Pagina Iniziale » Pancreas » Tumore pancreas
Tumore al Pancreas
Tumore pancreatico, neoplasia del pancreas, cancro del pancreas
Cos’è il pancreas
Il pancreas è una ghiandola posta profondamente nella cavità addominale, in stretta contiguità con il duodeno da cui è circondato ed al quale è connesso da un dotto (Wirsung) che porta il succo prodotto dagli acini pancreatici nell’intestino.
La ghiandola è costituita:
- da una parte esocrina (così definita perché ciò che produce se ne va all’esterno del corpo) che secerne il succo pancreatico, che viene immesso nell’intestino e che serve alla produzione degli enzimi digestivi;
- da una componente endocrina, che è deputata alla regolazione del metabolismo del glucosio del nostro corpo. Questa parte produce l’insulina.
L’organo può essere suddiviso in tre porzioni:
- Testa (la parte avvolta dal duodeno)
- Corpo (la porzione centrale)
- Coda (la parte terminale del pancreas, quella più vicina alla milza)
La testa (che è la parte più voluminosa) è la sede più frequente dei processi tumorali a carico del pancreas.
Cosa sono i tumori al pancreas?
I tumori al pancreas rappresentano un’importante capitolo delle malattie neoplastiche di cui si occupa il nostro gruppo.
Questi tumori, che possono originare sia dalla componente ghiandolare esocrina che da quella endocrina, possono essere benigni o maligni, come accade anche negli altri organi del corpo.
I tumori benigni sono rari e rappresentano circa il 6-10% della patologia del pancreas. I più frequenti sono rappresentati da
- Tumore a cellule acinari
- Cistoadenoma sieroso
- Cistoadenoma mucinoso
Gli ultimi due presentano un aspetto “cistico”: nei pazienti che hanno avuto nel loro passato la pancreatite, questo porta a problemi nel differenziarli dalle più semplici cisti pancreatiche.
In particolare, è molto importante verificare la possibile presenza del Cistoadenoma mucinoso, in quanto tale malattia rappresenta una forma di passaggio da un tumore benigno ad uno maligno.
Altri tumori benigni sono ancora più rari, come gli emangiolinfomi e gli schwannomi.
I tumori maligni rappresentano la maggioranza delle neoplasie pancreatiche. Sono malattie a decorso molto aggressivo e rappresentano attualmente la 4ª-5ª causa di morte per tumore nel mondo occidentale. Il cancro pancreatico colpisce maggiormente il sesso maschile e la popolazione anziana.
Negli ultimi decenni l’incidenza del cancro pancreatico è sensibilmente aumentata, sia in seguito al miglioramento delle tecniche diagnostiche (ne vengono riconosciuti di più perché è meno difficile vederli), sia per un aumento generalizzato della aspettativa di vita.
Il tumore maligno più frequente è l’adenocarcinoma duttale, che rappresenta il 90% circa delle neoplasie del pancreas.
Le altre varianti tumorali maligne sono meno frequenti, ma la prognosi rimane sempre severa:
- adenocarcinoma mucinoso
- carcinoma a cellule acinari
- adenocarcinoma squamoso
- carcinoma anaplastico
Come si manifestano i tumori del pancreas ? I sintomi
Sfortunatamente i sintomi legati ai tumori del pancreas in genere, ma particolarmente al più importante e frequente di essi (l’adenocarcinoma del pancreas), sono estremamente aspecifici e difficilmente fanno subito pensare ad un tumore del pancreas.
A causa della posizione del pancreas nel corpo umano, molto spesso non causano disturbi quando compaiono. Nella maggior parte dei casi la presenza di sintomi legati sicuramente ad un tumore del pancreas è indice di malattia già avanzata.
Alcuni sintomi, pressoché sempre presenti anche se aspecifici sono:
- dolore in sede epigastrica (con irradiazione al dorso)
- dispepsia (disturbi generici legati alla digestione)
- dimagramento e astenia (perdita delle forze)
La sintomatologia dolorosa, legata alla elevata invasività del tumore nei confronti delle fibre nervose, presenta una caratteristica irradiazione dorsale nelle forme tumorali che interessano il corpo del pancreas. Il dolore rappresenta spesso il sintomo più importante per i pazienti non operabili.
Sintomo specifico e particolarmente caratteristico dei tumori che interessano la porzione della testa del pancreas è rappresentato dall’ittero da stasi o ittero meccanico (presenza di pigmentazione gialla della cute), che insorge senza che il paziente riferisca alcun dolore.
Solo in fase molto avanzata può comparire una massa palpabile zona epigastrica o sottocostale (ipocondrio) sinistra.
