National Trends in Centralization of Surgical Care and Multimodality Therapy for Pancreatic Adenocarcinoma

AbstractBackgroundStudies have demonstrated that multimodality therapy and surgery at high volume centers are associated with a longer survival. However, it is unknown if these data have translated into national changes in care delivery.MethodsPatients with stages I –III pancreatic adenocarcinomas who underwent resections between 2004 and 2010 were identified from the National Cancer Data Base. The primary outcome was a 3-year overall survival. Temporal trends in survival outcomes and treatment variables were measured. A mediation analysis using the Lin metho d was used to discern the relative contribution of changes in treatment variables towards improvements in survival over time.ResultsA total of 22,196 patients were identified. Between 2004 and 2010, a 90-day peri-operative mortality remained unchanged (8.5  % to 8.4 %,p = 0.488), 3-year overall survival improved from 26 to 30% (p 
Source: Journal of Gastrointestinal Surgery - Category: Surgery Source Type: research

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AbstractThe application of robotic technology allows for the performance of multi-organ liver resections by multidisciplinary teams in a minimally invasive manner. Their technique and outcomes are not established. Herein we describe our technique with robotic liver surgery combined with colon, pancreas and urologic resections. Our patients are an 84-year-old (yo) female (Body Mass Index, BMI: 25) with a recently diagnosed right colon adenocarcinoma and two synchronous liver metastases at segments 5 and 6, a 75-year-old female (BMI: 50.4) with a history of right renal cell cancer status post (s/p) right robotic radical neph...
Source: Journal of Robotic Surgery - Category: Surgery Source Type: research
Objective: To compare the survival outcomes associated with clinical and pathological response in pancreatic ductal adenocarcinoma (PDAC) patients receiving neoadjuvant chemotherapy (NAC) with FOLFIRINOX (FLX) or gemcitabine/nab-paclitaxel (GNP) followed by curative-intent pancreatectomy. Background: Newer multiagent NAC regimens have resulted in improved clinical and pathological responses in PDAC; however, the effects of these responses on survival outcomes remain unknown. Methods: Clinicopathological and survival data of PDAC patients treated at 7 academic medical centers were analyzed. Primary outcomes were ove...
Source: Annals of Surgery - Category: Surgery Tags: PAPERS OF THE 139TH ASA ANNUAL MEETING Source Type: research
The American Society of Clinical Oncology guidelines recommend adjuvant chemoradiation for margin ‐positive (R1) and/or node‐positive (N+) pancreatic cancers. However, it is unclear if addition of adjuvant radiation to chemotherapy improves overall survival in this high‐risk cohort. In this propensity‐matched analysis of high‐risk pancreatic cancer patients (R1 or N+) from a large clin ical oncology database, we evaluate the benefit of adding adjuvant radiation to chemotherapy. We found evidence of superiority of adjuvant chemoradiation over adjuvant radiation alone in N+ patients but not in R1N0 patients. Abstra...
Source: Cancer Medicine - Category: Cancer & Oncology Authors: Tags: ORIGINAL RESEARCH Source Type: research
Although pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy, incremental progress has been realized over the past decade with new chemotherapeutic regimens, advanced surgical techniques, and an improved understanding of genetics. Although most patients are not candidates for surgical resection because of metastatic disease, many centers are focused on offering curative treatment for patients with borderline resectable (BR) or locally advanced (LA) tumors. These patients are treated with chemotherapy and radiation up front followed by surgical resection, and surgery often includes the resection and reconstr...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
CONCLUSIONS: Current evidence suggests that neoadjuvant chemotherapy has a beneficial effect on overall survival in resectable pancreatic ductal adenocarcinoma in comparison with upfront surgery and adjuvant therapy. Further trials are needed to address the need for practice change. PMID: 31304767 [PubMed - as supplied by publisher]
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
Abstract Background: Neoadjuvant therapy is a strategy for resectable and borderline resectable pancreatic cancer, but a consensus approach regarding optimal management is undetermined. Neoadjuvant options include chemotherapy with/without radiotherapy. Stereotactic body radiation therapy (SBRT) is a novel radiation technique that may provide benefit over conventionally fractionated radiation therapy (CFRT) in the neoadjuvant setting. The purpose of the present study is to determine neoadjuvant treatment with SBRT to other neoadjuvant treatment options for patients with resectable pancreatic cancer. Material and m...
Source: Acta Oncologica - Category: Cancer & Oncology Authors: Tags: Acta Oncol Source Type: research
The objective of this study was to evaluate the role of lymph node (LN) dissection and staging in outcomes of patients with pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy (NAC). Methods National Cancer Database was queried for patients with stages I to III PDAC diagnosed between 2004 and 2014. Overall survival (OS) was derived from Kaplan-Meier methods, and Cox-regression model was used to evaluate associations between the number of LN examined, number of positive nodes, and LN ratio with OS. Results A total 35,599 patients were included, 3395 (9%) underwent NAC, 19,865 (56%) received adjuvan...
Source: Pancreas - Category: Gastroenterology Tags: Original Articles Source Type: research
Pancreatic adenocarcinoma is the third leading cause of cancer related death. Data suggests that neoadjuvant chemotherapy prior to resection improves survival. In patients with jaundice, this requires preoperative ERCP with biliary stenting. Some patients with biliary stents develop cholangitis, requiring additional intervention. The impact of preoperative cholangitis on outcomes of patients with pancreatic cancer who undergo surgery is unknown. Here, we evaluated the impact of preoperative cholangitis on post operative outcomes and disease recurrence.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Saturday abstract Source Type: research
This study aims to perform analytical and clinical validation of a KRAS ctDNA assay in a Clinical Laboratory Improvement Amendments (CLIA) and College of American Pathology (CAP) certified clinical laboratory. EXPERIMENTAL DESIGN: Digital-droplet PCR (ddPCR) was used to detect the major PDAC-associated somatic KRAS mutations (G12D, G12V, G12R and Q61H) in liquid biopsies. For clinical validation, 290 pre-operative and longitudinal post-operative plasma samples were collected from 59 PDAC patients. The utility of ctDNA status to predict PDAC recurrence during follow-up was assessed. RESULTS: ctDNA was detected pre...
Source: Clinical Cancer Research - Category: Cancer & Oncology Authors: Tags: Clin Cancer Res Source Type: research
Conclusions: We found a highly reliable FI network, which revealed LIFR, PIK3R1, and MMP12 as novel prognostic biomarker candidates for GBC. These findings could accelerate biomarker discovery and therapeutic development in this cancer. Introduction Gallbladder cancer (GBC), the sixth most common gastrointestinal cancer, is an uncommon but challenging disease. Its incidence has recently increased highly worldwide (1). The risk factors for GBC include sex, aging, obesity, chronic cholecystitis, and cholelithiasis (2, 3). Because of the lack of an effective early diagnostic method, the disease often is not diagnosed ...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
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