TY - JOUR
T1 - Added value of intra-operative ultrasound to determine the resectability of locally advanced pancreatic cancer following FOLFIRINOX chemotherapy (IMAGE): a prospective multicenter study
AU - Dutch Pancreatic Cancer Group
AU - van Veldhuisen, Eran
AU - Walma, Marieke S.
AU - van Rijssen, L. Bengt
AU - Busch, Olivier R.
AU - Bruijnen, Rutger C. G.
AU - van Delden, Otto M.
AU - Mohammad, Nadia Haj
AU - de Hingh, Ignace H.
AU - Yo, Lonneke S.
AU - van Laarhoven, Hanneke W.
AU - van Leeuwen, Maarten S.
AU - Nio, C. Yung
AU - van Santvoort, Hjalmar C.
AU - de Vries, Jan
AU - Wessels, Frank J.
AU - Wilmink, Johanna W.
AU - Molenaar, I. Quintus
AU - Besselink, Marc G.
AU - van Lienden, Krijn P.
N1 - Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: Determining the resectability of locally advanced pancreatic cancer (LAPC) after FOLFIRINOX chemotherapy is challenging because CT-scans cannot reliably assess vascular involvement. This study evaluates the added value of intra-operative ultrasound (IOUS) in LAPC following FOLFIRINOX induction chemotherapy. Methods: Prospective multicenter study in patients with LAPC who underwent explorative laparotomy with IOUS after FOLFIRINOX chemotherapy. Resectability was defined according to the National Comprehensive Cancer Network guidelines. IOUS findings were compared with preoperative CT-scans and pathology results. Results: CT-staging in 38 patients with LAPC after FOLFIRINOX chemotherapy defined 22 patients LAPC, 15 borderline resectable and one resectable. IOUS defined 19 patients LAPC, 13 borderline resectable and six resectable. In 12/38 patients, IOUS changed the resectability status including five patients from borderline resectable to resectable and five patients from LAPC to borderline resectable. Two patients were upstaged from borderline resectable to LAPC. Tumor diameters were significantly smaller upon IOUS (31.7 ± 9.5 mm versus 37.1 ± 10.0 mm, p = 0.001) and resectability varied significantly (p = 0.043). Ultimately, 20 patients underwent resection of whom 14 were evaluated as (borderline) resectable on CT-scan, and 17 on IOUS. Discussion: This prospective study demonstrates that IOUS may change the resectability status up to a third of patients with LAPC following FOLFIRINOX chemotherapy.
AB - Background: Determining the resectability of locally advanced pancreatic cancer (LAPC) after FOLFIRINOX chemotherapy is challenging because CT-scans cannot reliably assess vascular involvement. This study evaluates the added value of intra-operative ultrasound (IOUS) in LAPC following FOLFIRINOX induction chemotherapy. Methods: Prospective multicenter study in patients with LAPC who underwent explorative laparotomy with IOUS after FOLFIRINOX chemotherapy. Resectability was defined according to the National Comprehensive Cancer Network guidelines. IOUS findings were compared with preoperative CT-scans and pathology results. Results: CT-staging in 38 patients with LAPC after FOLFIRINOX chemotherapy defined 22 patients LAPC, 15 borderline resectable and one resectable. IOUS defined 19 patients LAPC, 13 borderline resectable and six resectable. In 12/38 patients, IOUS changed the resectability status including five patients from borderline resectable to resectable and five patients from LAPC to borderline resectable. Two patients were upstaged from borderline resectable to LAPC. Tumor diameters were significantly smaller upon IOUS (31.7 ± 9.5 mm versus 37.1 ± 10.0 mm, p = 0.001) and resectability varied significantly (p = 0.043). Ultimately, 20 patients underwent resection of whom 14 were evaluated as (borderline) resectable on CT-scan, and 17 on IOUS. Discussion: This prospective study demonstrates that IOUS may change the resectability status up to a third of patients with LAPC following FOLFIRINOX chemotherapy.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85064406987&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31010633
U2 - https://doi.org/10.1016/j.hpb.2019.02.017
DO - https://doi.org/10.1016/j.hpb.2019.02.017
M3 - Article
C2 - 31010633
SN - 1365-182X
VL - 21
SP - 1385
EP - 1392
JO - HPB
JF - HPB
IS - 10
ER -