Come sono fatti ? L'aspetto
Il più comune dei tumori del pancreas, l’adenocarcinoma, è in genere costituito da un nodulo singolo, di consistenza dura, che si infiltra senza un apparente margine nel tessuto dell’organo.
I tumori cistici hanno invece l’aspetto di una vera e propria cisti, con una parete esterna che circonda la parte liquida.
Come si vedono i tumori del pancreas ? La diagnosi
La diagnosi del carcinoma del pancreas è sempre difficile e spesso tardiva, specialmente perché inizialmente i pazienti lamentano sintomi sfumati ed aspecifici. Bisogna poi ricordare che non si pensa sufficientemente a questa patologia, che invece è relativamente frequente. Numerose indagini laboratoristiche e strumentali sono disponibili per la diagnosi e stadiazione preoperatoria.
Esami di laboratorio
Marcatori tumorali: CA 19-9, CA 50
Radiologia
Ecografia: è il primo esame che viene eseguito nei pazienti con ittero, poiché è sensibile ed efficace nell’identificare eventuali calcoli biliari nel coledoco che possano essere i reali responsabili dell’ostruzione. L’indagine facilita poi la diagnosi differenziale tra processo ostruttivo di origine tumorale da quello non tumorale.
TC: La Tac è l’esame di scelta per identificare una lesione tumorale del pancreas. Fornisce migliori e più complete informazioni riguardo alla presenza della neoplasia, alle sue dimensioni, ai rapporti con le strutture anatomiche circostanti e alla presenza di metastasi in altri organi, in particolare nel fegato. La TAC consente un’accurata stadiazione di questa malattia. Mediante l’angio-TAC (esame che visualizza con il mezzo di contrasto i vasi arteriosi durante la TAC) è possibile individuare la presenza di infiltrazione del tumore a carico dei vasi sanguigni.
RM (Risonanza Magnetica Nucleare): non offre attualmente vantaggi significativi rispetto alla TAC; può offrire invece alcuni vantaggi in casi particolari, quando si vogliano valutare specificamente i vasi sanguigni intorno al pancreas e le vie biliari.
ERCP (Colangiopancreatografia retrograda endoscopica): Pur avendo un’alta attendibilità (la sensibilità della metodica è del 95% circa), il suo impiego deve essere selettivo, poiché l’esame è invasivo (il numero di pazienti che presenta dolori addominali acuti da infiammazione del pancreas dopo l’esecuzione di questo esame è alto). Quando i reperti dell’ecografia e della TAC sono dubbi, o quando i tumori sono piccoli (<2 cm), o quando c’è incertezza nella diagnosi è opportuno effettuare l’ ERCP con eventuale esame Citologico del succo pancreatico (in un prelievo di succo pancreatico si valuta la presenza di cellule tumorali). Nei pazienti itterici l’ERCP deve essere associata al drenaggio della via biliare per ridurre il valore di bilirubina nel sangue, in particolare se il paziente non è resecabile o se non può essere operato subito (entro 24-72 ore). Nei pazienti itterici resecabili è preferibile procedere all’intervento chirurgico senza ERCP preoperatoria ed in particolare senza alcun drenaggio. Diversi studi hanno dimostrato un aumento delle complicanze postoperatorie al drenaggio della via biliare effettuato prima dell’intervento.
Biopsia
Non è indicata se il paziente è candidato alla stadiazione laparoscopico/laparotomica o se è resecabile. Il motivo risiede nella possibilità di disseminare cellule tumorali lungo il tragitto dell’ ago.
E’ indispensabile nei pazienti con tumore avanzato, non resecabile o nei casi rari in cui si sospetti un linfoma (la terapia del linfoma è medica, non chirurgica).
La specificità per esiti positivi della biopsia con ago sottile è vicina al 100%, mentre il valore predittivo di esiti negativi è molto basso.
Come si curano i tumori del pancreas ? La terapia
La chirurgia rappresenta oggi il solo mezzo in grado di offrire ad una certa percentuale di pazienti (anche se relativamente piccola) una possibilità di cura. Nel 75% dei casi lo stadio della neoplasia al momento della diagnosi è già così avanzato che sono possibili solo provvedimenti palliativi. La particolare aggressività biologica che caratterizza questi tumori, unitamente alle difficoltà nel raggiungere una diagnosi, sono alla base della poco soddisfacente situazione terapeutica per questa malattia.
Trattamento radicale
Resezione radicale curativa. L’intervento da effettuare dipende dalla sede del tumore all’interno del pancreas. In considerazione del fatto che la maggior parte delle neoplasie si sviluppa nella porzione chiamata “testa”, l’intervento da effettuare è la duodeno-cefalopancreasectomia. Questo intervento prevede l’asportazione della “testa” del pancreas, del duodeno e della via biliare. La tecnica originale prevedeva anche l’asportazione della parte terminale dello stomaco (il piloro), ma più recentemente si tende ad evitare questa procedura. È indispensabile l’asportazione di tutti i linfonodi regionali. L’intervento è assai complesso e non è esente da rischi.
