levoleucovorin and Pancreatic-Fistula

Several studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head. Data concerning NAT for PDAC located in pancreatic body or tail are lacking.. Post hoc analysis of an international multicenter retrospective cohort of distal pancreatectomy for PDAC in 34 centers from 11 countries (2007-2015). Patients who underwent resection after NAT were matched (1:1 ratio), using propensity scores based on baseline characteristics, to patients who underwent upfront resection. Median overall survival was compared using the stratified log-rank test.. Among 1236 patients, 136 (11.0%) received NAT, most frequently FOLFIRINOX (25.7%). In total, 94 patients receiving NAT were matched to 94 patients undergoing upfront resection. NAT was associated with less postoperative major morbidity (Clavien-Dindo ≥ 3a, 10.6% vs. 23.4%, P = 0.020) and pancreatic fistula grade B/C (9.6% vs. 21.3%, P = 0.026). NAT did not improve overall survival [27 (95% CI 14-39) versus 31 months (95% CI 19-42), P = 0.277], as compared with upfront resection. In a sensitivity analysis of 251 patients with radiographic tumor involvement of splenic vessels, NAT (n = 37, 14.7%) was associated with prolonged overall survival [36 (95% CI 18-53) versus 20 months (95% CI 15-24), P = 0.049], as compared with upfront resection.. In this international multicenter cohort study, NAT for resected PDAC in pancreatic body or tail was associated with less morbidity and pancreatic fistula but similar overall survival in comparison with upfront resection. Prospective studies should confirm a survival benefit of NAT in patients with PDAC and splenic vessel involvement.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Female; Fluorouracil; Humans; Internationality; Irinotecan; Leucovorin; Male; Middle Aged; Neoadjuvant Therapy; Oxaliplatin; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Postoperative Complications; Propensity Score; Retrospective Studies; Survival Analysis

To improve short- and long-term outcomes of locally advanced pancreatic body-tail cancer followed by major vessels invasion.. A case report of pure laparoscopic DP-CAR procedure with portal vein resection for locally advanced pancreatic body-tail cancer followed by severe abdominal pain in a 49-year-old patient is presented.. Liver or stomach ischemia was not observed. Portal wall resection wasn't associated with any complication and resulted R0-resection. Postoperative period was complicated by Grade B pancreatic fistula. Preoperative abdominal pain completely disappeared after surgery. Surgery time was 330 min, intraoperative blood loss - 300 ml. The patient is currently undergoing FOLFIRINOX adjuvant chemotherapy. CT in 90 days after surgery confirmed no progression of disease or liver/stomach blood supply congestion.. Modern technologies provide the opportunity to perform pure laparoscopic advanced surgical procedures with major vessels resection. Pure laparoscopic DP-CAR procedure with portal vein resection is effective and safe procedure that can be performed with all principles of open surgery and is associated with acceptable short- and long-term results.. Улучшить непосредственные и отдаленные результаты хирургического лечения больных местно-распространенным раком тела—хвоста поджелудочной железы с инвазией магистральных сосудов.. Представлен клинический случай полностью лапароскопической DP-CAR с резекций воротной вены больной 49 лет по поводу местно-распространенной протоковой аденокарциномы тела—хвоста поджелудочной железы с выраженным болевым синдромом.. В результате операции ишемии печени и желудка не отмечено. Резекция воротной вены не привела к развитию каких-либо осложнений и позволила добиться R0-резекции. Послеоперационный период осложнился образованием панкреатической фистулы, grade B (ISGPF, 2016). После операции болевой синдром полностью купирован. Время операции составило 330 мин, объем кровопотери — 300 мл. Больная проходит адъювантную химиотерапию по схеме FOLFIRINOX. По данным КТ, через 90 дней после операции данных за прогрессирование заболевания не получено, нарушения кровоснабжения печени и желудка не выявлено.. Развитие современных технологий позволяет проводить технически сложные онкологические операции, в том числе с резекцией магистральных сосудов, лапароскопическим доступом. Полностью лапароскопическая DP-CAR с резекцией воротной вены является эффективной и безопасной процедурой, которую возможно выполнять по принципам открытой хирургии с удовлетворительными непосредственными и отдаленными результатами.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Celiac Artery; Fluorouracil; Humans; Irinotecan; Laparoscopy; Leucovorin; Middle Aged; Neoplasm Invasiveness; Oxaliplatin; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Portal Vein