REVIEW   

Minerva Chirurgica 2017 October;72(5):424-31

DOI: 10.23736/S0026-4733.17.07410-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Contemporary strategies to improve the outcome in locally advanced pancreatic cancer

Rick SCHNEIDER ¹, Christoph SPÄTH ², Ulrich NITSCHE ³, Mert ERKAN ⁴, Jörg KLEEFF ¹ ✉

¹ Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; ² Department of General Surgery, North Shore Hospital, Auckland, New Zealand; ³ Department of Surgery, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany; ⁴ Department of Surgery, Koç University School of Medicine, Istanbul, Turkey

Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease with an overall 5-year survival rate of less than 7%. After many years of basic and clinical research efforts, pancreatic cancer patients presenting with locally advanced, unresectable tumors remain a therapeutic challenge. Despite the lack of high quality randomized controlled trials, perioperative/neoadjuvant treatment strategies seem to be beneficial in these patients. At present the FOLFIRINOX regimen, which was established in the palliative setting, is increasingly recognized as the backbone of neoadjuvant therapy for locally advanced PDAC. Surgical resection follows the same principles and guidelines as upfront surgery specifically regarding the extent of resection including lymphadenectomy, vascular resections and multivisceral resections. Because of the limited diagnostic accuracy of restaging after neoadjuvant treatment, an adjusted intraoperative strategy is necessary to minimize the risk of debulking procedures and maximize the chance of a potential curative resection. Locally advanced PDAC requires a multidisciplinary and individualized treatment approach, and further research efforts for novel and innovative therapies. This article provides an updated overview on strategies to improve the outcome in locally advanced PDAC.

KEY WORDS: Pancreatic neoplasms - Adenocarcinoma - Neoadjuvant therapy - Molecular targeted therapy - Combined modality therapy - Operative surgical procedures