What would you recommend as first line therapy for a 68 y/o woman with local pancreatic cancer and no metastatic disease with ECOG-1? Surgical Resection Yongyut Sirivatanauksorn MD MSc PhD HPB & Transplant Surgery Unit Faculty of Medicine Siriraj Hospital
What would you recommend as first line therapy for a 68 y/o woman with local pancreatic cancer and no metastatic disease with ECOG-1? Chemoradiation: Rachna Shroff, MD Surgical Resection: Yongyut Sirivatanauksorn, MD
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What would you recommend as first line therapy for a 68 y/o woman with local pancreatic
cancer and no metastatic disease with ECOG-1? Surgical Resection
Yongyut Sirivatanauksorn MD MSc PhD
HPB & Transplant Surgery UnitFaculty of Medicine Siriraj Hospital
Pancreatic Cancer• High incidence of regionally advanced and
metastatic disease
• Only 10-15% patients have resectable
diseaseHead 60% Body/Tail 40%
20% resectable <5% resectable
20% 5-yr survival <15% 5-
yr survival
<3% alive at 5 years
a 68 y/o woman with local pancreatic cancer and no metastatic disease with ECOG-1?
Resectable Pancreatic CancerOnly 10–20% are candidates for attempted curative resection
no distant metastases
no radiographic evidence of portal vein or superior mesenteric vein involvement.
clear fat planes around the superior mesenteric artery, hepatic artery, and celiac axis.
Borderline Resectable Pancreatic Cancer
no distant metastases
tumor abutment of the SMA does not exceed 180 degrees of the vessel wall circumference
any venous involvement of the SMV or portal vein allows for safe resection and reconstruction
gastroduodenal artery (GDA) encasement up to the hepatic artery with either direct abutment or short segment encasement of the hepatic artery without extension to the celiac axis
any venous involvement of the SMV or portal vein allows for safe resection and reconstruction
Borderline Resectable Pancreatic Cancer
any venous involvement of the SMV or portal vein allows for safe resection and reconstruction
Borderline Resectable Pancreatic Cancer
Unresectable Locally Advanced Pancreatic Cancer
unreconstructible encasement of the SMV/PV
any celiac involvement
encasement (≥180°) of the SMA
aortic involvement
Fewer Than 1/3 Of Resectable Patients Receive Surgery
Results following Pancreaticoduodenect
omyDue to improved surgical skill and
perioperative care
Mortality rate 20%-40% in earlier days
During the past decades, dramatically decreased and currently is between 0-4% in experience centers with experience.
N Mortality Morbidity
Overall 1175 2% 38%
1970’s 23 30% -
1980’s 65 5% 30%
1990’s 514 2% 31%
2000’s 573 1% 45%
1423 Pancreaticoduodenectomies for Pancreatic Cancer
Winter JM, et al. J Gastrointest Surg 2006, 10:1199-1210