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State of the Art: Oncological Surgery of the Pancreas in the Era of Multimodal Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 8573

Special Issue Editor

Dr. Mario Gruppo

E-Mail Website
Guest Editor
Veneto Institute of Oncology, Unit of Surgical Oncology of Digestive Tract, Padua, Italy
Interests: pancreatic cancer; pancreatic surgery; pancreatic carcinogenesis; outcomes of pancreatic surgery; postoperative pancreatic fistula

Special Issue Information

Dear Colleagues,

I am pleased to announce an upcoming Special Issue of JCM entitled “State of the Art: Oncological Surgery of the Pancreas in the Era of Multimodal Treatment”.

Pancreatic cancer is currently the fourth leading cause of cancer deaths in the United States, and only 15–20% of patients are candidates for surgery at the time of diagnosis; among these, the median postoperative survival is <20 months, with a 5-year survival rate of only 20%.

Pancreatic resections are technically challenging and are accompanied by a substantial risk of postoperative complications. Today, due to improvements in surgical techniques and perioperative management, along with the wide use of minimally invasive approaches,  pancreatic resections are carried out routinely at high-volume centers with mortality rates <2% and acceptable complication rates. Furthermore, the development of new chemotherapeutic regimens, new multimodal pathways (neoadjuvant and total neoadjuvant) and a better knowledge of tumor biology have permitted an increase in the number of patients who can benefit from curative resections.

This Special Issue aims to provide the reader with an overview of current surgical and oncological outcomes, with a particular focus on the surgical approaches (open vs. minimally invasive) and the role of surgery (curative and palliative) in multimodal treatment.

Dr. Mario Gruppo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pancreatic cancer
  • Pancreatectomy
  • Minimally invasive pancreatic surgery
  • Postoperative pancreatic fistula
  • Overall survival

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Published Papers (4 papers)

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Research

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10 pages, 611 KiB  
Article
Delayed Gastric Emptying Does Not Influence Cancer-Specific Survival after Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma
by Christiane Pillny, Jessica Teschke, Jana Enderes, Steffen Manekeller, Jörg C. Kalff and Tim R. Glowka
J. Clin. Med. 2022, 11(14), 4200; https://doi.org/10.3390/jcm11144200 - 20 Jul 2022
Viewed by 1346
Abstract
Background: Delayed gastric emptying (DGE) remains the most frequent complication following pancreatoduodenectomy (PD). The present study investigates the influence of delayed gastric emptying on cancer-specific survival after PD. Methods: We included 267 patients who underwent PD between 2014 and 2021. They were analyzed [...] Read more.
Background: Delayed gastric emptying (DGE) remains the most frequent complication following pancreatoduodenectomy (PD). The present study investigates the influence of delayed gastric emptying on cancer-specific survival after PD. Methods: We included 267 patients who underwent PD between 2014 and 2021. They were analyzed regarding demographic factors, pre- and perioperative characteristics, surgical complications, and long-term survival. Results: Patients with a higher Charlson Comorbidity Index (CCI) or pre-existing pulmonary disease suffered significantly more from DGE. When experiencing PPH, a prolonged hospital stay, or major overall complications (Clavien-Dindo °III-V) were more common in the DGE group. Tumor size over 3 cm negatively affected survival. Conclusions: DGE has no influence on long-term survival in PDAC patients, although it prolongs hospital stay. Full article
(This article belongs to the Special Issue State of the Art: Oncological Surgery of the Pancreas in the Era of Multimodal Treatment)
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Review

