1
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Endo Y, Tanaka M, Kitago M, Yagi H, Abe Y, Hasegawa Y, Hori S, Nakano Y, Iwasaki E, Kitagawa Y. Comparison Between Plastic and Metallic Biliary Stent Placement for Preoperative Patients with Pancreatic Head Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2024; 31:1319-1327. [PMID: 37952017 DOI: 10.1245/s10434-023-14523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/15/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Optimal preoperative biliary drainage for patients with pancreatic cancer before pancreatoduodenectomy remains unclear. This study aimed to investigate the comparison of efficacy and safety between a metallic stent (MS) and a plastic stent (PS). METHODS Comparative studies on the use of MS and PS for pancreatic cancer before pancreatoduodenectomy were systematically searched using the MEDLINE and Web of Science databases. Pre- and postoperative data also were extracted. Random-effects meta-analyses were performed to compare post-endoscopic retrograde cholangiopancreatography (ERCP) complications as well as intra- and postoperative outcomes between the two arms of the study, and pooled odds ratios (ORs) or mean differences (MDs) were calculated with 95 percent confidence intervals (CIs). RESULTS The study analyzed 12 studies involving 683 patients. Insertion of MS was associated with a lower incidence of re-intervention (OR, 0.06; 95% CI 0.03-0.15; P < 0.001), increased post-ERCP adverse events (OR, 2.22; 95% CI 1.13-4.36; P = 0.02), and similar operation time (MD, 18.0 min; 95% CI -29.1 to 65.6 min; P = 0.46), amount of blood loss (MD, 43.0 ml; 95% CI -207.1 to 288.2 ml; P = 0.73), and surgical complication rate (OR, 0.78; 95% CI 0.53-1.15; P = 0.21). The cumulative stent patency rate after 3 months was higher in the MS group than in the PS group (70-100 % vs 30.0-45.0 %). CONCLUSION For biliary drainage in patients with pancreatic cancer during this era of multidisciplinary treatment, MS use might be the first choice because MS provides a more durable biliary drainage and a similar risk of postoperative outcomes compared with PS.
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Affiliation(s)
- Yutaka Endo
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Masayuki Tanaka
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan.
| | - Minoru Kitago
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Hiroshi Yagi
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Yuta Abe
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Yasushi Hasegawa
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Shutaro Hori
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Yutaka Nakano
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Eisuke Iwasaki
- Departments of Internal Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Yuko Kitagawa
- Departments of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
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2
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Wei X, Yu S, Wang J, Xiang Z, Liu L, Min Y. Association between time from diagnosis to treatment and survival of patients with nasopharyngeal carcinoma: A population-based cohort study. Curr Probl Cancer 2024; 48:101060. [PMID: 38211418 DOI: 10.1016/j.currproblcancer.2024.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/06/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Treatment delays have frequently been observed in cancer patients. Whether the treatment delays would impair the survival of patients with nasopharyngeal carcinoma (NPC) is still unclear. METHODS The data were derived from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Patients were divided into groups of timely treatment (<1 month), intermediate delay (1 and 2 months), and long delay (3-6 months). The influence of different treatment delay intervals on long-term survival was evaluated by multivariate Cox regression analysis. RESULTS In total, 2,048 patients with NPC were included in our study. There were 551 patients in the early stage (I, II stage: 26.9 %) and 1,497 patients in the advanced stage (III, IV stage: 73.1 %). No significant difference in overall survival (OS) or cancer-specific survival (CSS) was observed among the groups with various treatment delay intervals (p = 0.48 in OS and p = 0.43 in CSS, respectively). However, upon adjusting for covariates, a significantly improved OS probability emerged in patients with intermediate treatment delays compared to those who received timely interventions in both the entire study population (adjustedHazard Ratio (aHR)=0.86, 95 % CI: 0.74-0.99, p = 0.043) and the subgroup with advanced stage (aHR=0.85, 95 % CI: 0.72-1.00, p = 0.049). Regarding the CSS probability, similar associations were also observed in the entire study population (aHR=0.84, 95 % CI: 0.71-0.98, p = 0.030) as well as the advanced-stage patients (aHR=0.83, 95 % CI: 0.70-0.99, p = 0.038). CONCLUSIONS Our results revealed that treatment delays are not associated with worse survival of NPC patients. Tumor-specific characteristics and subsequent treatment modalities play more pivotal roles in the prognosis of NPC.
