3rd St. Gallen EORTC Gastrointestinal Cancer Conference: Consensus recommendations on controversial issues in the primary treatment of pancreatic cancer.
Identifieur interne : 001334 ( Main/Exploration ); précédent : 001333; suivant : 0013353rd St. Gallen EORTC Gastrointestinal Cancer Conference: Consensus recommendations on controversial issues in the primary treatment of pancreatic cancer.
Auteurs : Manfred P. Lutz [Allemagne] ; John R. Zalcberg [Australie] ; Michel Ducreux [France] ; Daniela Aust [Allemagne] ; Marco J. Bruno [Pays-Bas] ; Markus W. Büchler [Allemagne] ; Jean-Robert Delpero [France] ; Beat Gloor [Suisse] ; Rob Glynne-Jones [Royaume-Uni] ; Werner Hartwig [Allemagne] ; Florence Huguet [France] ; Pierre Laurent-Puig [France] ; Florian Lordick [Allemagne] ; Patrick Maisonneuve [Italie] ; Julia Mayerle [Allemagne] ; Marc Martignoni [Allemagne] ; John Neoptolemos [Royaume-Uni] ; Andrew D. Rhim [États-Unis] ; Bruno M. Schmied [Suisse] ; Thomas Seufferlein [Allemagne] ; Jens Werner [Allemagne] ; Jean-Luc Van Laethem [Belgique] ; Florian Otto [Suisse]Source :
- European journal of cancer (Oxford, England : 1990) [ 1879-0852 ] ; 2017.
Descripteurs français
- KwdFr :
- MESH :
- anatomopathologie : Tumeurs du pancréas.
- usage thérapeutique : Protocoles de polychimiothérapie antinéoplasique.
- Cholangiographie, Consensus, Endoprothèses, Humains, Stade de la tumeur, Traitement médicamenteux adjuvant, Traitement néoadjuvant, Tumeurs du pancréas.
English descriptors
- KwdEn :
- MESH :
- methods : Chemotherapy, Adjuvant, Cholangiography, Neoadjuvant Therapy.
- pathology : Pancreatic Neoplasms.
- therapeutic use : Antineoplastic Combined Chemotherapy Protocols.
- therapy : Pancreatic Neoplasms.
- Consensus, Humans, Neoplasm Staging, Stents.
Abstract
The primary treatment of pancreatic cancer was the topic of the 3rd St. Gallen Conference 2016. A multidisciplinary panel reviewed the current evidence and discussed controversial issues in a moderated consensus session. Here we report on the key expert recommendations. It was generally accepted that radical surgical resection followed by adjuvant chemotherapy offers the only evidence-based treatment with a chance for cure. Initial staging should classify localised tumours as resectable or unresectable (i.e. locally advanced pancreatic cancer) although there remains a large grey-zone of potentially resectable disease between these two categories which has recently been named as borderline resectable, a concept which was generally accepted by the panel members. However, the definition of these borderline-resectable (BR) tumours varies between classifications due to their focus on either (i) technical hurdles (e.g. the feasibility of vascular resection) or (ii) oncological outcome (e.g. predicting the risk of a R1 resection and/or occult metastases). The resulting expert discussion focussed on imaging standards as well as the value of pretherapeutic laparoscopy. Indications for biliary drainage were seen especially before neoadjuvant therapy. Following standard resection, the panel unanimously voted for the use of adjuvant chemotherapy after R0 resection and considered it as a reasonable standard of care after R1 resection, even though the optimal pathologic evaluation and the definition of R0/R1 was the issue of an ongoing debate. The general concept of BR tumours was considered as a good basis to select patients for preoperative therapy, albeit its current impact on the therapeutic strategy was far less clear. Main focus of the conference was to discuss the limits of surgical resection and to identify ways to standardise procedures and to improve curative outcome, including adjuvant and perioperative treatment.
