Conversion surgery only for highly selected patients with unresectable pancreatic cancer: a satisfactory outcome in exchange for a lower resection rate

  • Seiji NatsumeEmail author
  • Yasuhiro Shimizu
  • Yoshiki Senda
  • Susumu Hijioka
  • Keitaro Matsuo
  • Seiji Ito
  • Koji Komori
  • Tetsuya Abe
  • Kazuo Hara
Original Article



The purpose of this study is to clarify the resection rate, safety, and significance of conversion surgery for highly selected patients with unresectable pancreatic cancer (URPca).


We studied 434 URPca patients. Conversion surgery was permitted only for patients who met following requirements: responders to first-line therapy, showing sufficient reduction of the local tumor to enable complete resection, at least 6 months of disease control, and no metastatic lesions detected on radiological examinations (for patients with metastatic disease). The overall survival (OS) was compared between patients who underwent surgery and those who did not. Furthermore, a multivariate analysis was performed to identify possible predictive factors for both total patients with URPca and responders.


Conversion surgery was performed in 18 patients (4.1%). The pathologically complete resection rate was 88.9% (16/18). The median operative time, blood loss, and hospitalization duration were 450 min, 780 ml, and 29 days, respectively. The OS was significantly better in patients who underwent surgery than in those who did not. In a multivariate analysis, conversion surgery was shown to be significantly correlated with the OS both in total patients and responders.


A satisfactory outcome was achieved for highly selected patients with URPca in exchange for a lower resection rate (4.1%).


Unresectable pancreatic cancer Conversion surgery Resection rate 


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.