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Affiliation(s)
- Xiaoyuan Wei
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Siting Yu
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Jun Wang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Zhongzheng Xiang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Lei Liu
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| | - Yu Min
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
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3
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Frountzas M, Liatsou E, Schizas D, Pergialiotis V, Vailas M, Kritikos N, Toutouzas KG. The impact of surgery delay on survival of resectable pancreatic cancer: A systematic review of observational studies. Surg Oncol 2022; 45:101855. [DOI: 10.1016/j.suronc.2022.101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022]
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4
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Balzano V, Laurent E, Florence AM, Lecuyer AI, Lefebvre C, Heitzmann P, Hammel P, Lecomte T, Grammatico-Guillon L. Time interval from last visit to imaging diagnosis influences outcome in pancreatic adenocarcinoma: A regional population-based study on linked medico-administrative and clinical data. Ther Adv Med Oncol 2022; 14:17588359221113264. [PMID: 36090802 PMCID: PMC9449516 DOI: 10.1177/17588359221113264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Excessive waiting time intervals for the diagnosis and treatment of patients with pancreatic cancer can influence their prognosis but they remain unclear. The objective was to describe time intervals from the medical visit to diagnostic imaging and to treatment and their prognostic impact in pancreatic cancer in one French region. Methods: This retrospective observational multicentre study included all patients with pancreatic cancer seen for the first time in 2017 in multidisciplinary team meetings (MTMs), where clinical data were collected. A probabilistic matching with the medico-administrative data from the French national healthcare database (Système National des Données de Santé) was performed to define the care pathway from clinical presentation to the beginning of treatment. Median key time intervals were estimated for both resected and unresected tumours. Factors associated with 1-year survival were studied using Cox model. Results: A total of 324 patients (88% of total patients with MTM presentation) were matched and included: male 54%, mean age 72 years ±9.2, Eastern Cooperative Oncology Group (ECOG) PS > 1 19.5%, metastatic disease at diagnosis 47.4%, tumour resection 16%. At 1 year, 57% had died (65% in the unresected group and 17% in the resected group). The median time interval from the medical visit to diagnostic imaging was 15 days [Q1–Q3: 8–44]. After imaging, median time intervals to definite diagnosis and to first treatment were 11 and 20 days, respectively. Significant prognostic factors associated with the risk of death at 1 year were ECOG PS > 1 (hazard ratio (HR) 2.1 [1.4–3.0]), metastasis (HR 2.7 [1.9–3.9]), no tumour resection (HR 2.7 [1.3–5.6]) and time interval between the medical visit and diagnostic imaging ⩾25 days (HR 1.7 [1.2–2.3]). Conclusion: Delay in access to diagnostic imaging impacted survival in patients with pancreatic cancer, regardless of whether tumour resection had been performed.
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Affiliation(s)
- Vittoria Balzano
- OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France.,Gastroenterology and Digestive Oncology Department, Teaching Hospital of Tours, Tours, France
| | - Emeline Laurent
- Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France.,Research Unit EA7505 "Education, Ethics and Health", University of Tours, Tours, France
| | - Aline-Marie Florence
- Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France.,Department of Public Healht, Faculty of Medicine,University of Tours, France
| | - Anne-Isabelle Lecuyer
- Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France.,Research Unit EA7505 "Education, Ethics and Health", University of Tours, Tours, France
| | - Carole Lefebvre
- OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France
| | - Patrick Heitzmann
- OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France
| | - Pascal Hammel
- Digestive and Medical Oncology Department, Paul Brousse University Hospital, Villejuif, France.,Paris-Saclay University, Villejuif, France
| | - Thierry Lecomte
- OncoCentre, Cancer network of the Centre-Val de Loire region, Tours, France.,University of Tours, Faculty of Medicine, Tours, France.,Gastroenterology and Digestive Oncology Department, Teaching Hospital of Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Department of Public Healht, Faculty of Medicine, University of Tours, France.,Public Health Unit, Epidemiology (EpiDcliC), Teaching Hospital of Tours, 2 Boulevard Tonnellé, 37044 Tours cedex 9, France
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5
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Brugel M, Bouché O, Kianmanesh R, Teuma L, Tashkandi A, Regimbeau JM, Pessaux P, Royer B, Rhaiem R, Perrenot C, Neuzillet C, Piardi T, Deguelte S. Time from first seen in specialist care to surgery does not influence survival outcome in patients with upfront resected pancreatic adenocarcinoma. BMC Surg 2021; 21:413. [PMID: 34876080 PMCID: PMC8649990 DOI: 10.1186/s12893-021-01409-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study evaluated the impact of time to surgery (TTS) on overall survival (OS), disease free survival (DFS) and postoperative complication rate in patients with upfront resected pancreatic adenocarcinoma (PA). METHODS We retrospectively included patients who underwent upfront surgery for PA between January 1, 2004 and December 31, 2014 from four French centers. TTS was defined as the number of days between the date of the first consultation in specialist care and the date of surgery. DFS for a 14-day TTS was the primary endpoint. We also analyzed survival depending on different delay cut-offs (7, 14, 28, 60 and 75 days). RESULTS A total of 168 patients were included. 59 patients (35%) underwent an upfront surgery within 14 days. Patients in the higher delay group (> 14 days) had significantly more vein resections and endoscopic biliary drainage. Adjusted OS (p = 0.44), DFS (p = 0.99), fistulas (p = 0.41), hemorrhage (p = 0.59) and severe post-operative complications (p = 0.82) were not different according to TTS (> 14 days). Other delay cut-offs had no impact on OS or DFS. DISCUSSION TTS seems to have no impact on OS, DFS and 90-day postoperative morbidity.