DOI: 10.1016/j.ejca.2017.03.022
PubMed: 28460245
Affiliations:
- Allemagne, Australie, Belgique, France, Italie, Pays-Bas, Royaume-Uni, Suisse, États-Unis
- Bade-Wurtemberg, Bavière, Canton de Berne, District de Dresde, District de Haute-Bavière, District de Karlsruhe, District de Tübingen, Lombardie, Michigan, Provence-Alpes-Côte d'Azur, Sarre (Land), Saxe (Land), Victoria (État), Île-de-France
- Berne, Dresde, Heidelberg, Marseille, Melbourne, Milan, Munich, Paris, Sarrebruck, Ulm
- Université Louis-et-Maximilien de Munich
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Le document en format XML
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d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Gloor, Beat" sort="Gloor, Beat" uniqKey="Gloor B" first="Beat" last="Gloor">Beat Gloor</name><affiliation wicri:level="3"><nlm:affiliation>Klinik für Viszerale und Transplantationschirurgie, Inselspital, Bern, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Klinik für Viszerale und Transplantationschirurgie, Inselspital, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Glynne Jones, Rob" sort="Glynne Jones, Rob" uniqKey="Glynne Jones R" first="Rob" last="Glynne-Jones">Rob Glynne-Jones</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood</wicri:regionArea><wicri:noRegion>Northwood</wicri:noRegion></affiliation></author><author><name sortKey="Hartwig, Werner" sort="Hartwig, Werner" uniqKey="Hartwig W" first="Werner" last="Hartwig">Werner Hartwig</name><affiliation wicri:level="4"><nlm:affiliation>Department of General, Visceral and Transplantation Surgery, Klinikum der Universität München, Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of General, Visceral and Transplantation Surgery, Klinikum der Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Huguet, Florence" sort="Huguet, Florence" uniqKey="Huguet F" first="Florence" last="Huguet">Florence Huguet</name><affiliation wicri:level="1"><nlm:affiliation>Radiooncology Service, Hôpital Tenon (Hôpitaux Universitaires Est Parisien), Paris Cedex 20, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Radiooncology Service, Hôpital Tenon (Hôpitaux Universitaires Est Parisien), Paris Cedex 20</wicri:regionArea><wicri:noRegion>Paris Cedex 20</wicri:noRegion><wicri:noRegion>Paris Cedex 20</wicri:noRegion></affiliation></author><author><name sortKey="Laurent Puig, Pierre" sort="Laurent Puig, Pierre" uniqKey="Laurent Puig P" first="Pierre" last="Laurent-Puig">Pierre Laurent-Puig</name><affiliation wicri:level="3"><nlm:affiliation>Université René Descartes, UFR Biomédicale des Saints-Pères, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Université René Descartes, UFR Biomédicale des Saints-Pères, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Lordick, Florian" sort="Lordick, Florian" uniqKey="Lordick F" first="Florian" last="Lordick">Florian Lordick</name><affiliation wicri:level="1"><nlm:affiliation>University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Cancer Center Leipzig (UCCL), University Medicine Leipzig</wicri:regionArea><wicri:noRegion>University Medicine Leipzig</wicri:noRegion><wicri:noRegion>University Medicine Leipzig</wicri:noRegion><wicri:noRegion>University Medicine Leipzig</wicri:noRegion></affiliation></author><author><name sortKey="Maisonneuve, Patrick" sort="Maisonneuve, Patrick" uniqKey="Maisonneuve P" first="Patrick" 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Medizinische Klinik und Poliklinik II, Klinikum der Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author><author><name sortKey="Martignoni, Marc" sort="Martignoni, Marc" uniqKey="Martignoni M" first="Marc" last="Martignoni">Marc Martignoni</name><affiliation wicri:level="3"><nlm:affiliation>Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author><author><name sortKey="Neoptolemos, John" sort="Neoptolemos, John" uniqKey="Neoptolemos J" first="John" last="Neoptolemos">John Neoptolemos</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Liverpool University, Liverpool, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Surgery, Liverpool University, Liverpool</wicri:regionArea><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author><author><name sortKey="Rhim, Andrew D" sort="Rhim, Andrew D" uniqKey="Rhim A" first="Andrew