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10 pages, 246 KiB  
Review
Advances and Remaining Challenges in the Treatment for Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma
by Megan L. Sulciner, Stanley W. Ashley and George Molina
J. Clin. Med. 2022, 11(16), 4866; https://doi.org/10.3390/jcm11164866 - 19 Aug 2022
Cited by 3 | Viewed by 1488
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest malignancies in the United States. Improvements in imaging have permitted the categorization of patients according to radiologic involvement of surrounding vasculature, i.e., upfront resectable, borderline resectable, and locally advanced disease, and this, in turn, [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest malignancies in the United States. Improvements in imaging have permitted the categorization of patients according to radiologic involvement of surrounding vasculature, i.e., upfront resectable, borderline resectable, and locally advanced disease, and this, in turn, has influenced the sequence of chemotherapy, surgery, and radiation therapy. Though surgical resection remains the only curative treatment option, recent studies have shown improved overall survival with neoadjuvant chemotherapy, especially among patients with borderline resectable/locally advanced disease. The role of radiologic imaging after neoadjuvant therapy and the potential benefit of adjuvant therapy for borderline resectable and locally advanced disease remain areas of ongoing investigation. The advances made in the treatment of patients with borderline resectable/locally advanced disease are promising, yet disparities in access to cancer care persist. This review highlights the significant advances that have been made in the treatment of borderline resectable and locally advanced PDAC, while also calling attention to the remaining challenges. Full article
(This article belongs to the Special Issue State of the Art: Oncological Surgery of the Pancreas in the Era of Multimodal Treatment)
15 pages, 1682 KiB  
Review
Local Ablative Therapy Associated with Immunotherapy in Locally Advanced Pancreatic Cancer: A Solution to Overcome the Double Trouble?—A Comprehensive Review
by Jonathan Garnier, Olivier Turrini, Anne-Sophie Chretien and Daniel Olive
J. Clin. Med. 2022, 11(7), 1948; https://doi.org/10.3390/jcm11071948 - 31 Mar 2022
Cited by 6 | Viewed by 2869
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a major killer and is a challenging clinical research issue with abysmal survival due to unsatisfactory therapeutic efficacy. Two major issues thwart the treatment of locally advanced nonresectable pancreatic cancer (LAPC): high micrometastasis rate and surgical inaccessibility. Local [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) remains a major killer and is a challenging clinical research issue with abysmal survival due to unsatisfactory therapeutic efficacy. Two major issues thwart the treatment of locally advanced nonresectable pancreatic cancer (LAPC): high micrometastasis rate and surgical inaccessibility. Local ablative therapies induce a systemic antitumor response (i.e., abscopal effect) in addition to local effects. Thus, the incorporation of additional therapies could be key to improving immunotherapy’s clinical efficacy. In this systematic review, we explore recent applications of local ablative therapies combined with immunotherapy to overcome immune resistance in PDAC and discuss future perspectives and challenges. Particularly, we describe four chemoradiation studies and nine reports on irreversible electroporation (IRE). Clinically, IRE is the ablative therapy of choice, utilized in all but two clinical trials, and may create a favorable microenvironment for immunotherapy. Various immunotherapies have been used in combination with IRE, such as NK cell- or γδ T cell-based therapy, as well as immune checkpoint inhibitors. The results of the clinical trials presented in this review and the advancement potential of these therapies to phase II/III trials remain unknown. A multiple treatment approach involving chemotherapy, local ablation, and immunotherapy holds promise in overcoming the double trouble of LAPC. Full article
(This article belongs to the Special Issue State of the Art: Oncological Surgery of the Pancreas in the Era of Multimodal Treatment)
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14 pages, 2283 KiB  
Review
Could Total Neoadjuvant Therapy Followed by Surgical Resection Be the New Standard of Care in Pancreatic Cancer? A Systematic Review and Meta-Analysis
by Ottavia De Simoni, Marco Scarpa, Caterina Soldà, Francesca Bergamo, Sara Lonardi, Alberto Fantin, Pierluigi Pilati and Mario Gruppo
J. Clin. Med. 2022, 11(3), 812; https://doi.org/10.3390/jcm11030812 - 3 Feb 2022
Cited by 8 | Viewed by 2153
Abstract
Background. Total neoadjuvant therapy (TNT), intended as induction chemotherapy (IC) followed by radio-chemotherapy (RCT), has been taking hold in the treatment of pancreatic ductal adenocarcinoma (PDAC). The aim of this review is to summarize the available evidence on the role of TNT followed [...] Read more.
Background. Total neoadjuvant therapy (TNT), intended as induction chemotherapy (IC) followed by radio-chemotherapy (RCT), has been taking hold in the treatment of pancreatic ductal adenocarcinoma (PDAC). The aim of this review is to summarize the available evidence on the role of TNT followed by curative surgery. Methods. Eligible studies were those reporting on patients with PDAC undergoing curative surgery after TNT. The primary endpoint was overall survival (OS). Results. A total of 1080 patients with PDAC who had undergone TNT were analyzed. The most common IC regimen was Gemcitabine (N 620, 57%). Toxicity during IC varied from 14% to 51%. Disease progression during IC varied from 3% to 25%. 607 (62%) patients underwent curative surgery after IC + CRT. In meta-analysis, the available data on lymph node metastases radicality and 2 years OS had better results in favor of TNT groups (OR 1.77, 95% CI 1.20–2.60, p = 0.004 and OR 2.03, 95% CI 1.19–3.47, p = 0.01 and OR 1.64, CI 1.09–2.47, p = 0.02, respectively). Conclusions. Despite the heterogeneity of the studies, different selection criteria, and non-negligible drop-out rate, TNT demonstrated a potential superiority to NAT without CRT in oncological and pathological outcomes, even if the main differences seem to depend on the IC regimen. Full article
(This article belongs to the Special Issue State of the Art: Oncological Surgery of the Pancreas in the Era of Multimodal Treatment)
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