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Affiliation(s)
- M. Brugel
- Department of Ambulatory Oncology Care Unit, Centre Hospitalier Universitaire de Reims, Rue du general Koenig, Reims, France
| | - O. Bouché
- Department of Ambulatory Oncology Care Unit, Centre Hospitalier Universitaire de Reims, Rue du general Koenig, Reims, France
- University Reims Champagne-Ardenne (URCA), Reims, France
| | - R. Kianmanesh
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - L. Teuma
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - A. Tashkandi
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - J. M. Regimbeau
- Digestive Surgery Department, CHU Amiens Picardie, 1 rond-point du Professeur Christian Cabrol, Amiens, France
- University of Picardie Jules-Vernes, 51 boulevard de Chateaudun, Amiens, France
| | - P. Pessaux
- General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, 1 quai Louis Pasteur, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - B. Royer
- General Surgeon, Clinique de Courlancy, 38bis rue de Courlancy, Bezannes, France
| | - R. Rhaiem
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - C. Perrenot
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - C. Neuzillet
- Medical Oncology Department, Institut Curie, 35 rue Dailly, Saint-Cloud, France
- Versailles Saint-Quentin University, Paris Saclay University, Saint-Cloud, France
| | - T. Piardi
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - S. Deguelte
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
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6
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Joliat GR, Labgaa I, Gilgien J, Demartines N. Prognostic Impact of Time to Surgery in Patients With Resectable Pancreatic Ductal Adenocarcinoma. Pancreas 2021; 50:104-110. [PMID: 33370031 DOI: 10.1097/mpa.0000000000001719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Some studies suggested the importance of performing pancreatoduodenectomy expeditiously in resectable pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the prognostic value of time to surgery in patients undergoing pancreatoduodenectomy for PDAC. METHODS All PDAC patients who underwent upfront pancreatoduodenectomy were collected (2000-2015). Diagnosis date was the computed tomography scan date where a suspicious pancreatic head lesion was observed. Survival analyses were performed using Kaplan-Meier method. Cox model was used to find predictive factors of survival. RESULTS A total of 192 patients underwent pancreatoduodenectomy. The median time to surgery was 27 days (interquartile range, 17-40 days). The best dichotomous threshold for 24-month overall survival (OS) was 30 days. The median OS was similar between groups with time to surgery of fewer than 30 days and time to surgery of 30 days or more (25 vs 21 months, P = 0.609). Similar results were found for median recurrence-free survivals (19 vs 15 months, P = 0.561). On Cox regressions, time to surgery was not associated with shorter OS. Only lymph node invasion and adjuvant chemotherapy were independent OS predictors (hazard ratio, 2.610, P = 0.006, and hazard ratio, 2.042, P = 0.001). CONCLUSIONS Delaying surgery 30 days or more after diagnostic computed tomography scan was not associated with poorer OS and recurrence-free survival. Moreover, time to surgery was not prognostic of OS.
