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22.04.2017 | Original Article

Predictive risk factors for peritoneal recurrence after pancreatic cancer resection and strategies for its prevention

verfasst von: Kyohei Ariake, Fuyuhiko Motoi, Hideo Ohtsuka, Koji Fukase, Kunihiro Masuda, Masamichi Mizuma, Hiroki Hayashi, Kei Nakagawa, Takanori Morikawa, Shimpei Maeda, Tatsuyuki Takadate, Takeshi Naitoh, Shinichi Egawa, Michiaki Unno

Erschienen in: Surgery Today | Ausgabe 12/2017

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Abstract

Purpose

To evaluate the risk factors for peritoneal recurrence (PR) of pancreatic adenocarcinoma and to discuss the appropriate management strategies.

Methods

We reviewed the medical records of 236 patients who underwent pancreatectomy for pancreatic adenocarcinoma. We then compared the clinicopathological characteristics of patients with vs. those without PR. The independent risk factors for PR were defined using the Cox proportional hazards regression model.

Results

The median survival of patients with PR was 13.3 months after surgical treatment. The PR group had a significantly higher incidence of portal vein resection, longer operative time (≥648 min), greater blood loss (≥2179 mL), blood transfusion, tumor size, portal vein invasion, artery invasion, pancreatic nerve plexus invasion, and histological grade. Multivariate analysis revealed that excessive blood loss (≥2179 mL; P = 0.010), artery invasion (P = 0.025), pancreatic nerve plexus invasion (P = 0.001), and histological grade 3 (P = 0.011) were independent risk factors for PR. Excessive blood loss was also strongly related to tumor size (P = 0.018).

Conclusions

Local invasion and tumor size-related factors suggested the possibility of intraoperative dissemination at the time of tumor resection. Preoperative treatment and an operative procedure to prevent tumor exposure may help prevent PR.

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Poruk KE, Firpo MA, Adler DG, Mulvihill SJ. Screening for pancreatic cancer: why, how, and who? Ann Surg. 2013;257(1):17–26.CrossRefPubMedPubMedCentral

Fukuda Y, Yamada D, Eguchi H, Iwagami Y, Noda T, Asaoka T, et al. A novel preoperative predictor of pancreatic fistula by using computed tomography after distal pancreatectomy with staple closure. Surg Today. 2017. doi:10.1007/s00595-017-1495-9.PubMed

Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668–85.CrossRefPubMed

Massucco P, Capussotti L, Magnino A, Sperti E, Gatti M, Muratore A, et al. Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: analysis of perioperative outcome and survival. Ann Surg Oncol. 2006;13(9):1201–8.CrossRefPubMed

Hackert T, Sachsenmaier M, Hinz U, Schneider L, Michalski CW, Springfeld C, et al. Locally advanced pancreatic cancer: neoadjuvant therapy with FOLFIRINOX results in resectability in 60% of the patients. Ann Surg. 2016;264(3):457–63.CrossRefPubMed

Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350(12):1200–10.CrossRefPubMed

Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007;246(5):734–40.CrossRefPubMed

Hishinuma S, Ogata Y, Tomikawa M, Ozawa I, Hirabayashi K, Igarashi S. Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings. J Gastrointest Surg. 2006;10(4):511–8.CrossRefPubMed

Shibata K, Matsumoto T, Yada K, Sasaki A, Ohta M, Kitano S. Factors predicting recurrence after resection of pancreatic ductal carcinoma. Pancreas. 2005;31(1):69–73.CrossRefPubMed

10.

Takahashi H, Ohigashi H, Ishikawa O, Gotoh K, Yamada T, Nagata S, et al. Perineural invasion and lymph node involvement as indicators of surgical outcome and pattern of recurrence in the setting of preoperative gemcitabine-based chemoradiation therapy for resectable pancreatic cancer. Ann Surg. 2012;255(1):95–102.CrossRefPubMed

11.

Papavasiliou P, Hoffman JP, Cohen SJ, Meyer JE, Watson JC, Chun YS. Impact of preoperative therapy on patterns of recurrence in pancreatic cancer. HPB (Oxford). 2014;16(1):34–9.CrossRef

12.

Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817–25.CrossRefPubMed

13.

Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369(18):1691–703.CrossRef

14.

Ishikawa O, Wada H, Ohigashi H, Doki Y, Yokoyama S, Noura S, et al. Postoperative cytology for drained fluid from the pancreatic bed after “curative” resection of pancreatic cancers: does it predict both the patient’s prognosis and the site of cancer recurrence? Ann Surg. 2003;238(1):103–10.PubMedPubMedCentral

15.

Hirota M, Shimada S, Yamamoto K, Tanaka E, Sugita H, Egami H, et al. Pancreatectomy using the no-touch isolation technique followed by extensive intraoperative peritoneal lavage to prevent cancer cell dissemination: a pilot study. JOP. 2005;6(2):143–51.PubMed

16.

