Cargando…
Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging?
Indications and outcomes of extended pancreatectomies have been recently appraised by the International Study Group for Pancreatic Surgery. However, no definitive conclusions have been drawn, particularly in the setting of neoadjuvant treatments. We present here a case of 53-year-old man diagnosed w...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Association of Hepato-Biliary-Pancreatic Surgery
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061049/ https://www.ncbi.nlm.nih.gov/pubmed/32181436 http://dx.doi.org/10.14701/ahbps.2020.24.1.90 |
_version_ | 1783504338948194304 |
---|---|
author | Giuliani, Tommaso López Rubio, Maria Montalvá Oron, Eva Maupoey Ibañez, Javier Boscá Robledo, Andrea López Valdivia, Cecilia Pérez Rojas, Judith Lopez Andujar, Rafael |
author_facet | Giuliani, Tommaso López Rubio, Maria Montalvá Oron, Eva Maupoey Ibañez, Javier Boscá Robledo, Andrea López Valdivia, Cecilia Pérez Rojas, Judith Lopez Andujar, Rafael |
author_sort | Giuliani, Tommaso |
collection | PubMed |
description | Indications and outcomes of extended pancreatectomies have been recently appraised by the International Study Group for Pancreatic Surgery. However, no definitive conclusions have been drawn, particularly in the setting of neoadjuvant treatments. We present here a case of 53-year-old man diagnosed with a bulky adenocarcinoma of the tail of the pancreas and infiltrating the adjacent organs and the thoracic wall. The patient was sent to neoadjuvant chemotherapy and he underwent 12 cycles of FOLFIRINOX. Since a significant radiological response was observed after chemotherapy, the patient was scheduled for extended distal pancreatectomy with en bloc resection of the thoracic wall, in order to achieve a radical resection. The surgery is herein described with all technical details. The patient was discharged after an uneventful early post-operative course and subsequently readmitted for a late grade B post-operative pancreatic fistula, which was ultimately treated successfully. Pathology showed complete response. When performed in centers with ample experience in pancreatic surgery, extended pancreatic resections represent a viable curative option with acceptable surgical outcomes. In this setting, challenging tailored resections should be considered to achieve negative margins, particularly following maximized effective downstaging strategies. |
format | Online Article Text |
id | pubmed-7061049 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Korean Association of Hepato-Biliary-Pancreatic Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-70610492020-03-16 Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging? Giuliani, Tommaso López Rubio, Maria Montalvá Oron, Eva Maupoey Ibañez, Javier Boscá Robledo, Andrea López Valdivia, Cecilia Pérez Rojas, Judith Lopez Andujar, Rafael Ann Hepatobiliary Pancreat Surg Case Report Indications and outcomes of extended pancreatectomies have been recently appraised by the International Study Group for Pancreatic Surgery. However, no definitive conclusions have been drawn, particularly in the setting of neoadjuvant treatments. We present here a case of 53-year-old man diagnosed with a bulky adenocarcinoma of the tail of the pancreas and infiltrating the adjacent organs and the thoracic wall. The patient was sent to neoadjuvant chemotherapy and he underwent 12 cycles of FOLFIRINOX. Since a significant radiological response was observed after chemotherapy, the patient was scheduled for extended distal pancreatectomy with en bloc resection of the thoracic wall, in order to achieve a radical resection. The surgery is herein described with all technical details. The patient was discharged after an uneventful early post-operative course and subsequently readmitted for a late grade B post-operative pancreatic fistula, which was ultimately treated successfully. Pathology showed complete response. When performed in centers with ample experience in pancreatic surgery, extended pancreatic resections represent a viable curative option with acceptable surgical outcomes. In this setting, challenging tailored resections should be considered to achieve negative margins, particularly following maximized effective downstaging strategies. Korean Association of Hepato-Biliary-Pancreatic Surgery 2020-02 2020-02-27 /pmc/articles/PMC7061049/ /pubmed/32181436 http://dx.doi.org/10.14701/ahbps.2020.24.1.90 Text en Copyright © 2020 by The Korean Association of Hepato-Biliary-Pancreatic Surgery http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Giuliani, Tommaso López Rubio, Maria Montalvá Oron, Eva Maupoey Ibañez, Javier Boscá Robledo, Andrea López Valdivia, Cecilia Pérez Rojas, Judith Lopez Andujar, Rafael Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging? |
title | Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging? |
title_full | Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging? |
title_fullStr | Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging? |
title_full_unstemmed | Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging? |
title_short | Extended distal pancreatectomy with thoracic wall resection after neoadjuvant FOLFIRINOX: Is there a limit of resection for pancreatic cancer after downstaging? |
title_sort | extended distal pancreatectomy with thoracic wall resection after neoadjuvant folfirinox: is there a limit of resection for pancreatic cancer after downstaging? |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061049/ https://www.ncbi.nlm.nih.gov/pubmed/32181436 http://dx.doi.org/10.14701/ahbps.2020.24.1.90 |
work_keys_str_mv | AT giulianitommaso extendeddistalpancreatectomywiththoracicwallresectionafterneoadjuvantfolfirinoxistherealimitofresectionforpancreaticcancerafterdownstaging AT lopezrubiomaria extendeddistalpancreatectomywiththoracicwallresectionafterneoadjuvantfolfirinoxistherealimitofresectionforpancreaticcancerafterdownstaging AT montalvaoroneva extendeddistalpancreatectomywiththoracicwallresectionafterneoadjuvantfolfirinoxistherealimitofresectionforpancreaticcancerafterdownstaging AT maupoeyibanezjavier extendeddistalpancreatectomywiththoracicwallresectionafterneoadjuvantfolfirinoxistherealimitofresectionforpancreaticcancerafterdownstaging AT boscarobledoandrea extendeddistalpancreatectomywiththoracicwallresectionafterneoadjuvantfolfirinoxistherealimitofresectionforpancreaticcancerafterdownstaging AT lopezvaldiviacecilia extendeddistalpancreatectomywiththoracicwallresectionafterneoadjuvantfolfirinoxistherealimitofresectionforpancreaticcancerafterdownstaging AT perezrojasjudith extendeddistalpancreatectomywiththoracicwallresectionafterneoadjuvantfolfirinoxistherealimitofresectionforpancreaticcancerafterdownstaging AT lopezandujarrafael extendeddistalpancreatectomywiththoracicwallresectionafterneoadjuvantfolfirinoxistherealimitofresectionforpancreaticcancerafterdownstaging |