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Affiliation(s)
- Gaëtan-Romain Joliat
- From the Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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7
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Steen MW, van Rijssen LB, Festen S, Busch OR, Groot Koerkamp B, van der Geest LG, de Hingh IH, van Santvoort HC, Besselink MG, Gerhards MF. Impact of time interval between multidisciplinary team meeting and intended pancreatoduodenectomy on oncological outcomes. BJS Open 2020; 4:884-892. [PMID: 32841533 PMCID: PMC7528524 DOI: 10.1002/bjs5.50319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 05/29/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Dutch guidelines indicate that treatment of pancreatic head and periampullary malignancies should be started within 3 weeks of the multidisciplinary team (MDT) meeting. This study aimed to assess the impact of time to surgery on oncological outcomes. METHODS This was a retrospective population-based cohort study of patients with pancreatic head and periampullary malignancies included in the Netherlands Cancer Registry. Patients scheduled for pancreatoduodenectomy and who were discussed in an MDT meeting from May 2012 to December 2016 were eligible. Time to surgery was defined as days between the final preoperative MDT meeting and surgery, categorized in tertiles (short interval, 18 days or less; intermediate, 19-32 days; long, 33 days or more). Oncological outcomes included overall survival, resection rate and R0 resection rate. RESULTS A total of 2027 patients were included, of whom 677, 665 and 685 had a short, intermediate and long time interval to surgery respectively. Median time to surgery was 25 (i.q.r. 14-36) days. Longer time to surgery was not associated with overall survival (hazard ratio 0·99, 95 per cent c.i. 0·87 to 1·13; P = 0·929), resection rate (relative risk (RR) 0·96, 95 per cent c.i. 0·91 to 1·01; P = 0·091) or R0 resection rate (RR 1·01, 0·94 to 1·09; P = 0·733). Patients with pancreatic ductal adenocarcinoma and a long time interval had a lower resection rate (RR 0·92, 0·85 to 0·99; P = 0·029). DISCUSSION A longer time interval between the last MDT meeting and pancreatoduodenectomy did not decrease overall survival.
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Affiliation(s)
- M W Steen
- Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands.,Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L B van Rijssen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - S Festen
- Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - O R Busch
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - B Groot Koerkamp
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - L G van der Geest
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands
| | - I H de Hingh
- Regional Academic Cancer Centre Utrecht, St Antonius Hospital Nieuwegein and University Medical Centre, Utrecht Cancer Centre Utrecht, Eindhoven, the Netherlands
| | - H C van Santvoort
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
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8
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Tuech JJ, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L. Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic. J Visc Surg 2020; 157:S7-S12. [PMID: 32249098 PMCID: PMC7269902 DOI: 10.1016/j.jviscsurg.2020.03.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery-go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer-colon, pancreas, oesogastric, hepatocellular carcinoma-morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality-oesogastric, hepatic or pancreatic-is most often best deferred.
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Affiliation(s)
- J-J Tuech
- Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France.
| | - A Gangloff
- Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Di Fiore
- Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France; Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - P Michel
- Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France; Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - K Slim
- Department of digestive surgery, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - M Pocard
- Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France; Service de chirurgie digestive et cancérologique Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France
| | - L Schwarz
- Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France
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9
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Catanese S, Pentheroudakis G, Douillard JY, Lordick F. ESMO Management and treatment adapted recommendations in the COVID-19 era: Pancreatic Cancer. ESMO Open 2020; 5:e000804. [PMID: 32423899 PMCID: PMC7239531 DOI: 10.1136/esmoopen-2020-000804] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic is challenging the capacities of health systems in many countries. National healthcare services have to manage unexpected shortages of healthcare resources that have to be re-allocated according to the principles of fair and ethical prioritisation, in order to maintain the highest levels of care to all patients, ensure the safety of patients and healthcare workers, and save as many lives as possible. Also, cancer care services have to pursue restructuring, following the same evidence-based dispositions. In this article, we propose a guidance to the management of pancreatic cancer during the pandemic, prioritised according to a three-tiered framework, and based on expert clinical judgement and magnitude of benefit expected from specific interventions. Since the availability of resources for diagnostic procedures, surgery and postoperative care, systemic therapy and radiotherapy may differ, the authors have separated the prioritisation analyses. The impact of postponing or abrogating cancer interventions on outcomes according to a high, medium or low priority scale is outlined and discussed. The implementation of healthcare services using telemedicine is explored; it reveals itself as functional and effective for limiting patients' need to travel to centres and thereby has the potential to reduce diffusion of SARS-CoV-2. Pancreatic cancer demands a considerable amount of medical resources. Therefore, the redefinition of its diagnostic and therapeutic algorithms with a rigorous method is crucial in order to ensure the highest quality of continuum of care in the broader context of the pandemic and the challenged healthcare systems.
