Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality in the western countries for both men and women. Until in 2015, it remains one of the most challenging malignancies with a dismal prognosis and limited therapeutic options. The 5-year survival rate for pancreatic cancer is around 5%, which is the lowest among all different cancer sites. The poor prognosis of PDAC is largely attributed to delayed diagnosis due to nonspecific symptoms in the early stages of the disease, biological aggressiveness leading to rapid metastases, lack of effective screening methods, and resistance to radiation and chemotherapies. In the event of metastases, patients were traditionally referred to palliative treatments. Thanks to continuous progresses in the surgical expertise, synchronous and metachronous metastases resections seem technically feasible nowadays. These reports describe 2 several clinical cases in which patients with Pancreatic Adenocarcinoma, and synchronous and metachronous liver metastases respectively, were treated with a surgical approach. Patients showed a better survival rate compared current data in the literature. Our results, often in conflict with the guidelines and recent evidences, confirm the need for a new vision of the metastases "problem" in patients with Pancreatic Adenocarcinoma.KEY WORDS: Metastases, Pancreatic Adenocarcinoma, Surgical resection.
L’Adenocarcinoma Duttale del Pancreas è la quarta causa di mortalità nei paesi occidentali, sia nell’uomo che nella donna. Ancora oggi, rimane il tumore con prognosi peggiore ed approcci terapeutici limitati e la sopravvivenza a 5 anni raggiunge il 5%. Il ritardo nella diagnosi dovuto a sintomi non specifici nelle fasi precoci della malattia, la particolare aggressività biologica e la conseguente precoce metastatizzazione, la mancanza di programmi standardizzati di screening, la chemio-radio resistenza del tumore, sono responsabili, nella maggior parte dei casi, della prognosi infausta. In caso di metastasi, i pazienti sono tradizionalmente trattati con procedure palliative. Grazie ai continui progressi della chirurgia, la resezione di metastasi sincrone e metacrone sembra oggigiorno possibile e in grado di migliorare la sopravvivenza del paziente. Lo studio descrive due emblematici casi di Adenocarcinoma Duttale del Pancreas complicati da metastasi sincrone epatica e metacrona polmonare bilobare resecate chirurgicamente. In entrambi i casi, i pazienti hanno mostrato un tasso di sopravvivenza superiore rispetto ai dati presenti attualmente in letteratura. I nostri risultati, alla luce delle recenti lineeguida ed evidenze, confermano la necessità di una nuova interpretazione del parametro M nei pazienti affetti da Adenocarcinoma Duttale del Pancreas.
Surgical resection of synchronous and metachronous metastases from pancreatic adenocarcinoma. Two case reports in the light of recent evidences
Nardo B.Writing – Original Draft Preparation
2015-01-01
Abstract
Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality in the western countries for both men and women. Until in 2015, it remains one of the most challenging malignancies with a dismal prognosis and limited therapeutic options. The 5-year survival rate for pancreatic cancer is around 5%, which is the lowest among all different cancer sites. The poor prognosis of PDAC is largely attributed to delayed diagnosis due to nonspecific symptoms in the early stages of the disease, biological aggressiveness leading to rapid metastases, lack of effective screening methods, and resistance to radiation and chemotherapies. In the event of metastases, patients were traditionally referred to palliative treatments. Thanks to continuous progresses in the surgical expertise, synchronous and metachronous metastases resections seem technically feasible nowadays. These reports describe 2 several clinical cases in which patients with Pancreatic Adenocarcinoma, and synchronous and metachronous liver metastases respectively, were treated with a surgical approach. Patients showed a better survival rate compared current data in the literature. Our results, often in conflict with the guidelines and recent evidences, confirm the need for a new vision of the metastases "problem" in patients with Pancreatic Adenocarcinoma.KEY WORDS: Metastases, Pancreatic Adenocarcinoma, Surgical resection.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.