Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit?
Surgery among patients with borderline resectable pancreatic cancer (BRPC) and venous disease has emerged as a viable strategy to achieve curative treatment. By definition, these patients are at increased risk of a positive resection margin, however, controversy exists with regards to necessity of r...
Main Authors: | , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2019-10-01
|
Series: | Frontiers in Oncology |
Subjects: | |
Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2019.01060/full |
id |
doaj-3dd9f4136f9341f58f7ddb18e30897c4 |
---|---|
record_format |
Article |
spelling |
doaj-3dd9f4136f9341f58f7ddb18e30897c42020-11-25T00:04:11ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2019-10-01910.3389/fonc.2019.01060483390Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit?Rupaly Pandé0Keith J. Roberts1Keith J. Roberts2Department of HPB Surgery and Liver Transplant, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, United KingdomDepartment of HPB Surgery and Liver Transplant, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, United KingdomDepartment of Immunology and Immunotherapy, University of Birmingham, Birmingham, United KingdomSurgery among patients with borderline resectable pancreatic cancer (BRPC) and venous disease has emerged as a viable strategy to achieve curative treatment. By definition, these patients are at increased risk of a positive resection margin, however, controversy exists with regards to necessity of radical surgery and optimum pathways with no consensus on definitive treatment. A surgery first approach is possible though outcomes vary but patients can have an efficient pathway to surgery, particularly if biliary drainage is avoided which limits overall complications. Neoadjuvant therapy (NAT) is emerging as a widely used strategy to improve oncological outcomes, including resection margin status. However, some patients progress on NAT whilst others suffer major complications whilst elderly patients are unlikely to be offered effective NAT limiting the widespread applicability of this therapy. In this article an overview of the entire pathway is presented along with assimilation of current best evidence to determine optimal routes to surgery for BRPC with venous involvement.https://www.frontiersin.org/article/10.3389/fonc.2019.01060/fullborderline resectable pancreaic adenocarcinomavein resection and reconstructionneoadjuvant and adjuvant chemotherapiesupfront surgeryfast track surgery |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rupaly Pandé Keith J. Roberts Keith J. Roberts |
spellingShingle |
Rupaly Pandé Keith J. Roberts Keith J. Roberts Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit? Frontiers in Oncology borderline resectable pancreaic adenocarcinoma vein resection and reconstruction neoadjuvant and adjuvant chemotherapies upfront surgery fast track surgery |
author_facet |
Rupaly Pandé Keith J. Roberts Keith J. Roberts |
author_sort |
Rupaly Pandé |
title |
Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit? |
title_short |
Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit? |
title_full |
Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit? |
title_fullStr |
Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit? |
title_full_unstemmed |
Determining Optimal Routes to Surgery for Borderline Resectable Venous Pancreatic Cancer—Where Is the Least Harm and Most Benefit? |
title_sort |
determining optimal routes to surgery for borderline resectable venous pancreatic cancer—where is the least harm and most benefit? |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Oncology |
issn |
2234-943X |
publishDate |
2019-10-01 |
description |
Surgery among patients with borderline resectable pancreatic cancer (BRPC) and venous disease has emerged as a viable strategy to achieve curative treatment. By definition, these patients are at increased risk of a positive resection margin, however, controversy exists with regards to necessity of radical surgery and optimum pathways with no consensus on definitive treatment. A surgery first approach is possible though outcomes vary but patients can have an efficient pathway to surgery, particularly if biliary drainage is avoided which limits overall complications. Neoadjuvant therapy (NAT) is emerging as a widely used strategy to improve oncological outcomes, including resection margin status. However, some patients progress on NAT whilst others suffer major complications whilst elderly patients are unlikely to be offered effective NAT limiting the widespread applicability of this therapy. In this article an overview of the entire pathway is presented along with assimilation of current best evidence to determine optimal routes to surgery for BRPC with venous involvement. |
topic |
borderline resectable pancreaic adenocarcinoma vein resection and reconstruction neoadjuvant and adjuvant chemotherapies upfront surgery fast track surgery |
url |
https://www.frontiersin.org/article/10.3389/fonc.2019.01060/full |
work_keys_str_mv |
AT rupalypande determiningoptimalroutestosurgeryforborderlineresectablevenouspancreaticcancerwhereistheleastharmandmostbenefit AT keithjroberts determiningoptimalroutestosurgeryforborderlineresectablevenouspancreaticcancerwhereistheleastharmandmostbenefit AT keithjroberts determiningoptimalroutestosurgeryforborderlineresectablevenouspancreaticcancerwhereistheleastharmandmostbenefit |
_version_ |
1725430677693792256 |