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Affiliation(s)
- Silvia Catanese
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | | | | | - Florian Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
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10
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Tuech JJ, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L. [Strategy for the practice of digestive and oncologic surgery in COVID-19 epidemic situation]. ACTA ACUST UNITED AC 2020; 157:S6-S12. [PMID: 32834885 PMCID: PMC7271206 DOI: 10.1016/j.jchirv.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
La pandémie due au COVID-19 modifie l’organisation des soins et change la réalisation de la chirurgie digestive. Les priorités sanitaires et les circuits de soins sont modifiés. La chirurgie d’urgence reste prioritaire. Les interventions pour chirurgie fonctionnelles sont à reporter. La chirurgie par laparoscopie doit suivre des règles strictes pour ne pas exposer les professionnels à un surrisque. Le questionnement principal concerne la chirurgie oncologique, opérer ou reporter ? Il existe probablement un sur risque opératoire induit par la pandémie qui doit être mis en balance avec le retard de prise en charge chirurgical. Pour chaque type de cancer, colon, pancréas, œsogastrique, hépatocarcinome, la morbi-mortalité est rappelée et mise en parallèle avec le risque oncologique lié au retard à la chirurgie et/ou au temps de doublement de la tumeur. Cette comparaison permet de proposer des stratégies, ainsi pour les cancers coliques (T1-2, N0), il est souhaitable de retarder la chirurgie. Pour les lésions coliques avancées, il semble prudent de recommander une chimiothérapie néo adjuvante et d’attendre. Pour les cancers du rectum T3-4 et/ou N+, une radio-chimiothérapie est indiquée, une radiothérapie courte devra être discutée (suivie d’une période d’attente) afin de réduire le temps d’exposition à l’hôpital et d’éviter les infections. La majorité des chirurgies complexes à forte morbi-mortalité, œsogastrique, hépatique ou pancréatique doivent sans doute le plus souvent être reportée.
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Affiliation(s)
- J.-J. Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Auteur correspondant.
| | - A. Gangloff
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - F. Di Fiore
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - P. Michel
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - C. Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - K. Slim
- Department of digestive surgery, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - M. Pocard
- UMR 1275 CAP Paris-Tech, université de Paris, 75010 Paris, France
- Service de chirurgie digestive et cancérologique, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - L. Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
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Sudarshan M, Raja S. Commentary: Take your time but quickly! Impact of time to surgery in early esophageal cancer. J Thorac Cardiovasc Surg 2020; 159:1636-1637. [PMID: 32035647 DOI: 10.1016/j.jtcvs.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Monisha Sudarshan
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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12
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Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. J Gastrointest Surg 2020; 24:2357-2373. [PMID: 32607860 PMCID: PMC7325836 DOI: 10.1007/s11605-020-04712-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines. METHODS A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer. RESULTS For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery. CONCLUSION Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes.
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Lambert A, Schwarz L, Borbath I, Henry A, Van Laethem JL, Malka D, Ducreux M, Conroy T. An update on treatment options for pancreatic adenocarcinoma. Ther Adv Med Oncol 2019; 11:1758835919875568. [PMID: 31598142 PMCID: PMC6763942 DOI: 10.1177/1758835919875568] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022] Open
Abstract
Pancreatic cancer is one of the most lethal solid organ tumors. Due to the rising incidence, late diagnosis, and limited treatment options, it is expected to be the second leading cause of cancer deaths in high income countries in the next decade. The multidisciplinary treatment of this disease depends on the stage of cancer at diagnosis (resectable, borderline, locally advanced, and metastatic disease), and combines surgery, chemotherapy, chemoradiotherapy, and supportive care. The landscape of multidisciplinary pancreatic cancer treatment is changing rapidly, especially in locally advanced disease, and the number of treatment options in metastatic disease, including personalized medicine, innovative targets, immunotherapy, therapeutic vaccines, adoptive T-cell transfer, or stemness inhibitors, will probably expand in the near future. This review summarizes the current literature and provides an overview of how new therapies or new therapeutic strategies (neoadjuvant therapies, conversion surgery) will guide multidisciplinary disease management, future clinical trials, and, hopefully, will increase overall survival.
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Affiliation(s)
- Aurélien Lambert
- Department of Medical Oncology, Institut de Cancérologie de Lorraine and Université de Lorraine, Nancy, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, France
| | - Ivan Borbath
- Department of Gastroenterology and Digestive Oncology, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Aline Henry
- Department of Supportive Care in Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Jean-Luc Van Laethem
- Department of Gastroenterology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - David Malka
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Thierry Conroy
- Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne, 50519 Vandoeuvre-lès-Nancy CEDEX, France
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