Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 25Role of vascular reconstruction for patients with locally advanced pancreatic cancer who have vascular encasement
1:45 minutes.
TRANSCRIPTION:
DR LOVE: So I want to just take a breath and let the three of you throw out any questions, particularly about this issue of resectability and neoadjuvant therapy. Phil, any questions? DR BROOKS: Yes, I struggle with it, especially either with our own surgical oncologists or when patients have seen surgical oncologists elsewhere. So what you said, if they use the word — if people agree that there’s encasement, not abutment, and once there’s encasement, regardless of the response, would you say that to make that patient resectable he’s going to need some vascular — the surgery, regardless of the response, is going to have to then involve removing those vessels to really get to what you need? DR BEKAII-SAAB: So this would be a locally advanced patient. And these patients are less likely to get to surgery. Now, that said, historically only 10% of those patients would ever make it to surgery after neoadjuvant therapy. In our experience, actually, with using FOLFIRINOX — and all these patients in our practice, at least, have received radiation, unlike the borderline resectable — we’ve been able to bring that number up to 30% of the patients. And most of them required a vascular reconstruction. That said, there was, interestingly, a small baseline of patients who had such a great response that it didn’t even translate radiographically into a meaningful response, but when the patient was taken to surgery, there was complete separation of the planes, actually, in the operating room. And those patients didn’t even need vascular reconstruction. But that’s a small baseline of those patients who actually end up going to surgery. |