Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trial
Abstract Background One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our coh...
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | BMC Cancer |
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| Online Access: | http://link.springer.com/article/10.1186/s12885-019-6148-5 |
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| author | U. A. Wittel D. Lubgan M. Ghadimi O. Belyaev W. Uhl W. O. Bechstein R. Grützmann W. M. Hohenberger A. Schmid L. Jacobasch R. S. Croner A. Reinacher-Schick U. T. Hopt A. Pirkl H. Oettle R. Fietkau H. Golcher |
| author_facet | U. A. Wittel D. Lubgan M. Ghadimi O. Belyaev W. Uhl W. O. Bechstein R. Grützmann W. M. Hohenberger A. Schmid L. Jacobasch R. S. Croner A. Reinacher-Schick U. T. Hopt A. Pirkl H. Oettle R. Fietkau H. Golcher |
| author_sort | U. A. Wittel |
| collection | DOAJ |
| description | Abstract Background One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer. Methods Pretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared. Results One hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P < 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p < 0.05). Conclusion Excellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors. Trial registration EudraCT:2009-014476-21 (2013-02-22) and NCT01827553 (2013-04-09). |
| first_indexed | 2024-04-13T04:56:58Z |
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| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-04-13T04:56:58Z |
| publishDate | 2019-10-01 |
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| spelling | doaj.art-3df49ff93ebe4801921e89633ae378f02022-12-22T03:01:27ZengBMCBMC Cancer1471-24072019-10-011911910.1186/s12885-019-6148-5Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trialU. A. Wittel0D. Lubgan1M. Ghadimi2O. Belyaev3W. Uhl4W. O. Bechstein5R. Grützmann6W. M. Hohenberger7A. Schmid8L. Jacobasch9R. S. Croner10A. Reinacher-Schick11U. T. Hopt12A. Pirkl13H. Oettle14R. Fietkau15H. Golcher16Department for General- und Visceral Surgery, Medical Center and Faculty of Medicine University of FreiburgDepartment of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Department of General, Visceral and Pediatric Surgery, Medical Center Georg-August-University GöttingenDepartment of Surgery, St. Josef Hospital Ruhr-University BochumDepartment of Surgery, St. Josef Hospital Ruhr-University BochumDepartment of General and Visceral Surgery, Frankfurt University Hospital and ClinicsDepartment of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Department of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Private Practice, Hematology/OncologyDepartment of Surgery, University Hospital MagdeburgDepartment for Hematology, Oncology and Palliative Care, St Josef-Hospital, Ruhr-University BochumDepartment for General- und Visceral Surgery, Medical Center and Faculty of Medicine University of FreiburgMedical Centre for Information and Communication Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Outpatient Department Hematology/OncologyDepartment of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Abstract Background One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer. Methods Pretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared. Results One hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P < 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p < 0.05). Conclusion Excellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors. Trial registration EudraCT:2009-014476-21 (2013-02-22) and NCT01827553 (2013-04-09).http://link.springer.com/article/10.1186/s12885-019-6148-5Pancreatic cancerDetermination of resectabilityLocally advancedBorderline resectableProspective randomized multicenter trial |
| spellingShingle | U. A. Wittel D. Lubgan M. Ghadimi O. Belyaev W. Uhl W. O. Bechstein R. Grützmann W. M. Hohenberger A. Schmid L. Jacobasch R. S. Croner A. Reinacher-Schick U. T. Hopt A. Pirkl H. Oettle R. Fietkau H. Golcher Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trial BMC Cancer Pancreatic cancer Determination of resectability Locally advanced Borderline resectable Prospective randomized multicenter trial |
| title | Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trial |
| title_full | Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trial |
| title_fullStr | Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trial |
| title_full_unstemmed | Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trial |
| title_short | Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma – results of the Conko-007 multicenter trial |
| title_sort | consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma results of the conko 007 multicenter trial |
| topic | Pancreatic cancer Determination of resectability Locally advanced Borderline resectable Prospective randomized multicenter trial |
| url | http://link.springer.com/article/10.1186/s12885-019-6148-5 |
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