John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

Pancreatic adenocarcinoma: who should be operated on? Volume 24, issue 8, Octobre 2017

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Author
Hôpital Beaujon, pôle des maladies de l’appareil digestif, service de chirurgie hépatobiliaire et pancréatique, 100 boulevard Général Leclerc, 92110 Clichy, France
* Tirés à part
  • Key words: pancreatic adenocarcinoma, resecability, induction treatment pancreaticoduodenectomy, vascular resection
  • DOI : 10.1684/hpg.2017.1506
  • Page(s) : 798-807
  • Published in: 2017

Surgical resection is still necessary for cure of pancreatic adenocarcinoma. However, resection is possible in only 10% to 20% cases. Complete resection, with tumor-free margins (> 1 mm, R0) of a localized tumor (no visceral or distant lymph node metastases) can be followed by cure, with an expected median survival presently ranging from 30 to 40 months. However, surgery is not the only treatment associated with prolonged survival, is still associated with a significant mortality and important mortality, particularly after pancreaticoduodenectomy, and should ideally be followed by adjuvant chemotherapy to improve long term survival. All these points underline the need for both tumors and patients selection in the perspective of surgery. Multiphasic contrast-enhanced CT scan, including thin slices and recently performed, is necessary to classify tumors into resectable, borderline resectable and locally advanced ones. For border-line resectable tumors, induction treatment including chemotherapy and/ou chemoradiation therapy is more and more frequently used to increase possibilities of R0 resection. Some locally advanced tumors can become resectable after chemotherapy leading to a major tumor response. The value of routine neo-adjuvant chemotherapy for resectable tumors is presently under evaluation.