Altri interventi prevedono l’asportazione della sola “coda” del pancreas o anche di tutto il pancreas. Gli interventi di asportazione della sola coda pancreatica trovano oggi nella metodica laparoscopica una delle vie di esecuzioni preferite.
In caso di diffusione del tumore oltre il pancreas (ad esempio: infiltrazione retropancreatica, coinvolgimento vasale… ecc.) la resezione del pancreas può essere associato a Radioterapia Intraoperatoria.
Nei pazienti con rischio chirurgico basso ma con malattia avanzata è possibile proporre un trattamento con chemioterapia preoperatorio (neoadiuvante) seguito dalla resezione pancreatica nei pazienti che rispondono alla terapia.
Trattamento palliativo
I trattamenti palliativi sono tesi ad eliminare i sintomi che rendono difficile una normale vita del paziente. L’infiltrazione tumorale dello stomaco o del duodeno che impedisce la normale alimentazione può essere superata con un by-pass chirurgico.
L’ittero può essere alleviato o mediante un intervento chirurgico (anastomosi bilio-digestiva) o mediante un drenaggio endoscopico.
Recentemente alcuni protocolli chemioterapici sembrano aver dato un lieve incremento della sopravvivenza nei pazienti con neoplasie avanzate non resecabili.
Vero o falso sul tumore del pancreas.
Le risposte date dal Prof. Gian Luca Grazi, dell’Istituto Nazionale Tumori “Regina Elena”, di Roma, in occasione della Giornata Mondiale dedicata a questa malattia.
- Ultimo aggiornamento della pagina: 03/10/2023
Linee Guida per la Diagnosi ed il Trattamento del Tumore del Pancreas
2023
Conroy T; Pfeiffer P; Vilgrain V; Lamarca A; Seufferlein T; O'Reilly E M; Hackert T; Golan T; Prager G; Haustermans K; Vogel A; Ducreux M; Committee E G
Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up Journal Article
In: Ann. Oncol., 2023.
@article{Conroy2023-ah,
title = {Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up},
author = {T Conroy and P Pfeiffer and V Vilgrain and A Lamarca and T Seufferlein and E M O'Reilly and T Hackert and T Golan and G Prager and K Haustermans and A Vogel and M Ducreux and ESMO Guidelines Committee},
url = {https://www.sciencedirect.com/science/article/pii/S0923753423008244?via%3Dihub
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doi = {10.1016/j.annonc.2023.08.009},
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journal = {Ann. Oncol.},
abstract = {Highlights
• The guideline covers diagnosis, staging, risk assessment, treatment, disease monitoring and follow-up.
• The multidisciplinary expert author group is from different institutions and countries in Europe, Asia and the USA.
• Recommendations are based on available scientific data and the authors’ collective expert opinion.
• ESMO-MCBS and ESCAT scores provide levels of evidence for treatment choices, including targeted therapies.
• In clinical practice, all recommendations provided need to be discussed with patients in a shared decision-making approach.},
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• The guideline covers diagnosis, staging, risk assessment, treatment, disease monitoring and follow-up.
• The multidisciplinary expert author group is from different institutions and countries in Europe, Asia and the USA.
• Recommendations are based on available scientific data and the authors’ collective expert opinion.
• ESMO-MCBS and ESCAT scores provide levels of evidence for treatment choices, including targeted therapies.
• In clinical practice, all recommendations provided need to be discussed with patients in a shared decision-making approach.
2021
di Oncologia Medica (AIOM) A I
Linee guida Carcinoma del Pancreas Esocrino Working paper
2021.
@workingpaper{nokey,
title = {Linee guida Carcinoma del Pancreas Esocrino},
author = {Associazione Italiana di Oncologia Medica (AIOM)},
url = {https://snlg.iss.it/wp-content/uploads/2021/10/LG_270_ca_pancreas_agg2021.pdf},
year = {2021},
date = {2021-10-04},
urldate = {2021-10-04},
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pubstate = {published},
tppubtype = {workingpaper}
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for Patients N G
Pancreatic Cancer Working paper
2021.
@workingpaper{nokey,
title = {Pancreatic Cancer},
author = {NCCN Guidelines for Patients},
url = {https://www.nccn.org/patients/guidelines/content/PDF/pancreatic-patient.pdf},
year = {2021},
date = {2021-01-04},
keywords = {},
pubstate = {published},
tppubtype = {workingpaper}
}
2020
Okusaka T; Nakamura M; Yoshida M; Kitano M; Uesaka K; Ito Y; Furuse J; Hanada K; Okazaki K
Clinical Practice Guidelines for Pancreatic Cancer 2019 from the Japan Pancreas Society: A Synopsis Journal Article
In: Pancreas, vol. 49, no 3, pp. 326 – 335, 2020, ISSN: 08853177, (Cited by: 63; All Open Access, Green Open Access, Hybrid Gold Open Access).
