Clinical trial NCT06206382: Surgical Results of Resection of Locally Advanced Pancreatic Cancer
Official title: Surgical Outcome of Borderline Resectable Pancreatic Cancer: Upfront Surgery Versus Neoadjuvant Chemotherapy (Single Center Experience)
Study type: OBSERVATIONAL
Overall status: NOT_YET_RECRUITING
Conditions: Pancreas Cancer
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2024-01-16
Enrollment: 80
Sex: ALL
Minimum age (years): 20
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Patients of borderline respectable pancreatic cancer undergoing Whipple operation

Brief summary: The aim is to compare the surgical outcomes between upfront surgery and surgery after neoadjuvant chemotherapy in terms of morbidity and mortality

Detailed description: Pancreatic cancer is the fourth leading cause of cancer death in the United States. While surgical resection remains the only curative option, more than 80% of patients present with unresectable disease. Unfortunately, even among those who undergo resection, the reported median survival is 15-23 mo, with a 5-year survival of approximately 20%. Disappointingly, over the past several decades, despite improvements in diagnostic imaging, surgical technique and chemotherapeutic options, only modest improvements in survival have been realized. Nevertheless, it remains clear that surgical resection is a prerequisite for achieving long-term survival and cure. The concept of borderline resectable pancreatic cancer has evolved from several clinical observations made over decades. It has been recognized for some time that the prognosis for patients undergoing surgical resection for pancreatic ductal adenocarcinoma (PDAC) is highly dependent on margin status, with total gross excision and histologically negative margins (R0 resection) being associated with the best outcomes. Survival for patients who undergo total gross excision but have histologically positive margins (R1 resection) have a reduced survival in most series

Eligibility criteria: Inclusion Criteria:

* Patients under surgical management for pancreatic cancer
* Patients whose radiological findings are compatible with resectability of the tumour including vascular encasement

Exclusion Criteria:

* Patients who are medically unfit for surgery
* Patients whose radioliogical findins suggestive of unresectability of the tumour including vascular abutment or infiltration more than 180 dergree

Primary outcomes:
measure: Mortality
timeFrame: 3 years
Secondary outcomes:
measure: Morbidity
timeFrame: 6 months
Other outcomes:
Locations:
Study officials:
References:
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citation: Han S, Choi DW, Choi SH, Heo JS, Han IW, You YH. Long-term outcomes following en bloc resection for pancreatic ductal adenocarcinoma of the head with portomesenteric venous invasion. Asian J Surg. 2021 Jan;44(1):313-320. doi: 10.1016/j.asjsur.2020.07.021. Epub 2020 Sep 21.
citation: Lapshyn H, Schulte T, Petruch N, Petrova E, Honselmann K, Deichmann S, Braun R, Kulemann B, Hoeppner J, Rades D, Keck T, Wellner UF, Bausch D, Bolm L. Postoperative Outcomes of Tangential versus Segmental Resection and End-to-end Reconstruction of the Superior Mesenterico-Portal Vein During Pancreatoduodenectomy for Pancreatic Adenocarcinoma: A Single-Center Experience. Anticancer Res. 2021 Oct;41(10):5123-5130. doi: 10.21873/anticanres.15329.
citation: Yu XZ, Li J, Fu DL, Di Y, Yang F, Hao SJ, Jin C. Benefit from synchronous portal-superior mesenteric vein resection during pancreaticoduodenectomy for cancer: a meta-analysis. Eur J Surg Oncol. 2014 Apr;40(4):371-8. doi: 10.1016/j.ejso.2014.01.010. Epub 2014 Feb 7.
citation: Tewari M. Significance of pathological positive superior mesenteric/portal venous invasion in pancreatic cancer. Hepatobiliary Pancreat Dis Int. 2016 Dec;15(6):572-578. doi: 10.1016/s1499-3872(16)60156-x.