D" last="Rhim">Andrew D. Rhim</name><affiliation wicri:level="2"><nlm:affiliation>University of Michigan, Ann Arbor, MI, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Michigan, Ann Arbor, MI</wicri:regionArea><placeName><region type="state">Michigan</region></placeName></affiliation></author><author><name sortKey="Schmied, Bruno M" sort="Schmied, Bruno M" uniqKey="Schmied B" first="Bruno M" last="Schmied">Bruno M. Schmied</name><affiliation wicri:level="1"><nlm:affiliation>Klinik für Chirurgie, Kantonsspital St. Gallen, St. Gallen, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Klinik für Chirurgie, Kantonsspital St. Gallen, St. Gallen</wicri:regionArea><wicri:noRegion>St. Gallen</wicri:noRegion></affiliation></author><author><name sortKey="Seufferlein, Thomas" sort="Seufferlein, Thomas" uniqKey="Seufferlein T" first="Thomas" last="Seufferlein">Thomas Seufferlein</name><affiliation wicri:level="3"><nlm:affiliation>Department of Internal Medicine I, Ulm University, Ulm, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Internal Medicine I, Ulm University, Ulm</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Tübingen</region><settlement type="city">Ulm</settlement></placeName></affiliation></author><author><name sortKey="Werner, Jens" sort="Werner, Jens" uniqKey="Werner J" first="Jens" last="Werner">Jens Werner</name><affiliation wicri:level="4"><nlm:affiliation>Department of General, Visceral and Transplantation Surgery, Klinikum der Universität München, Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of General, Visceral and Transplantation Surgery, Klinikum der Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Van Laethem, Jean Luc" sort="Van Laethem, Jean Luc" uniqKey="Van Laethem J" first="Jean-Luc" last="Van Laethem">Jean-Luc Van Laethem</name><affiliation wicri:level="1"><nlm:affiliation>Hopital Erasme, Anderlecht, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Hopital Erasme, Anderlecht</wicri:regionArea><wicri:noRegion>Anderlecht</wicri:noRegion></affiliation></author><author><name sortKey="Otto, Florian" sort="Otto, Florian" uniqKey="Otto F" first="Florian" last="Otto">Florian Otto</name><affiliation wicri:level="1"><nlm:affiliation>Tumor- und Brustzentrum ZeTuP, St. Gallen, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Tumor- und Brustzentrum ZeTuP, St. Gallen</wicri:regionArea><wicri:noRegion>St. Gallen</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:28460245</idno><idno type="pmid">28460245</idno><idno type="doi">10.1016/j.ejca.2017.03.022</idno><idno type="wicri:Area/PubMed/Corpus">000987</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000987</idno><idno type="wicri:Area/PubMed/Curation">000984</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000984</idno><idno type="wicri:Area/PubMed/Checkpoint">000984</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000984</idno><idno type="wicri:Area/Ncbi/Merge">004730</idno><idno type="wicri:Area/Ncbi/Curation">004730</idno><idno type="wicri:Area/Ncbi/Checkpoint">004730</idno><idno type="wicri:Area/Main/Merge">001329</idno><idno type="wicri:Area/Main/Curation">001334</idno><idno type="wicri:Area/Main/Exploration">001334</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">3rd St. Gallen EORTC Gastrointestinal Cancer Conference: Consensus recommendations on controversial issues in the primary treatment of pancreatic cancer.</title><author><name sortKey="Lutz, Manfred P" sort="Lutz, Manfred P" uniqKey="Lutz M" first="Manfred P" last="Lutz">Manfred P. Lutz</name><affiliation wicri:level="3"><nlm:affiliation>CaritasKlinikum St. Theresia, Saarbrücken, Germany. Electronic address: m.lutz@caritasklinikum.de.