Author | Douglas B. Evans, MD


Combined-Modality Treatment for Operable Pancreatic Adenocarcinoma

March 01, 2005

Although in centers where pancreatectomy is performed frequently,associated morbidity and mortality rates have improved, long-term outcomesin pancreatic adenocarcinoma patients remain poor when surgeryis the sole therapeutic modality. The impact of adjuvant chemotherapyon survival in patients with localized pancreatic cancer remainsincompletely defined. The European Study Group for Pancreatic Cancer(ESPAC)-1 trial has suggested that overall survival rates are superiorwhen chemotherapy is added to surgery, even when regimens believedto be relatively ineffective in the treatment of advanced diseaseare used. The role of radiotherapy given with chemotherapy is alsounresolved, but chemoradiation continues to receive consideration inthe multimodality approach to localized pancreatic cancer. Enhancedcollaboration and increased involvement by pancreatic surgeons havehelped in the recruitment of pancreatic cancer patients for large-scalerandomized clinical trials in Europe and the United States. Many newerchemotherapeutic agents with efficacy in gastrointestinal cancers haveyet to be investigated in the adjuvant and neoadjuvant settings.

Endoscopic Ultrasound in the Diagnosis and Staging of Pancreatic Cancer

January 01, 2002

Drs. Levy and Wiersema have provided an authoritative review of the role of endoscopic ultrasonography in the diagnosis and staging of pancreatic cancer. As outlined in their article, endoscopic ultrasound has emerged as an important tool in the diagnostic evaluation of many patients with suspected pancreatic neoplasms. We concur that endoscopic ultrasound is part of the standard preoperative evaluation of patients with biochemically confirmed insulinoma and gastrinoma syndromes and of at-risk patients with multiple endocrine neoplasia type 1. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration (FNA) can also accurately determine the etiology of a cystic pancreatic neoplasm by differentiating between mucinous, serous, and inflammatory (pseudocyst) lesions.

Neoadjuvant Strategies for Pancreatic Cancer

June 01, 2001

Recent prospective and retrospective data suggest that the use of multimodality therapy combining pancreaticoduodenectomy with postoperative adjuvant chemotherapy (fluorouracil) and external-beam radiation

Pancreatic Cancer Surgical Practice Guidelines

July 01, 1997

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in