Pancreatic ductal adenocarcinoma(PDAC)continues to have a dismal prognosis,with a 5-year survival rate of<5%.Most(70%-80%)patients are classified as unresectable(UR)disease.Recent progress in chemotherapeutic appro...Pancreatic ductal adenocarcinoma(PDAC)continues to have a dismal prognosis,with a 5-year survival rate of<5%.Most(70%-80%)patients are classified as unresectable(UR)disease.Recent progress in chemotherapeutic approaches has provided a high response rate and improved short-term survival.Recently,conversion surgery(CS),which is defined as an additional surgery during multimodal therapy in patients with initially UR-PDAC who respond favorably to anti-cancer treatments,has been successfully introduced as a novel treatment option for locally advanced(UR-LA)and metastatic(UR-M)PDAC.Several studies have demonstrated high resectability rates(UR-LA,20%-57%;UR-M,2%-24%),high margin-negative resection rates(27%-91%),and high negative lymph node rates(29%-83%)in patients who underwent CS.Most studies also demonstrated acceptable mortality and morbidity.Median survival time(MST)varied between 24.9 and 35.3 months for patients with UR-LA,19.5 and 64 months for UR-LA/M,and 26 and 56 months for UR-M,which is better than the MST of patients who did not undergo CS.The presence of M disease did not affect survival in patients who underwent CS.However,the actual clinical benefits of resection have not yet been fully investigated.There are still several issues to be resolved in this area.Therefore,sustained efforts to conduct appropriately designed clinical trials for confirming the efficacy of CS in the subset of patients with initially UR-PDAC are warranted.展开更多
文摘Pancreatic ductal adenocarcinoma(PDAC)continues to have a dismal prognosis,with a 5-year survival rate of<5%.Most(70%-80%)patients are classified as unresectable(UR)disease.Recent progress in chemotherapeutic approaches has provided a high response rate and improved short-term survival.Recently,conversion surgery(CS),which is defined as an additional surgery during multimodal therapy in patients with initially UR-PDAC who respond favorably to anti-cancer treatments,has been successfully introduced as a novel treatment option for locally advanced(UR-LA)and metastatic(UR-M)PDAC.Several studies have demonstrated high resectability rates(UR-LA,20%-57%;UR-M,2%-24%),high margin-negative resection rates(27%-91%),and high negative lymph node rates(29%-83%)in patients who underwent CS.Most studies also demonstrated acceptable mortality and morbidity.Median survival time(MST)varied between 24.9 and 35.3 months for patients with UR-LA,19.5 and 64 months for UR-LA/M,and 26 and 56 months for UR-M,which is better than the MST of patients who did not undergo CS.The presence of M disease did not affect survival in patients who underwent CS.However,the actual clinical benefits of resection have not yet been fully investigated.There are still several issues to be resolved in this area.Therefore,sustained efforts to conduct appropriately designed clinical trials for confirming the efficacy of CS in the subset of patients with initially UR-PDAC are warranted.