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>CaritasKlinikum St. Theresia, Saarbrücken</wicri:regionArea><placeName><region type="land" nuts="2">Sarre (Land)</region><settlement type="city">Sarrebruck</settlement></placeName></affiliation></author><author><name sortKey="Zalcberg, John R" sort="Zalcberg, John R" uniqKey="Zalcberg J" first="John R" last="Zalcberg">John R. Zalcberg</name><affiliation wicri:level="3"><nlm:affiliation>Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, The Alfred Centre, Melbourne, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, The Alfred Centre, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Ducreux, Michel" sort="Ducreux, Michel" uniqKey="Ducreux M" first="Michel" last="Ducreux">Michel Ducreux</name><affiliation wicri:level="1"><nlm:affiliation>Institut Gustave Roussy, Villejuif, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Institut Gustave Roussy, Villejuif</wicri:regionArea><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Aust, Daniela" sort="Aust, Daniela" uniqKey="Aust D" first="Daniela" last="Aust">Daniela Aust</name><affiliation wicri:level="3"><nlm:affiliation>Department of Pathology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Pathology, Universitätsklinikum Carl Gustav Carus, Dresden</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Dresde</region><settlement type="city">Dresde</settlement></placeName></affiliation></author><author><name sortKey="Bruno, Marco J" sort="Bruno, Marco J" uniqKey="Bruno M" first="Marco J" last="Bruno">Marco J. Bruno</name><affiliation wicri:level="1"><nlm:affiliation>Department of Gastroenterology & Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Gastroenterology & Hepatology, Erasmus Medical Center, University Medical Center Rotterdam</wicri:regionArea><wicri:noRegion>University Medical Center Rotterdam</wicri:noRegion></affiliation></author><author><name sortKey="Buchler, Markus W" sort="Buchler, Markus W" uniqKey="Buchler M" first="Markus W" last="Büchler">Markus W. Büchler</name><affiliation wicri:level="3"><nlm:affiliation>Chirurgische Universitätsklinik, Heidelberg, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Chirurgische Universitätsklinik, Heidelberg</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Delpero, Jean Robert" sort="Delpero, Jean Robert" uniqKey="Delpero J" first="Jean-Robert" last="Delpero">Jean-Robert Delpero</name><affiliation wicri:level="3"><nlm:affiliation>Department of Surgery, Institut Paoli Calmettes, Marseille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Surgery, Institut Paoli Calmettes, Marseille</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Gloor, Beat" sort="Gloor, Beat" uniqKey="Gloor B" first="Beat" last="Gloor">Beat Gloor</name><affiliation wicri:level="3"><nlm:affiliation>Klinik für Viszerale und Transplantationschirurgie, Inselspital, Bern, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Klinik für Viszerale und Transplantationschirurgie, Inselspital, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Glynne Jones, Rob" sort="Glynne Jones, Rob" uniqKey="Glynne Jones R" first="Rob" last="Glynne-Jones">Rob Glynne-Jones</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood</wicri:regionArea><wicri:noRegion>Northwood</wicri:noRegion></affiliation></author><author><name sortKey="Hartwig, Werner" sort="Hartwig, Werner" uniqKey="Hartwig W" first="Werner" last="Hartwig">Werner Hartwig</name><affiliation wicri:level="4"><nlm:affiliation>Department of General, Visceral and Transplantation Surgery, Klinikum der Universität München, Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of General, Visceral and Transplantation Surgery, Klinikum der Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Huguet, Florence" sort="Huguet, Florence" uniqKey="Huguet F" first="Florence" last="Huguet">Florence Huguet</name><affiliation wicri:level="1"><nlm:affiliation>Radiooncology Service, Hôpital Tenon (Hôpitaux Universitaires Est Parisien), Paris Cedex 20, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Radiooncology Service, Hôpital Tenon (Hôpitaux Universitaires Est Parisien), Paris Cedex 20</wicri:regionArea><wicri:noRegion>Paris Cedex 20</wicri:noRegion><wicri:noRegion>Paris Cedex 20</wicri:noRegion></affiliation></author><author><name sortKey="Laurent Puig, Pierre" sort="Laurent Puig, Pierre" uniqKey="Laurent Puig P" first="Pierre" last="Laurent-Puig">Pierre Laurent-Puig</name><affiliation wicri:level="3"><nlm:affiliation>Université René Descartes, UFR Biomédicale des Saints-Pères, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Université René Descartes, UFR Biomédicale des Saints-Pères, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Lordick, Florian" sort="Lordick, Florian" uniqKey="Lordick F" first="Florian" last="Lordick">Florian Lordick</name><affiliation wicri:level="1"><nlm:affiliation>University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>University