Rochefort MM, Ankeny JS, Kadera BE, Donald GW, Isacoff W, Wainberg ZA, et al. Impact of tumor grade on pancreatic cancer prognosis: validation of a novel TNMG staging system. Ann Surg Oncol. 2013;20(13):4322–9.CrossRefPubMed

17.

Wasif N, Ko CY, Farrell J, Wainberg Z, Hines OJ, Reber H, et al. Impact of tumor grade on prognosis in pancreatic cancer: should we include grade in AJCC staging? Ann Surg Oncol. 2010;17(9):2312–20.CrossRefPubMedPubMedCentral

18.

Tomihara T, Eguchi H, Yamada D, Gotoh K, Kawamoto K, Wada H, et al. Preoperative chemoradiotherapy does not compromise the feasibility of adjuvant chemotherapy for patients with pancreatic ductal adenocarcinoma. Surg Today. 2017;47(2):218–26.CrossRefPubMed

19.

Nagai S, Fujii T, Kodera Y, Kanda M, Sahin TT, Kanzaki A, et al. Impact of operative blood loss on survival in invasive ductal adenocarcinoma of the pancreas. Pancreas. 2011;40(1):3–9.CrossRefPubMed

20.

Benson D, Barnett CC Jr. Perioperative blood transfusions promote pancreas cancer progression. J Surg Res. 2011;166(2):275–9.CrossRefPubMed

21.

Arita T, Ichikawa D, Konishi H, Komatsu S, Shiozaki A, Hiramoto H, et al. Increase in peritoneal recurrence induced by intraoperative hemorrhage in gastrectomy. Ann Surg Oncol. 2015;22(3):758–64.CrossRefPubMed

22.

Kamei T, Kitayama J, Yamashita H, Nagawa H. Intraoperative blood loss is a critical risk factor for peritoneal recurrence after curative resection of advanced gastric cancer. World J Surg. 2009;33(6):1240–6.CrossRefPubMed

23.

Ueno H, Ikeda M, Ueno M, Mizuno N, Ioka T, Omuro Y, et al. Phase I/II study of nab-paclitaxel plus gemcitabine for chemotherapy-naive Japanese patients with metastatic pancreatic cancer. Cancer Chemother Pharmacol. 2016;77(3):595–603.CrossRefPubMed

24.

Okusaka T, Ikeda M, Fukutomi A, Ioka T, Furuse J, Ohkawa S, et al. Phase II study of FOLFIRINOX for chemotherapy-naive Japanese patients with metastatic pancreatic cancer. Cancer Sci. 2014;105(10):1321–6.CrossRefPubMedPubMedCentral

25.

Nitsche U, Wenzel P, Siveke JT, Braren R, Holzapfel K, Schlitter AM, et al. Resectability after first-line FOLFIRINOX in initially unresectable locally advanced pancreatic cancer: a single-center experience. Ann Surg Oncol. 2015;22(Suppl 3):S1212–20.CrossRefPubMed

26.

Hirota M, Kanemitsu K, Takamori H, Chikamoto A, Tanaka H, Sugita H, et al. Pancreatoduodenectomy using a no-touch isolation technique. Am J Surg. 2010;199(5):e65–8.CrossRefPubMed

27.

Yamamoto K, Shimada S, Hirota M, Yagi Y, Matsuda M, Baba H. EIPL (extensive intraoperative peritoneal lavage) therapy significantly reduces peritoneal recurrence after pancreatectomy in patients with pancreatic cancer. Int J Oncol. 2005;27(5):1321–8.PubMed

28.

Kuramoto M, Shimada S, Ikeshima S, Matsuo A, Yagi Y, Matsuda M, et al. Extensive intraoperative peritoneal lavage as a standard prophylactic strategy for peritoneal recurrence in patients with gastric carcinoma. Ann Surg. 2009;250(2):242–6.CrossRefPubMed

Titel: Predictive risk factors for peritoneal recurrence after pancreatic cancer resection and strategies for its prevention
verfasst von: Kyohei Ariake
Fuyuhiko Motoi
Hideo Ohtsuka
Koji Fukase
Kunihiro Masuda
Masamichi Mizuma
Hiroki Hayashi
Kei Nakagawa
Takanori Morikawa
Shimpei Maeda
Tatsuyuki Takadate
Takeshi Naitoh
Shinichi Egawa
Michiaki Unno
Publikationsdatum: 22.04.2017
Verlag: Springer Japan
Erschienen in: Surgery Today / Ausgabe 12/2017
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-017-1531-9

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Predictive risk factors for peritoneal recurrence after pancreatic cancer resection and strategies for its prevention