@article{Okusaka2020326,
title = {Clinical Practice Guidelines for Pancreatic Cancer 2019 from the Japan Pancreas Society: A Synopsis},
author = {Takuji Okusaka and Masafumi Nakamura and Masahiro Yoshida and Masayuki Kitano and Katsuhiko Uesaka and Yoshinori Ito and Junji Furuse and Keiji Hanada and Kazuichi Okazaki},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85082094118&doi=10.1097%2fMPA.0000000000001513&partnerID=40&md5=2711a0bb237001a4c9b21c33e3fb8145},
doi = {10.1097/MPA.0000000000001513},
issn = {08853177},
year = {2020},
date = {2020-01-01},
urldate = {2020-01-01},
journal = {Pancreas},
volume = {49},
number = {3},
pages = {326 – 335},
publisher = {Lippincott Williams and Wilkins},
abstract = {Objectives Clinical Practice Guidelines for Pancreatic Cancer were first published in 2006 by the Japan Pancreas Society, and they were revised in 2009, 2013, and 2016. In July 2019, the Clinical Practice Guidelines for Pancreatic Cancer 2019 were newly revised in Japanese. Methods For this version, we developed the new guidelines according to the Minds Manual for Guideline Development 2017, which includes the concepts of GRADE (Grading Recommendations Assessment, Development, and Evaluation), to enable a better understanding of the current guidelines. Results The guidelines show algorithms for the diagnosis, treatment, and chemotherapy of pancreatic cancer and address 7 subjects: diagnosis, surgical therapy, adjuvant therapy, radiation therapy, chemotherapy, stent therapy, and supportive and palliative medicine. They include 56 clinical questions and 84 statements. There are statements corresponding to clinical questions, evidence levels, recommendation strengths, and agreement rates. Conclusions These guidelines represent the most standard clinical and practical management guidelines at this time in Japan. This is the English synopsis of the Clinical Practice Guidelines for Pancreatic Cancer 2019 in Japanese and is an attempt to disseminate the Japanese guidelines worldwide for introducing the Japanese approach for clinical management of pancreatic cancer. © Wolters Kluwer Health, Inc. All rights reserved.},
note = {Cited by: 63; All Open Access, Green Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
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}
Habib J R; Wolfgang C L
Synopsis of the UK National Institute for Health and Care Excellence Guidelines on the Diagnosis and Management of Pancreatic Cancer Journal Article
In: JAMA Surgery, vol. 155, no 12, pp. 1164 – 1165, 2020, ISSN: 21686254, (Cited by: 0).
@article{Habib20201164,
title = {Synopsis of the UK National Institute for Health and Care Excellence Guidelines on the Diagnosis and Management of Pancreatic Cancer},
author = {Joseph R. Habib and Christopher L. Wolfgang},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85091271207&doi=10.1001%2fjamasurg.2020.3751&partnerID=40&md5=8ab334ab645a8c071623802956cfa7a2},
doi = {10.1001/jamasurg.2020.3751},
issn = {21686254},
year = {2020},
date = {2020-01-01},
urldate = {2020-01-01},
journal = {JAMA Surgery},
volume = {155},
number = {12},
pages = {1164 – 1165},
publisher = {American Medical Association},
note = {Cited by: 0},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Prades J; Arnold D; Brunner T; Cardone A; Carrato A; Coll-Ortega C; Luze S D; Garel P; Goossens M E; Grilli R; Harris M; Louagie M; Malats N; Minicozzi P; Partelli S; Pastorekova S; Petrulionis M; Price R; Sclafani F; Smolkova B; Borras J M
Bratislava Statement: Consensus recommendations for improving pancreatic cancer care Journal Article
In: ESMO Open, vol. 5, no 6, 2020, ISSN: 20597029, (Cited by: 10; All Open Access, Gold Open Access, Green Open Access).
