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Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

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Conversion Surgery for Advanced Pancreatic Cancer.

Thomas Hank¹, Oliver Strobel¹

¹Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.

Journal of Clinical Medicine

|November 14, 2019

Summary

Neoadjuvant therapy (NAT) followed by conversion surgery is a growing strategy for locally advanced pancreatic cancer (LAPC). FOLFIRINOX shows promise, but outcomes vary, necessitating standardized prospective studies.

Keywords:

FOLFIRINOX conversion surgery locally advanced pancreatic cancer neoadjuvant therapy pancreatic cancer

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Area of Science:

Oncology
Surgical Oncology
Gastroenterology

Background:

Locally advanced pancreatic cancer (LAPC) was historically treated with palliative therapy.
The advent of effective chemotherapy regimens has led to increased use of neoadjuvant therapy (NAT) and conversion surgery for pancreatic ductal adenocarcinoma.
Evidence from prospective studies remains limited, with most data derived from retrospective analyses.

Purpose of the Study:

To review current neoadjuvant therapy (NAT) regimens for LAPC.
To analyze conversion rates, survival outcomes, and factors influencing post-resection results after NAT.
To discuss surgical strategies for conversion surgery in the context of LAPC.

Main Methods:

Review of recent large retrospective studies on NAT and conversion surgery for LAPC.
Analysis of different NAT regimens, focusing on FOLFIRINOX.
Evaluation of reported conversion rates, survival data, and surgical approaches.

Main Results:

FOLFIRINOX is the most common NAT regimen, associated with high conversion rates.
Reported conversion rates vary widely (less than 5% to over 50%) due to heterogeneity in study design and criteria.
Long-term outcomes are heterogeneous, influenced by varying resectability criteria and treatment strategies.

Conclusions:

Radiological criteria for resectability become less definitive after NAT; surgical exploration is recommended for patients without progressive disease.
Conversion surgery for LAPC after NAT requires a focus on radical resection around peripancreatic vessels and should be performed in expert centers.
Future research must be prospective, include intention-to-treat analyses, and establish stringent criteria for inclusion and resection to clarify outcomes.