Cancer Center Leipzig (UCCL), University Medicine Leipzig</wicri:regionArea><wicri:noRegion>University Medicine Leipzig</wicri:noRegion><wicri:noRegion>University Medicine Leipzig</wicri:noRegion><wicri:noRegion>University Medicine Leipzig</wicri:noRegion></affiliation></author><author><name sortKey="Maisonneuve, Patrick" sort="Maisonneuve, Patrick" uniqKey="Maisonneuve P" first="Patrick" last="Maisonneuve">Patrick Maisonneuve</name><affiliation wicri:level="3"><nlm:affiliation>Istituto Europeo di Oncologia, Divisione di Epidemiologia e Biostatistica, Milan, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Istituto Europeo di Oncologia, Divisione di Epidemiologia e Biostatistica, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Mayerle, Julia" sort="Mayerle, Julia" uniqKey="Mayerle J" first="Julia" last="Mayerle">Julia Mayerle</name><affiliation wicri:level="3"><nlm:affiliation>Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin, Greifswald, Germany; Medizinische Klinik und Poliklinik II, Klinikum der Universität München, Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin, Greifswald, Germany; Medizinische Klinik und Poliklinik II, Klinikum der Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author><author><name sortKey="Martignoni, Marc" sort="Martignoni, Marc" uniqKey="Martignoni M" first="Marc" last="Martignoni">Marc Martignoni</name><affiliation wicri:level="3"><nlm:affiliation>Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author><author><name sortKey="Neoptolemos, John" sort="Neoptolemos, John" uniqKey="Neoptolemos J" first="John" last="Neoptolemos">John Neoptolemos</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Liverpool University, Liverpool, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Surgery, Liverpool University, Liverpool</wicri:regionArea><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author><author><name sortKey="Rhim, Andrew D" sort="Rhim, Andrew D" uniqKey="Rhim A" first="Andrew D" last="Rhim">Andrew D. Rhim</name><affiliation wicri:level="2"><nlm:affiliation>University of Michigan, Ann Arbor, MI, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Michigan, Ann Arbor, MI</wicri:regionArea><placeName><region type="state">Michigan</region></placeName></affiliation></author><author><name sortKey="Schmied, Bruno M" sort="Schmied, Bruno M" uniqKey="Schmied B" first="Bruno M" last="Schmied">Bruno M. Schmied</name><affiliation wicri:level="1"><nlm:affiliation>Klinik für Chirurgie, Kantonsspital St. Gallen, St. Gallen, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Klinik für Chirurgie, Kantonsspital St. Gallen, St. Gallen</wicri:regionArea><wicri:noRegion>St. Gallen</wicri:noRegion></affiliation></author><author><name sortKey="Seufferlein, Thomas" sort="Seufferlein, Thomas" uniqKey="Seufferlein T" first="Thomas" last="Seufferlein">Thomas Seufferlein</name><affiliation wicri:level="3"><nlm:affiliation>Department of Internal Medicine I, Ulm University, Ulm, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Internal Medicine I, Ulm University, Ulm</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Tübingen</region><settlement type="city">Ulm</settlement></placeName></affiliation></author><author><name sortKey="Werner, Jens" sort="Werner, Jens" uniqKey="Werner J" first="Jens" last="Werner">Jens Werner</name><affiliation wicri:level="4"><nlm:affiliation>Department of General, Visceral and Transplantation Surgery, Klinikum der Universität München, Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of General, Visceral and Transplantation Surgery, Klinikum der Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Van Laethem, Jean Luc" sort="Van Laethem, Jean Luc" uniqKey="Van Laethem J" first="Jean-Luc" last="Van Laethem">Jean-Luc Van Laethem</name><affiliation wicri:level="1"><nlm:affiliation>Hopital Erasme, Anderlecht, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Hopital Erasme, Anderlecht</wicri:regionArea><wicri:noRegion>Anderlecht</wicri:noRegion></affiliation></author><author><name sortKey="Otto, Florian" sort="Otto, Florian" uniqKey="Otto F" first="Florian" last="Otto">Florian Otto</name><affiliation wicri:level="1"><nlm:affiliation>Tumor- und Brustzentrum ZeTuP, St. Gallen, Switzerland.