Current topics regarding the treatment of pancreas / Шинэ санаа Шинэ нээлт

ABSTRACT

Background:Pancreas ductal adenocarcinoma (PDAC) remains the mostmalignant digestive disease, but several treatment strategies for PDAC have beendeveloped. Here we describe some current topics regarding the treatment ofPDACs in Nagasaki, Japan.1 Prevention of pancreas fistula (PF) after pancreas resectionAdjuvant chemotherapy for PDAC was demonstrated to be useful to prolongpatients’ survival after the resection of PDAC. To introduce adjuvant chemotherapyfor PDAC quickly, it is important to prevent the development of a PF afterpancreas resection. We evaluated the safety and efficacy of early drain removalon postoperative day 1 after distal pancreatectomy (DP; n=71), and we found thatearly drain removal was safe and effective for preventing grade B/C PFs (0% vs.late removal 16%; p<0.001).2 Laparoscopic surgery for PDACLaparoscopic distal pancreatectomy (Lap-DP) for low-grade malignant tumors atthe left side of the pancreas has been recognized to be safe and feasible, and afew studies have already obtained similar findings for PDAC compared to openDP. We have been performing the Lap-DP for PDACs without invasion beyondthe pancreas, and the modified radical antegrade modular pancreatosplenectomy(mRAMPS) is conducted at our institute. The plexus around the celiac artery orsuperior mesenteric artery is dissected to a limited extent. Histologically, all of ourPDAC patients who underwent a Lap-DP (n=5) achieved an R0 resection.3 Dendritic cell-based therapeutic vaccination for PDACThe treatment of unresectable or recurrent PDAC is not promising. We startedadministering a dendritic cell-based therapeutic vaccination in such cases alongwith the use of the anticancer drugs gemcitabine and/or S-1. A total of eightpatients received this therapy, and it seemed that the patients with recurrenceafter resection and those who had strong delayed-type hypersensitivity aroundthe injected lesion had a favorable prognosis, although the results were obtainedwith a small number of patients.Conclusions:Our recent treatments for PDAC are feasible and useful. It is important to developvarious ways to prolong the survival of PDAC patients.