The tumour shrinkage following treatment was confirmed. (D) The disappearance of peritoneal deposits was observed.
Figure 3
Figure 3
Positron emission tomography findings during treatment. (A) Standardized uptake value on the pancreatic tail was observed before treatment introduction. (B) There was no uptake in the area.
See this image and copyright information in PMC

Comment in

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