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Tumor- und Brustzentrum ZeTuP, St. Gallen</wicri:regionArea><wicri:noRegion>St. Gallen</wicri:noRegion></affiliation></author></analytic><series><title level="j">European journal of cancer (Oxford, England : 1990)</title><idno type="eISSN">1879-0852</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antineoplastic Combined Chemotherapy Protocols (therapeutic use)</term><term>Chemotherapy, Adjuvant (methods)</term><term>Cholangiography (methods)</term><term>Consensus</term><term>Humans</term><term>Neoadjuvant Therapy (methods)</term><term>Neoplasm Staging</term><term>Pancreatic Neoplasms (pathology)</term><term>Pancreatic Neoplasms (therapy)</term><term>Stents</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Cholangiographie ()</term><term>Consensus</term><term>Endoprothèses</term><term>Humains</term><term>Protocoles de polychimiothérapie antinéoplasique (usage thérapeutique)</term><term>Stade de la tumeur</term><term>Traitement médicamenteux adjuvant ()</term><term>Traitement néoadjuvant ()</term><term>Tumeurs du pancréas ()</term><term>Tumeurs du pancréas (anatomopathologie)</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Tumeurs du pancréas</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Chemotherapy, Adjuvant</term><term>Cholangiography</term><term>Neoadjuvant Therapy</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Pancreatic Neoplasms</term></keywords><keywords scheme="MESH" qualifier="therapeutic use" xml:lang="en"><term>Antineoplastic Combined Chemotherapy Protocols</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Pancreatic Neoplasms</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Protocoles de polychimiothérapie antinéoplasique</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Consensus</term><term>Humans</term><term>Neoplasm Staging</term><term>Stents</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Cholangiographie</term><term>Consensus</term><term>Endoprothèses</term><term>Humains</term><term>Stade de la tumeur</term><term>Traitement médicamenteux adjuvant</term><term>Traitement néoadjuvant</term><term>Tumeurs du pancréas</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The primary treatment of pancreatic cancer was the topic of the 3rd St. Gallen Conference 2016. A multidisciplinary panel reviewed the current evidence and discussed controversial issues in a moderated consensus session. Here we report on the key expert recommendations. It was generally accepted that radical surgical resection followed by adjuvant chemotherapy offers the only evidence-based treatment with a chance for cure. Initial staging should classify localised tumours as resectable or unresectable (i.e. locally advanced pancreatic cancer) although there remains a large grey-zone of potentially resectable disease between these two categories which has recently been named as borderline resectable, a concept which was generally accepted by the panel members. However, the definition of these borderline-resectable (BR) tumours varies between classifications due to their focus on either (i) technical hurdles (e.g. the feasibility of vascular resection) or (ii) oncological outcome (e.g. predicting the risk of a R1 resection and/or occult metastases). The resulting expert discussion focussed on imaging standards as well as the value of pretherapeutic laparoscopy. Indications for biliary drainage were seen especially before neoadjuvant therapy. Following standard resection, the panel unanimously voted for the use of adjuvant chemotherapy after R0 resection and considered it as a reasonable standard of care after R1 resection, even though the optimal pathologic evaluation and the definition of R0/R1 was the issue of an ongoing debate. The general concept of BR tumours was considered as a good basis to select patients for preoperative therapy, albeit its current impact on the therapeutic strategy was far less clear. Main focus of the conference was to discuss the limits of surgical resection and to identify ways to standardise procedures and to improve curative outcome, including adjuvant and perioperative treatment.