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Following radiographic restaging, the majority of pancreatic ductal adenocarcinomas in persons who had previously undergone unsuccessful resection attempts were reclassified as resectable or borderline resectable.

Surgical oncologist Jason B. Fleming, MD, and fellow medical, surgical, and radiation oncologists from the University of Texas M.D. Anderson Cancer Center in Houston, Texas, evaluated 88 patients with pancreatic cancer to determine whether accurate radiographic restaging, multimodality treatment, and advanced surgical technique could offer persons previously deemed unresectable the possibility for curative salvage pancreatectomy. In a statement announcing the group’s findings, which were published in Journal of the American College of Surgeons (2012;215[1]:41-51), Fleming commented that the key to screening patients for treatment and staging of their cancer lies in the interpretation of preoperative computed tomography (CT) scans by both radiologist and surgeon to give the surgeon a clear idea of tumor location and vessel involvement before beginning the surgery.

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All study participants originally received diagnoses of operable, localized cancer at outside institutions, but attempts at tumor removal were aborted when the initial surgery revealed more extensive disease than originally detected. Through radiographic restaging, Fleming’s team confirmed that only seven (8%) tumors were actually locally advanced and unresectable. Nearly all the others (92%) were found to be resectable (n=61) or borderline resectable (n=20). 

A total of 66 patients (81%) subsequently underwent successful reoperative pancrea
tectomy using surgery first (9%) or preoperative chemoradiation (91%). Median overall survival was 29.6 months for the successfully resected patients, compared with 10.6 months for those with locally advanced unresectable disease at initial referral and 5.1 months for those patients who developed metastatic disease before resection. 

The major complication rate was 20%, with three patients (4.5%) dying perioperatively. ONA