Conversion Surgery Shows Great Potential Against Pancreatic Cancers


Part of the digestive system, the pancreas plays a key role within the body.  On the one hand, it is responsible for secreting important hormones, including insulin (which regulates the metabolism of carbohydrates, fats, and protein) and on the other, it produces enzymes which help the digestive process.  There is still no clear reason which sets off the disease in this organ, but as with most other cancer cases, it’s linked with abnormal cell division and growth.

The American Cancer Society estimates about 56,000 new diagnoses each year and approximately 45,000 fatalities as a result.  Current standard treatment involves combination chemotherapy, but this is often limited to patients with good performance status.  Even so, the prognosis for instances of locally advanced unresectable (UR‑LA) pancreatic ductal adenocarcinoma (PDAC) are fairly poor, typically 6 to 11 months.

A new approach is looking to improve the situation and results so far have been significant.  Conversion surgery, especially when combined with a gemcitabine and nab‑paclitaxel (GnP), has successfully treated many advanced cases.

One example was of a 67 year old woman presenting high levels of carbohydrate antigen 19‑9 (CA19‑9, tumor marker).  Radiological examination revealed a pancreatic tumor in contact with the superior mesenteric artery and a diagnosis of UR‑LA PDAC was set.  After six courses of GnP, the tumor shrunk from 50 to 18 mm and allowed for a pancreatoduodenectomy to be performed.  14 months after surgery doctors found no recurrence.

Another case involving a 43 year old woman complaining of back pain followed a similar course.  After the radiological examination established a pancreatic tumor and 12 sessions of gemcitabine plus nab‑paclitaxel over 9 months, the patient underwent surgery and was alive even 19 months after initial treatment.

For the 18 cases of UR-LA PDAC treated with gemcitabine plus S‑1 (GS) therapy, and 11 cases with GnP therapy, reductions in the tumors were 73.7 and 51.6%, respectively, following GS therapy, and 86.7 and 68.8%, respectively, following GnP therapy.

Oncological evidence suggests that the chemo-radiotherapy procedure “should be considered for recognizing radiological responses (tumor shrinkage adjacent to major arteries) and reductions in CA199 levels”.