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Belgique</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Suisse</li><li>États-Unis</li></country><region><li>Bade-Wurtemberg</li><li>Bavière</li><li>Canton de Berne</li><li>District de Dresde</li><li>District de Haute-Bavière</li><li>District de Karlsruhe</li><li>District de Tübingen</li><li>Lombardie</li><li>Michigan</li><li>Provence-Alpes-Côte d'Azur</li><li>Sarre (Land)</li><li>Saxe (Land)</li><li>Victoria (État)</li><li>Île-de-France</li></region><settlement><li>Berne</li><li>Dresde</li><li>Heidelberg</li><li>Marseille</li><li>Melbourne</li><li>Milan</li><li>Munich</li><li>Paris</li><li>Sarrebruck</li><li>Ulm</li></settlement><orgName><li>Université Louis-et-Maximilien de Munich</li></orgName></list><tree><country name="Allemagne"><region name="Sarre (Land)"><name sortKey="Lutz, Manfred P" sort="Lutz, Manfred P" uniqKey="Lutz M" first="Manfred P" last="Lutz">Manfred P. Lutz</name></region><name sortKey="Aust, Daniela" sort="Aust, Daniela" uniqKey="Aust D" first="Daniela" last="Aust">Daniela Aust</name><name sortKey="Buchler, Markus W" sort="Buchler, Markus W" uniqKey="Buchler M" first="Markus W" last="Büchler">Markus W. Büchler</name><name sortKey="Hartwig, Werner" sort="Hartwig, Werner" uniqKey="Hartwig W" first="Werner" last="Hartwig">Werner Hartwig</name><name sortKey="Lordick, Florian" sort="Lordick, Florian" uniqKey="Lordick F" first="Florian" last="Lordick">Florian Lordick</name><name sortKey="Martignoni, Marc" sort="Martignoni, Marc" uniqKey="Martignoni M" first="Marc" last="Martignoni">Marc Martignoni</name><name sortKey="Mayerle, Julia" sort="Mayerle, Julia" uniqKey="Mayerle J" first="Julia" last="Mayerle">Julia Mayerle</name><name sortKey="Seufferlein, Thomas" sort="Seufferlein, Thomas" uniqKey="Seufferlein T" first="Thomas" last="Seufferlein">Thomas Seufferlein</name><name sortKey="Werner, Jens" sort="Werner, Jens" uniqKey="Werner J" first="Jens" last="Werner">Jens Werner</name></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Zalcberg, John R" sort="Zalcberg, John R" uniqKey="Zalcberg J" first="John R" last="Zalcberg">John R. Zalcberg</name></region></country><country name="France"><noRegion><name sortKey="Ducreux, Michel" sort="Ducreux, Michel" uniqKey="Ducreux M" first="Michel" last="Ducreux">Michel Ducreux</name></noRegion><name sortKey="Delpero, Jean Robert" sort="Delpero, Jean Robert" uniqKey="Delpero J" first="Jean-Robert" last="Delpero">Jean-Robert Delpero</name><name sortKey="Huguet, Florence" sort="Huguet, Florence" uniqKey="Huguet F" first="Florence" last="Huguet">Florence Huguet</name><name sortKey="Laurent Puig, Pierre" sort="Laurent Puig, Pierre" uniqKey="Laurent Puig P" first="Pierre" last="Laurent-Puig">Pierre Laurent-Puig</name></country><country name="Pays-Bas"><noRegion><name sortKey="Bruno, Marco J" sort="Bruno, Marco J" uniqKey="Bruno M" first="Marco J" last="Bruno">Marco J. Bruno</name></noRegion></country><country name="Suisse"><region name="Canton de Berne"><name sortKey="Gloor, Beat" sort="Gloor, Beat" uniqKey="Gloor B" first="Beat" last="Gloor">Beat Gloor</name></region><name sortKey="Otto, Florian" sort="Otto, Florian" uniqKey="Otto F" first="Florian" last="Otto">Florian Otto</name><name sortKey="Schmied, Bruno M" sort="Schmied, Bruno M" uniqKey="Schmied B" first="Bruno M" last="Schmied">Bruno M. Schmied</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Glynne Jones, Rob" sort="Glynne Jones, Rob" uniqKey="Glynne Jones R" first="Rob" last="Glynne-Jones">Rob Glynne-Jones</name></noRegion><name sortKey="Neoptolemos, John" sort="Neoptolemos, John" uniqKey="Neoptolemos J" first="John" last="Neoptolemos">John Neoptolemos</name></country><country name="Italie"><region name="Lombardie"><name sortKey="Maisonneuve, Patrick" sort="Maisonneuve, Patrick" uniqKey="Maisonneuve P" first="Patrick" last="Maisonneuve">Patrick Maisonneuve</name></region></country><country name="États-Unis"><region name="Michigan"><name sortKey="Rhim, Andrew D" sort="Rhim, Andrew D" uniqKey="Rhim A" first="Andrew D" last="Rhim">Andrew D. Rhim</name></region></country><country name="Belgique"><noRegion><name sortKey="Van Laethem, Jean Luc" sort="Van Laethem, Jean Luc" uniqKey="Van Laethem J" first="Jean-Luc" last="Van Laethem">Jean-Luc Van Laethem</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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