International Session（Symposium）5(JSGS・JSGE・JGES)
Fri. November 6th   9:30 - 12:00   Room 3: Kobe International Exhibition Hall No.2 Building Conference Room 3A
IS-S5-Keynote Lecture
 Remaining issues in neoadjuvant treatment for borderline resectable pancreatic cancer
Itaru Endo
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine
Treatment strategies were chosen based on resectability criteria consisting of 'resectable', 'borderline resectable', and 'unresectable' in pancreatic cancer. Borderline resectable (BR) means a tumor invades severely to the portal vein or hepatic artery of superior mesenteric artery. Neoadjuvant chemotherapy followed by re-evaluation of resectability criteria and surgical resection has been adopted as the standard treatment worldwide. In Japan, a nationwide research group for the pancreatic resection conducted a questionnaire survey concerning BR PDAC in 2010, collecting clinical data from a total of 624 patients. Resection rate and R0 resection rate were 86.4% and 65.9%, resepectively.
PV/SMV resection were performed in 69 % (430/624). Although the 5-year overall survival of BR-PV patients was 15%, it was significantly worse in the patients with BR-A (3.4-6.8%). A systematic review showed overall resection rate was 65%. Among them, R0 resection rates was 57.4%. We should clarify whether R1 resection is caused by insufficient treatment strength and/or inappropriate operative procedures. To obtain not only R0 resection but also good overall survival, evaluation of treatment effects before surgery is highly important. Currently pathological responses in the resected specimen showed unevenness according to institutions. It is obscure why the overall survival rates and R0 resection rates have been improved in spite of fair histological effects. A novel, reliable, commonly available diagnostic modalities should be developed. Furthermore, appropriate choice of chemotherapeutic regimens should be established in accordance with patients resectablity criteria (BR-PV vs BR-A). As the keynote lecture of this symposium, these issues should be discussed.
Index Term 1: pancreatic cancer
Index Term 2: neoadjuvant therapy
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