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Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy

BACKGROUND: Ductal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies. To date, no guidelines exists for isolated resectable metachronous disease. It is still unknown, which patients may benefit from relapse surgery. The aim of our study was to compare disease free sur...

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Autores principales: Safi, S. A., Lehwald-Tywuschik, N., Rehders, A., Fluegen, G., Haeberle, L., Keitel, V., Knoefel, W. T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931536/
https://www.ncbi.nlm.nih.gov/pubmed/33658016
http://dx.doi.org/10.1186/s12893-021-01082-w
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author Safi, S. A.
Lehwald-Tywuschik, N.
Rehders, A.
Fluegen, G.
Haeberle, L.
Keitel, V.
Knoefel, W. T.
author_facet Safi, S. A.
Lehwald-Tywuschik, N.
Rehders, A.
Fluegen, G.
Haeberle, L.
Keitel, V.
Knoefel, W. T.
author_sort Safi, S. A.
collection PubMed
description BACKGROUND: Ductal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies. To date, no guidelines exists for isolated resectable metachronous disease. It is still unknown, which patients may benefit from relapse surgery. The aim of our study was to compare disease free survival (DFS) and post relapse survival (PRS) in patients with isolated local recurrence, metachronous hepatic or pulmonary metastases. METHODS: Patients with isolated resectable local recurrence, metachronous hepatic or pulmonary metastases were included for survival analyses. PRS of surgically treated patients (local (n = 11), hepatic (n = 6) and pulmonary metastases (n = 9)) was compared to conservatively treated patients (local (n = 17), hepatic (n = 37) and pulmonary metastases (n = 8)). RESULTS: Resected PDAC patients suffering from isolated metachronous hepatic metastases initially had a higher T-stage and venous invasion (V1) compared to the other patients. DFS in the metachronous pulmonary metastases group was longer compared to DFS of the hepatic metastases and local recurrence groups. Surgical resection significantly improved PRS in patients with local recurrence and pulmonary metastases, when compared to patients receiving chemotherapy alone. Very-long term survivors (> 5 years) were detected following secondary resection of local recurrence and 45% of these patients were still alive at the end of our study period. CONCLUSION: Although DFS in PDAC patients suffering from isolated local recurrence was dismal and comparable to that of patients with isolated hepatic metastases, very-long term survivors were present only in this group. These results indicate that a surgical approach for isolated local recurrence, if anatomically possible, should be considered.
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spelling pubmed-79315362021-03-05 Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy Safi, S. A. Lehwald-Tywuschik, N. Rehders, A. Fluegen, G. Haeberle, L. Keitel, V. Knoefel, W. T. BMC Surg Research Article BACKGROUND: Ductal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies. To date, no guidelines exists for isolated resectable metachronous disease. It is still unknown, which patients may benefit from relapse surgery. The aim of our study was to compare disease free survival (DFS) and post relapse survival (PRS) in patients with isolated local recurrence, metachronous hepatic or pulmonary metastases. METHODS: Patients with isolated resectable local recurrence, metachronous hepatic or pulmonary metastases were included for survival analyses. PRS of surgically treated patients (local (n = 11), hepatic (n = 6) and pulmonary metastases (n = 9)) was compared to conservatively treated patients (local (n = 17), hepatic (n = 37) and pulmonary metastases (n = 8)). RESULTS: Resected PDAC patients suffering from isolated metachronous hepatic metastases initially had a higher T-stage and venous invasion (V1) compared to the other patients. DFS in the metachronous pulmonary metastases group was longer compared to DFS of the hepatic metastases and local recurrence groups. Surgical resection significantly improved PRS in patients with local recurrence and pulmonary metastases, when compared to patients receiving chemotherapy alone. Very-long term survivors (> 5 years) were detected following secondary resection of local recurrence and 45% of these patients were still alive at the end of our study period. CONCLUSION: Although DFS in PDAC patients suffering from isolated local recurrence was dismal and comparable to that of patients with isolated hepatic metastases, very-long term survivors were present only in this group. These results indicate that a surgical approach for isolated local recurrence, if anatomically possible, should be considered. BioMed Central 2021-03-03 /pmc/articles/PMC7931536/ /pubmed/33658016 http://dx.doi.org/10.1186/s12893-021-01082-w Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Safi, S. A.
Lehwald-Tywuschik, N.
Rehders, A.
Fluegen, G.
Haeberle, L.
Keitel, V.
Knoefel, W. T.
Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy
title Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy
title_full Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy
title_fullStr Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy
title_full_unstemmed Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy
title_short Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy
title_sort site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931536/
https://www.ncbi.nlm.nih.gov/pubmed/33658016
http://dx.doi.org/10.1186/s12893-021-01082-w
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