Department of Gastroenterological Surgery II, Hokkaido University, Faculty of Medicine, West-7, North-15, Kita-ku, Sapporo, 060-8638, Hokkaido, Japan.
J Hepatobiliary Pancreat Sci. 2018 Jul;25(7):342-350. doi: 10.1002/jhbp.565. Epub 2018 Jun 28.
Conversion surgery (CS) is expected as a new therapeutic strategy for patients with unresectable pancreatic cancer (UR-PC). We analyzed outcomes of CS for patients with UR-PC and evaluated the survival benefit of CS.
Thirty-four patients diagnosed with UR-PC according to the National Comprehensive Cancer Network guideline underwent CS in our hospital. Resectability was considered by multimodal images in patients who underwent nonsurgical treatment (NST) for more than 6 months. CS was performed only in patients who were judged to be able to undergo R0 resection.
Twenty-six patients had locally advanced PC, and eight had distant metastases. The median duration of NST was 9 (range 5-44) months. R0 resection was achieved in 30 patients (88.2%). Six patients (17.6%) showed Evans grade ≥III. Three- and 5-year overall survival (OS) rates from initial treatment were 74% and 56.9%, respectively, with median survival time (MST) of 5.3 years. The actual 5-year OS rate in 19 patients was 47.4% with an MST of 4.0 years. Patients with Evans grade ≥III had a better prognosis than those with Evans grade <III (P = 0.0092, log-rank test).
Conversion surgery might have survival benefits to patients with UR-PC who responded favorably to NST.
转换手术（CS）有望成为不可切除胰腺癌（UR-PC）患者的一种新的治疗策略。我们分析了 CS 治疗 UR-PC 患者的结果，并评估了 CS 的生存获益。
根据国家综合癌症网络指南，34 例被诊断为 UR-PC 的患者在我院接受 CS。在接受非手术治疗（NST）超过 6 个月的患者中，通过多模态图像评估可切除性。仅对判断能够进行 R0 切除的患者进行 CS。
26 例患者为局部晚期 PC，8 例患者发生远处转移。NST 的中位时间为 9（5-44）个月。30 例患者达到 R0 切除（88.2%）。6 例（17.6%）患者 Evans 分级≥III。初始治疗的 3 年和 5 年总生存率（OS）分别为 74%和 56.9%，中位生存时间（MST）为 5.3 年。19 例患者的实际 5 年 OS 率为 47.4%，MST 为 4.0 年。Evans 分级≥III 的患者预后优于 Evans 分级<III 的患者（P=0.0092，对数秩检验）。
对于对 NST 反应良好的 UR-PC 患者，转换手术可能具有生存获益。
