Clinical Challenges in Surgery HPB: Pancreatic Head Cancer

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 21 June 2021

⏱️ 50 minutes

🔗️ Recording | iTunes | RSS

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Summary

Description: Pancreatic adenocarcinoma is a highly lethal cancer with a dismal long-term prognosis requiring complex multidisciplinary planning in order to optimize outcomes. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with a borderline resectable pancreatic head mass.

Learning Objectives: In this episode, we review risk factors for pancreatic adenocarcinoma, key steps of the diagnostic work-up and pre-operative planning, and definitions of resectable, borderline resectable, and unresectable tumors. The history of chemotherapy for pancreatic cancer is briefly reviewed, highlighting the importance of multi-agent regimens and role of neoadjuvant therapy. Finally, we highlight the critical steps of the Whipple procedure.

Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center

Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center

Connor Chick, MD (@connor_chick) is a PGY-4 General Surgery resident at Brooke Army Medical Center

Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical Center

Links to Papers Referenced in this Episode

Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival
J Gastrointest Surg. 2014 Jan;18(1):16-24
https://pubmed.ncbi.nlm.nih.gov/24241967/

Preoperative biliary drainage for cancer of the head of the pancreas
N Engl J Med. 2010 Jan 14;362(2):129-37
https://pubmed.ncbi.nlm.nih.gov/20071702/

1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience
J Gastrointest Surg. 2006 Nov;10(9):1199-210; discussion 1210-1.
https://pubmed.ncbi.nlm.nih.gov/17114007/

Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial
JAMA. 2013 Oct 9;310(14):1473-81.
https://pubmed.ncbi.nlm.nih.gov/24104372/

Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial
Lancet. 2017 Mar 11;389(10073):1011-1024
https://pubmed.ncbi.nlm.nih.gov/28129987/

FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer
N Engl J Med. 2018 Dec 20;379:2395-2406
https://www.nejm.org/doi/full/10.1056/NEJMoa1809775

Surgical Outcome Results From SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma
Ann Surg. 2020 Sep 1;272(3):481-486.doi: 10.1097/SLA.0000000000004155
https://pubmed.ncbi.nlm.nih.gov/32740235/

ASCO Guidelines Potentially Curable Pancreatic Adenocarcinoma
https://www.asco.org/research-guidelines/quality-guidelines/guidelines/gastrointestinal-cancer#/12146

NCCN Guidelines Pancreatic Adenocarcinoma
https://www.nccn.org/guidelines/nccn-guidelines/guidelines-detail?category=1&id=1455

Transcript

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0:00.0	All right, I'm Jack Greenlich.
0:02.0	I think you can listen to music from relaxing, to celebrating, to getting yourself prepared.
0:08.0	I like all sorts, honestly. I like hip-hop, R&B, and then house music as well.
0:13.0	So yeah, there's no guilt in places around here.
0:15.0	Jack wears the Bose Quiet Comfort Ultra headphones, enjoying his favourite music,
0:20.0	with more immersive sounds than ever before.
0:23.0	Wow, the music's just everything, isn't it?
0:25.0	Search Bose headphones.
0:27.0	Bose, sound is power.
0:30.0	Behind the knife, the Surgery Podcast,
0:33.0	where we take a behind-the-scenes intimate look at surgery from leaders in the field.
0:51.0	All right, welcome to Behind the Knife.
0:53.0	This is a first episode done by the new HPV group, that's us.
0:58.0	So my name is Tim Vreeland.
1:00.0	I'm a surgical oncologist and HPV surgeon at Brook Army Medical Center in San Antonio, Texas.
1:06.0	And I'm joined here by Dan Nelson, who is another Army surgical oncologist in El Paso, Texas.
1:14.0	And then two of our residents from Brook Army Medical Center,
1:18.0	Connor Chick, who is finishing his R3 year,
1:21.0	and then Lexi Adams, who is finishing her research here,
1:24.0	and will be starting her R3 year in the summer here.
1:28.0	So, like I said, we're the new HPV team,
1:32.0	so we're going to be doing some episodes around the world of a badabillary surgery.
	...

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