@article{Prades2020,
title = {Bratislava Statement: Consensus recommendations for improving pancreatic cancer care},
author = {Joan Prades and Dirk Arnold and Thomas Brunner and Antonella Cardone and Alfredo Carrato and Cristina Coll-Ortega and Samuel De Luze and Pascal Garel and Maria E Goossens and Roberto Grilli and Meggan Harris and Marleen Louagie and Núria Malats and Pamela Minicozzi and Stefano Partelli and Silvia Pastorekova and Marius Petrulionis and Richard Price and Francesco Sclafani and Bozena Smolkova and Josep M Borras},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85096154220&doi=10.1136%2fesmoopen-2020-001051&partnerID=40&md5=a1a1e96aa9a620297317971d66a8340a},
doi = {10.1136/esmoopen-2020-001051},
issn = {20597029},
year = {2020},
date = {2020-01-01},
urldate = {2020-01-01},
journal = {ESMO Open},
volume = {5},
number = {6},
publisher = {BMJ Publishing Group},
abstract = {Pancreatic cancer is one of the most lethal tumours, and it is the fourth cause of cancer death in Europe. Despite its important public health impact, no effective treatments exist, nor are there high-visibility research efforts to improve care. This alarming situation is emblematic of a larger group of cancer diseases, known as neglected cancers. To address the impact of these diseases, the European Commission-supported Innovative Partnership for Action Against Cancer launched a multi-stakeholder initiative to determine key steps that healthcare systems can rapidly implement to improve their response. A working group comprising 20 representatives from European medical societies, patient associations, cancer plan organisations and other relevant European healthcare stakeholders was organised. A consensus process based on the results of different studies, discussion of research outcomes, and development and endorsement of draft statements resulted in 22 consensus recommendations (the Bratislava Statement). The statement argues that substantial improvements can be achieved in patient outcomes by centralising pancreatic cancer care around state-of-the-art reference centres, staffed by expert multidisciplinary teams capable of providing high-quality care. This organisational model requires a specific care framework encompassing primary, palliative and survivorship care, and a policy environment prioritising the use of quality criteria and performance assessments as well as research investments dedicated to prevention, risk prediction, early detection and diagnosis. In order to address the challenges posed by neglected cancers in general and pancreatic cancer in particular, a specific control strategy tailored to this reality is required. ©},
note = {Cited by: 10; All Open Access, Gold Open Access, Green Open Access},
keywords = {},
pubstate = {published},
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}
2018
NICE
NICE Guidelines: Pancreatic cancer in adults: diagnosis and pancreatic cancer in adults: diagnosis and management Bachelor Thesis
2018.
@bachelorthesis{nokey,
title = {NICE Guidelines: Pancreatic cancer in adults: diagnosis and pancreatic cancer in adults: diagnosis and management},
author = {NICE},
editor = {NICE},
url = {https://www.bsg.org.uk/wp-content/uploads/2019/12/NICE-Guideline-Pancreatic-Cancer-in-Adults_-Diagnosis-and-Management-Feb2018.pdf},
year = {2018},
date = {2018-02-07},
urldate = {2018-02-07},
abstract = {This guideline covers diagnosing and managing pancreatic cancer in adults aged 18 and over. It aims to improve care by ensuring quicker and more accurate diagnosis, and by specifying the most effective treatments for people depending on how advanced their cancer is.
For recommendations on identifying pancreatic cancer in primary care, or when to refer people to a specialist, see the NICE guideline on recognition and referral for suspected cancer.
It is for Healthcare professionals, Commissioners and providers; Adults aged 18 and over with pancreatic cancer, their families and carers.},
keywords = {},
pubstate = {published},
tppubtype = {bachelorthesis}
}
For recommendations on identifying pancreatic cancer in primary care, or when to refer people to a specialist, see the NICE guideline on recognition and referral for suspected cancer.
It is for Healthcare professionals, Commissioners and providers; Adults aged 18 and over with pancreatic cancer, their families and carers.
Isaji S; Mizuno S; Windsor J A; Bassi C; Castillo C F; Hackert T; Hayasaki A; Katz M H G; Kim S; Kishiwada M; Kitagawa H; Michalski C W; Wolfgang C L
International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017 Journal Article
In: Pancreatology, vol. 18, no 1, pp. 2 – 11, 2018, ISSN: 14243903, (Cited by: 265; All Open Access, Hybrid Gold Open Access).
