Detailed Abstract
[BP Oral Presentation 1 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP OP 1-S4] Unresectable Pancreatic Cancer Is Not Always “Unresectable” in the Era of Multidisciplinary Treatment: Proposal of ABCD Criteria
Atsushi OBA 1, Koiro OMIYA 1, Aya MAEKAWA 1, Yosuke INOUE 1, Kosuke KOBAYASHI 1, Yoshihiro ONO 1, Takafumi SATO 1, Hiromichi ITO 1, Yu TAKAHASHI 1
1 Division of Hepatobiliary And Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, JAPAN
Background : Despite recent advancements in multi-agent chemotherapy for metastatic PC, the indications for metastasectomy are still controversial. This study aims to evaluate the outcomes of metastasectomy for pancreatic cancer (PC) and proposes new ABCD criteria.
Methods : We evaluated consecutive patients with PC who underwent metastasectomy for synchronous or metachronous metastasis between 2014 and 2021. The general surgical indications were: (1: Anatomy) tumor shrinkage, (2: Biology) CA19-9 normal/normalization, (3: Condition) modified Glasgow prognostic score = 0, and (4: Duration) a sufficient treatment period ≥ 6–8 months. Contrast-enhanced computed tomography (CE-CT) and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) were performed to monitor the metastatic liver lesions.
Results : Thirty-five (3.3%) of the 1052 patients with synchronous metastases and 20 (5.7%) of the 351 patients who presented with metachronous metastases after initial pancreatectomy underwent metastasectomy. The median overall survival from initiating treatment for metastatic disease was 52.6 months, with no significant difference observed between synchronous and metachronous cases, liver metastases and others, or oligometastases and non-oligometastases. Among the disappearing liver lesions on CE-CT detected on EOB-MRI, 76.9% (10/13) contained pathological residual tumors. Among the disappearing lesions on both CE-CT and EOB-MRI, 33% (10/30) had pathological/clinical residual tumors. The accuracy of EOB-MRI was 0.746, which was higher than that of CE-CT (0.627).
Conclusions : The metastasectomy criteria based on ABCD resectability status and systematic evaluation of the lesions resulted in promising outcomes in metastatic PC. EOB-MRI played a valuable role in providing additional information after a favorable response to chemotherapy.
Methods : We evaluated consecutive patients with PC who underwent metastasectomy for synchronous or metachronous metastasis between 2014 and 2021. The general surgical indications were: (1: Anatomy) tumor shrinkage, (2: Biology) CA19-9 normal/normalization, (3: Condition) modified Glasgow prognostic score = 0, and (4: Duration) a sufficient treatment period ≥ 6–8 months. Contrast-enhanced computed tomography (CE-CT) and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) were performed to monitor the metastatic liver lesions.
Results : Thirty-five (3.3%) of the 1052 patients with synchronous metastases and 20 (5.7%) of the 351 patients who presented with metachronous metastases after initial pancreatectomy underwent metastasectomy. The median overall survival from initiating treatment for metastatic disease was 52.6 months, with no significant difference observed between synchronous and metachronous cases, liver metastases and others, or oligometastases and non-oligometastases. Among the disappearing liver lesions on CE-CT detected on EOB-MRI, 76.9% (10/13) contained pathological residual tumors. Among the disappearing lesions on both CE-CT and EOB-MRI, 33% (10/30) had pathological/clinical residual tumors. The accuracy of EOB-MRI was 0.746, which was higher than that of CE-CT (0.627).
Conclusions : The metastasectomy criteria based on ABCD resectability status and systematic evaluation of the lesions resulted in promising outcomes in metastatic PC. EOB-MRI played a valuable role in providing additional information after a favorable response to chemotherapy.
SESSION
BP Oral Presentation 1
Room B 3/21/2024 3:30 PM - 4:30 PM