医学
叶黄素
新辅助治疗
四分位间距
队列
胰腺切除术
放射治疗
胰腺癌
普通外科
外科
癌症
肿瘤科
内科学
切除术
乳腺癌
结直肠癌
伊立替康
作者
Bradley N. Reames,Alex B. Blair,Robert W. Krell,Vincent P. Groot,Georgios Gemenetzis,James C. Padussis,Sarah P. Thayer,Massimo Falconi,Christopher L. Wolfgang,Matthew J. Weiss,Chandrakanth Are,Jin He
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2019-08-21
卷期号:273 (6): 1173-1181
被引量:44
标识
DOI:10.1097/sla.0000000000003568
摘要
The aim of this study was to investigate surgeon preferences for the management of patients with locally advanced pancreatic cancer (LAPC).Select patients with LAPC may become candidates for curative resection following neoadjuvant therapy, and recent reports of survival are encouraging. Yet the optimal management approach remains unclear.An extensive electronic survey was systematically distributed by email to an international cohort of pancreas surgeons. Data collected included practice characteristics, management preferences, attitudes regarding contraindications to surgery, and 6 clinical vignettes of patients that ultimately received a margin negative resection (with detailed videos of post-neoadjuvant imaging) to assess propensity for surgical exploration if resection status is not known.A total of 153 eligible responses were received from 4 continents. Median duration of practice is 12 years (interquartile range 6-20) and 77% work in a university setting. Most surgeons (86%) are considered high volume (>10 resections/yr), 33% offer a minimally-invasive approach, and 50% offer arterial resections in select patients. Most (72%) always recommend neoadjuvant chemotherapy, and 65% prefer FOLFIRINOX. Preferences for the duration of chemotherapy varied widely: 39% prefer ≥2 months, 43% prefer ≥4 months, and 11% prefer ≥6 months. Forty-one percent frequently recommend neoadjuvant radiotherapy, and 53% prefer 5 to 6 weeks of chemoradiation. The proportion of surgeons favoring exploration following neoadjuvant varied extensively across 5 vignettes of LAPC, from 14% to 53%. In a vignette of oligometastatic liver metastases, 31% would offer exploration if a favorable therapy response is observed.In an international cohort of pancreas surgeons, there is substantial variation in management preferences, perceived contraindications to surgery, and the propensity to consider exploration in LAPC. These results emphasize the importance of a robust and nuanced multidisciplinary discussion for each patient, and suggest an evolving concept of "resectability."
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