@article{Isaji20182,
title = {International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017},
author = {Shuji Isaji and Shugo Mizuno and John A. Windsor and Claudio Bassi and Carlos Fernández-del Castillo and Thilo Hackert and Aoi Hayasaki and Matthew H. G. Katz and Sun-Whe Kim and Masashi Kishiwada and Hirohisa Kitagawa and Christoph W. Michalski and Christopher L. Wolfgang},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85035246382&doi=10.1016%2fj.pan.2017.11.011&partnerID=40&md5=9e732aecca1d54c1de22d6974f6b4d43},
doi = {10.1016/j.pan.2017.11.011},
issn = {14243903},
year = {2018},
date = {2018-01-01},
urldate = {2018-01-01},
journal = {Pancreatology},
volume = {18},
number = {1},
pages = {2 – 11},
publisher = {Elsevier B.V.},
abstract = {This statement was developed to promote international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) which was adopted by the National Comprehensive Cancer Network (NCCN) in 2006, but which has changed yearly and become more complicated. Based on a symposium held during the 20th meeting of the International Association of Pancreatology (IAP) in Sendai, Japan, in 2016, the presenters sought consensus on issues related to BR-PDAC. We defined patients with BR-PDAC according to the three distinct dimensions: anatomical (A), biological (B), and conditional (C). Anatomic factors include tumor contact with the superior mesenteric artery and/or celiac artery of less than 180° without showing stenosis or deformity, tumor contact with the common hepatic artery without showing tumor contact with the proper hepatic artery and/or celiac artery, and tumor contact with the superior mesenteric vein and/or portal vein including bilateral narrowing or occlusion without extending beyond the inferior border of the duodenum. Biological factors include potentially resectable disease based on anatomic criteria but with clinical findings suspicious for (but unproven) distant metastases or regional lymph nodes metastases diagnosed by biopsy or positron emission tomography-computed tomography. This also includes a serum carbohydrate antigen (CA) 19–9 level more than 500 units/ml. Conditional factors include the patients with potentially resectable disease based on anatomic and biologic criteria and with Eastern Cooperative Oncology Group (ECOG) performance status of 2 or more. The definition of BR-PDAC requires one or more positive dimensions (e.g. A, B, C, AB, AC, BC or ABC). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumor and vessels, but that biological and conditional dimensions are also important. The aim in presenting this consensus definition is also to highlight issues which remain controversial and require further research. © 2017 IAP and EPC},
note = {Cited by: 265; All Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2015
Ducreux M; Cuhna A Sa; Caramella C; Hollebecque A; Burtin P; Goéré D; Seufferlein T; Haustermans K; Laethem J L V; Conroy T; Arnold D
Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Journal Article
In: Annals of Oncology, vol. 26, pp. v56 – v68, 2015, ISSN: 09237534, (Cited by: 720; All Open Access, Bronze Open Access).
@article{Ducreux2015v56,
title = {Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up},
author = {M. Ducreux and A. Sa. Cuhna and C. Caramella and A. Hollebecque and P. Burtin and D. Goéré and T. Seufferlein and K. Haustermans and J. L. Van Laethem and T. Conroy and D. Arnold},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84941646402&doi=10.1093%2fannonc%2fmdv295&partnerID=40&md5=526c2e6c86d7844ec67e63fa004aee18},
doi = {10.1093/annonc/mdv295},
issn = {09237534},
year = {2015},
date = {2015-01-01},
urldate = {2015-01-01},
journal = {Annals of Oncology},
volume = {26},
pages = {v56 – v68},
publisher = {Oxford University Press},
note = {Cited by: 720; All Open Access, Bronze Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2014
Bockhorn M; Uzunoglu F G; Adham M; Imrie C; Milicevic M; Sandberg A A; Asbun H J; Bassi C; Büchler M; Charnley R M; Conlon K; Cruz L F; Dervenis C; Fingerhutt A; Friess H; Gouma D J; Hartwig W; Lillemoe K D; Montorsi M; Neoptolemos J P; Shrikhande S V; Takaori K; Traverso W; Vashist Y K; Vollmer C; Yeo C J; Izbicki J R
Borderline resectable pancreatic cancer: A consensus statement by the International Study Group of Pancreatic Surgery (ISGPS) Journal Article
In: Surgery (United States), vol. 155, no 6, pp. 977 – 988, 2014, ISSN: 00396060, (Cited by: 558).
