Divestment/skeletonization of the arteries in patients with advanced pancreatic ductal cancer

Published:January 08, 2021DOI:
      Every operation we perform has to balance operative risk with potential benefit. For cancer cases, the risk needs to justify the potential gain in disease-free survival or overall survival while not substantially decreasing quality of life. The management of pancreatic cancer has evolved tremendously during the past decade. Patients considered locally advanced, who 10 years ago never would have been considered for any operative intervention are now undergoing an R0 resection after total neoadjuvant therapy (TNT) with a chance for cure. After TNT with 8 to 12 cycles of neoadjuvant chemotherapy followed by 25 to 50.4 Gy of neoadjuvant chemoradiation, we are now performing technically challenging, heroic operations. But we must always remember that technical fortitude will never beat biology.
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        • Miao Y.
        • Jiang K.
        • Cai B.
        • et al.
        Arterial divestment instead of resection for locally advanced pancreatic cancer (LAPC).
        Pancreatology. 2016; 16: S59
        • Ferrone C.R.
        • Marchegiani G.
        • Hong T.S.
        • et al.
        Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer.
        Ann Surg. 2015; 261: 12-17
        • Murphy J.E.
        • Wo J.Y.
        • Ryan D.P.
        • et al.
        Total neoadjuvant therapy with FOLFIRINOX followed by individualized chemoradiotherapy for borderline resectable pancreatic adenocarcinoma: A phase 2 clinical trial.
        JAMA Oncol. 2018; 4: 963-969