  1. 1.
    Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, et al, JASPAC 01 Study Group. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388:248–57.CrossRefGoogle Scholar
  2. 2.
    Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206:833–46.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. Groupe tumeurs digestives of unicancer; PRODIGE Intergroup. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.CrossRefGoogle Scholar
  4. 4.
    Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.CrossRefGoogle Scholar
  5. 5.
    Hackert T, Sachsenmaier M, Hinz U, Schneider L, Michalski CW, Springfeld C, et al. Locally advanced pancreatic cancer: neoadjuvant therapy with FOLFIRINOX results in resectability in 60% of the patients. Ann Surg. 2016;264:457–63.CrossRefGoogle Scholar
  6. 6.
    Marthey L, Sa-Cunha A, Blanc JF, Gauthier M, Cueff A, Francois E, et al. FOLFIRINOX for locally advanced pancreatic adenocarcinoma: results of an AGEO multicenter prospective observational cohort. Ann Surg Oncol. 2015;22:295–301.CrossRefGoogle Scholar
  7. 7.
    Huguet F, Hajj C, Winston CB, Shi W, Zhang Z, Wu AJ, et al. Chemotherapy and intensity-modulated radiation therapy for locally advanced pancreatic cancer achieves a high rate of R0 resection. Acta Oncol. 2017;56:384–90.CrossRefGoogle Scholar
  8. 8.
    Nitsche U, Wenzel P, Siveke JT, Braren R, Holzapfel K, Schlitter AM, et al. Resectability after first-line FOLFIRINOX in initially unresectable locally advanced pancreatic cancer: a single-center experience. Ann Surg Oncol. 2015;22:1212–20.CrossRefGoogle Scholar
  9. 9.
    Moorcraft SY, Khan K, Peckitt C, Watkins D, Rao S, Cunningham D, et al. FOLFIRINOX for locally advanced or metastatic pancreatic ductal adenocarcinoma: the Royal Marsden experience. Clin Colorectal Cancer. 2014;13:232–8.CrossRefGoogle Scholar
  10. 10.
    Peddi PF, Lubner S, McWilliams R, Tan BR, Picus J, Sorscher SM, et al. Multi-institutional experience with FOLFIRINOX in pancreatic adenocarcinoma. JOP. 2012;13:497–501.Google Scholar
  11. 11.
    Blazer M, Wu C, Goldberg RM, Phillips G, Schmidt C, Muscarella P, et al. Neoadjuvant modified (m) FOLFIRINOX for locally advanced unresectable (LAPC) and borderline resectable (BRPC) adenocarcinoma of the pancreas. Ann Surg Oncol. 2015;22:1153–9.CrossRefGoogle Scholar
  12. 12.
    Nanda RH, El-Rayes B, Maithel SK, Landry J. Neoadjuvant modified FOLFIRINOX and chemoradiation therapy for locally advanced pancreatic cancer improves resectability. J Surg Oncol. 2015;111:1028–34.CrossRefGoogle Scholar
  13. 13.
    Boone BA, Steve J, Krasinskas AM, Zureikat AH, Lembersky BC, Gibson MK, et al. Outcomes with FOLFIRINOX for borderline resectable and locally unresectable pancreatic cancer. J Surg Oncol. 2013;108:236–41.CrossRefGoogle Scholar
  14. 14.
    Japan Pancreas Society. General rules for the study of pancreatic cancer. 7th ed. Tokyo: Kanehara shuppan; 2016.Google Scholar
  15. 15.
    Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.CrossRefGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a surgery. Ann Surg. 2004;240:205–13.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Bassi C, Marchegiani G, Derveins C, Sarr M, Abu Hial M, Adham M, et al. The 2016 updated of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.CrossRefGoogle Scholar
  18. 18.
    Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127:1335–9.CrossRefGoogle Scholar
  19. 19.
    Shinchi H, Maemura K, Mataki Y, Kurahara H, Sakoda M, Ueno S, et al. A phase II study of oral S-1 with concurrent radiotherapy followed by chemotherapy with S-1 alone for locally advanced pancreatic cancer. J Hepatobiliary Pancreat Sci. 2012;19:152–8.CrossRefGoogle Scholar
  20. 20.
    Sudo K, Yamaguchi T, Ishihara T, Nakamura K, Hara T, Denda T, et al. Phase II study of oral S-1 and concurrent radiotherapy in patients with unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2011;80:119–25.CrossRefGoogle Scholar
  21. 21.
    Ishii H, Furuse J, Boku N, Okusaka T, Ikeda M, Ohkawa S, et al. Phase II study of gemcitabine chemotherapy alone for locally advanced pancreatic carcinoma: JCOG0506. Jpn J Clin Oncol. 2010;40:573–9.CrossRefGoogle Scholar
  22. 22.
    Sho M, Akahori T, Tanaka T, Kinoshita S, Nagai M, Tamamoto T, et al. Importance of resectability status in neoadjuvant treatment for pancreatic cancer. J Hepatobiliary Pancreat Sci. 2015;22:563–70.CrossRefGoogle Scholar
  23. 23.
    Satoi S, Yamaue H, Kato K, Takahashi S, Hirono S, Takeda S, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2013;20:590–600.CrossRefGoogle Scholar
  24. 24.
    Opendro SS, Satoi S, Yanagimoto H, Toyokawa H, Hirooka S, Yamaki S, et al. Role of adjuvant surgery in initially unresectable pancreatic cancer after long-term chemotherapy or chemoradiation therapy: survival benefit? J Hepatobiliary Pancreat Sci. 2014;21:695–702.CrossRefGoogle Scholar
  25. 25.
    Lee J, Lee JC, Gromski MA, Kim HW, Kim J, Hwang JH. Clinical outcomes of FOLFIRINOX in locally advanced pancreatic cancer: a single center experience. Medicine. 2018;97:e13592.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Seiji Natsume
    • 1
    Email author
  • Yasuhiro Shimizu
    • 1
  • Yoshiki Senda
    • 1
  • Susumu Hijioka
    • 2
    • 4
  • Keitaro Matsuo
    • 3
  • Seiji Ito
    • 1
  • Koji Komori
    • 1
  • Tetsuya Abe
    • 1
  • Kazuo Hara
    • 2
  1. 1.Department of Gastroenterological SurgeryAichi Cancer Center HospitalNagoyaJapan
  2. 2.Department of GastroenterologyAichi Cancer Center HospitalNagoyaJapan
  3. 3.Division of Cancer Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
  4. 4.Department of Hepatobiliary and Pancreatic OncologyNational Cancer Center HospitalTokyoJapan

Personalised recommendations