@article{Bockhorn2014977,
title = {Borderline resectable pancreatic cancer: A consensus statement by the International Study Group of Pancreatic Surgery (ISGPS)},
author = {Maximilian Bockhorn and Faik G. Uzunoglu and Mustapha Adham and Clem Imrie and Miroslav Milicevic and Aken A. Sandberg and Horacio J. Asbun and Claudio Bassi and Markus Büchler and Richard M. Charnley and Kevin Conlon and Laureano Fernandez Cruz and Christos Dervenis and Abe Fingerhutt and Helmut Friess and Dirk J. Gouma and Werner Hartwig and Keith D. Lillemoe and Marco Montorsi and John P. Neoptolemos and Shailesh V. Shrikhande and Kyoichi Takaori and William Traverso and Yogesh K. Vashist and Charles Vollmer and Charles J. Yeo and Jakob R. Izbicki},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84901455120&doi=10.1016%2fj.surg.2014.02.001&partnerID=40&md5=ff29b14411d08f19636c8bd70084e5e5},
doi = {10.1016/j.surg.2014.02.001},
issn = {00396060},
year = {2014},
date = {2014-01-01},
urldate = {2014-01-01},
journal = {Surgery (United States)},
volume = {155},
number = {6},
pages = {977 – 988},
publisher = {Mosby Inc.},
abstract = {Background This position statement was developed to expedite a consensus on definition and treatment for borderline resectable pancreatic ductal adenocarcinoma (BRPC) that would have worldwide acceptability. Methods An international panel of pancreatic surgeons from well-established, high-volume centers collaborated on a literature review and development of consensus on issues related to borderline resectable pancreatic cancer. Results The International Study Group of Pancreatic Surgery (ISGPS) supports the National Comprehensive Cancer Network criteria for the definition of BRPC. Current evidence supports operative exploration and resection in the case of involvement of the mesentericoportal venous axis; in addition, a new classification of extrahepatic mesentericoportal venous resections is proposed by the ISGPS. Suspicion of arterial involvement should lead to exploration to confirm the imaging-based findings. Formal arterial resections are not recommended; however, in exceptional circumstances, individual therapeutic approaches may be evaluated under experimental protocols. The ISGPS endorses the recommendations for specimen examination and the definition of an R1 resection (tumor within 1 mm from the margin) used by the British Royal College of Pathologists. Standard preoperative diagnostics for BRPC may include: (1) serum levels of CA19-9, because CA19-9 levels predict survival in large retrospective series; and also (2) the modified Glasgow Prognostic Score and the neutrophil/lymphocyte ratio because of the prognostic relevance of the systemic inflammatory response. Various regimens of neoadjuvant therapy are recommended only in the setting of prospective trials at high-volume centers. Conclusion Current evidence justifies portomesenteric venous resection in patients with BRPC. Basic definitions were identified, that are currently lacking but that are needed to obtain further evidence and improvement for this important patient subgroup. A consensus for each topic is given. © 2014 Mosby, Inc. All rights reserved.},
note = {Cited by: 558},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hartwig W; Vollmer C M; Fingerhut A; Yeo C J; Neoptolemos J P; Adham M; Andrén-Sandberg Å; Asbun H J; Bassi C; Bockhorn M; Charnley R; Conlon K C; Dervenis C; Fernandez-Cruz L; Friess H; Gouma D J; Imrie C W; Lillemoe K D; Milićević M N; Montorsi M; Shrikhande S V; Vashist Y K; Izbicki J R; Büchler M W
In: Surgery (United States), vol. 156, no 1, pp. 1 – 14, 2014, ISSN: 00396060, (Cited by: 173).
@article{Hartwig20141,
title = {Extended pancreatectomy in pancreatic ductal adenocarcinoma: Definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS)},
author = {Werner Hartwig and Charles M. Vollmer and Abe Fingerhut and Charles J. Yeo and John P. Neoptolemos and Mustapha Adham and Åke Andrén-Sandberg and Horacio J. Asbun and Claudio Bassi and Max Bockhorn and Richard Charnley and Kevin C. Conlon and Christos Dervenis and Laureano Fernandez-Cruz and Helmut Friess and Dirk J. Gouma and Clem W. Imrie and Keith D. Lillemoe and Miroslav N. Milićević and Marco Montorsi and Shailesh V. Shrikhande and Yogesh K. Vashist and Jakob R. Izbicki and Markus W. Büchler},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84902548300&doi=10.1016%2fj.surg.2014.02.009&partnerID=40&md5=13369c977272015b86a212cc52cde706},
doi = {10.1016/j.surg.2014.02.009},
issn = {00396060},
year = {2014},
date = {2014-01-01},
urldate = {2014-01-01},
journal = {Surgery (United States)},
volume = {156},
number = {1},
pages = {1 – 14},
publisher = {Mosby Inc.},
abstract = {Background Complete macroscopic tumor resection is one of the most relevant predictors of long-term survival in pancreatic ductal adenocarcinoma. Because locally advanced pancreatic tumors can involve adjacent organs, "extended" pancreatectomy that includes the resection of additional organs may be needed to achieve this goal. Our aim was to develop a common consistent terminology to be used in centers reporting results of pancreatic resections for cancer. Methods An international panel of pancreatic surgeons working in well-known, high-volume centers reviewed the literature on extended pancreatectomies and worked together to establish a consensus on the definition and the role of extended pancreatectomy in pancreatic cancer. Results Macroscopic (R1) and microscopic (R0) complete tumor resection can be achieved in patients with locally advanced disease by extended pancreatectomy. Operative time, blood loss, need for blood transfusions, duration of stay in the intensive care unit, and hospital morbidity, and possibly also perioperative mortality are increased with extended resections. Long-term survival is similar compared with standard resections but appears to be better compared with bypass surgery or nonsurgical palliative chemotherapy or chemoradiotherapy. It was not possible to identify any clear prognostic criteria based on the specific additional organ resected. Conclusion Despite increased perioperative morbidity, extended pancreatectomy is warranted in locally advanced disease to achieve long-term survival in pancreatic ductal adenocarcinoma if macroscopic clearance can be achieved. Definitions of extended pancreatectomies for locally advanced disease (and not distant metastatic disease) are established that are crucial for comparison of results of future trials across different practices and countries, in particular for those using neoadjuvant therapy. © 2014 Mosby, Inc. All rights reserved.},
note = {Cited by: 173},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Tol J A M G; Gouma D J; Bassi C; Dervenis C; Montorsi M; Adham M; Andrén-Sandberg A; Asbun H J; Bockhorn M; Büchler M W; Conlon K C; Fernández-Cruz L; Fingerhut A; Friess H; Hartwig W; Izbicki J R; Lillemoe K D; Milicevic M N; Neoptolemos J P; Shrikhande S V; Vollmer C M; Yeo C J; Charnley R M
In: Surgery (United States), vol. 156, no 3, pp. 591 – 600, 2014, ISSN: 00396060, (Cited by: 362; All Open Access, Green Open Access).
@article{Tol2014591,
title = {Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: A consensus statement by the International Study Group on Pancreatic Surgery (ISGPS)},
author = {Johanna A. M. G. Tol and Dirk J. Gouma and Claudio Bassi and Christos Dervenis and Marco Montorsi and Mustapha Adham and Ake Andrén-Sandberg and Horacio J. Asbun and Maximilian Bockhorn and Markus W. Büchler and Kevin C. Conlon and Laureano Fernández-Cruz and Abe Fingerhut and Helmut Friess and Werner Hartwig and Jakob R. Izbicki and Keith D. Lillemoe and Miroslav N. Milicevic and John P. Neoptolemos and Shailesh V. Shrikhande and Charles M. Vollmer and Charles J. Yeo and Richard M. Charnley},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84907598225&doi=10.1016%2fj.surg.2014.06.016&partnerID=40&md5=6a50e3dd76405d21e33e07a0e91f959c},
doi = {10.1016/j.surg.2014.06.016},
issn = {00396060},
year = {2014},
date = {2014-01-01},
urldate = {2014-01-01},
journal = {Surgery (United States)},
volume = {156},
number = {3},
pages = {591 – 600},
publisher = {Mosby Inc.},
abstract = {Background The lymph node (Ln) status of patients with resectable pancreatic ductal adenocarcinoma is an important predictor of survival. The survival benefit of extended lymphadenectomy during pancreatectomy is, however, disputed, and there is no true definition of the optimal extent of the lymphadenectomy. The aim of this study was to formulate a definition for standard lymphadenectomy during pancreatectomy. Methods During a consensus meeting of the International Study Group on Pancreatic Surgery, pancreatic surgeons formulated a consensus statement based on available literature and their experience. Results The nomenclature of the Japanese Pancreas Society was accepted by all participants. Extended lymphadenectomy during pancreatoduodenectomy with resection of Ln's along the left side of the superior mesenteric artery (SMA) and around the celiac trunk, splenic artery, or left gastric artery showed no survival benefit compared with a standard lymphadenectomy. No level I evidence was available on prognostic impact of positive para-aortic Ln's. Consensus was reached on selectively removing suspected Ln's outside the resection area for frozen section. No consensus was reached on continuing or terminating resection in cases where these nodes were positive. Conclusion Extended lymphadenectomy cannot be recommended. Standard lymphadenectomy for pancreatoduodenectomy should strive to resect Ln stations no. 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a, and 17b. For cancers of the body and tail of the pancreas, removal of stations 10, 11, and 18 is standard. Furthermore, lymphadenectomy is important for adequate nodal staging. Both pancreatic resection in relatively fit patients or nonresectional palliative treatment were accepted as acceptable treatment in cases of positive Ln's outside the resection plane. This consensus statement could serve as a guide for surgeons and researchers in future directives and new clinical studies.},
note = {Cited by: 362; All Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2013
Committee E G
Informazioni per il paziente basate sulle Linee Guida per la Pratica Clinica ESMO (European Society of Medical Oncology) Working paper
2013.
@workingpaper{nokey,
title = {Informazioni per il paziente basate sulle Linee Guida per la Pratica Clinica ESMO (European Society of Medical Oncology)},
author = {ESMO Guidelines Committee},
url = {https://www.esmo.org/content/download/102598/1812535/file/IT-Cancro-del-Pancreas-una-Guida-per-il-Paziente.pdf},
year = {2013},
date = {2013-01-07},
urldate = {2022-01-03},
keywords = {},
pubstate = {published},
tppubtype = {workingpaper}
}
