Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Collective review of pancreatic carcinosarcoma, a very rare pancreatic malignancy

  • Mirang Lee (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Young Jae Cho (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Hye-Sol Jung (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Won-Gun Yun (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Youngmin Han (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Wooil Kwon (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Jin-Young Jang (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine)
  • Received : 2022.09.05
  • Accepted : 2022.12.05
  • Published : 2023.05.31
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Abstract

Pancreatic carcinosarcoma is a very rare malignancy with a poor prognosis. Because of these characteristics, a treatment strategy for it has not been established yet. The aim of this study was to establish a therapeutic strategy for pancreatic carcinosarcoma. We reviewed data of a 65-year-old female patient who was diagnosed with pancreatic carcinosarcoma through endoscopic ultrasound-guided fine needle aspiration biopsy before surgery. For literature review, we searched PubMed using terms of "Pancreatic" or "Pancreas" and "carcinosarcoma" or "carcinosarcomatous". The patient received 11 cycles of neoadjuvant treatment with leucovorin, fluorouracil, irinotecan, oxaliplatin and pembrolizumab because the tumor was borderline resectable. She underwent stereotactic ablative body radiotherapy (SABR) with 35 Gy in 5 fractions, followed by robotic pylorus-preserving pancreaticoduodenectomy. After surgery, the patient received adjuvant chemotherapy in the same regimen as before surgery. She is alive without any recurrence. Among 48 patients within 33 available papers, the median survival time was 15 months. The survival rate of patients who received adjuvant chemotherapy tended to be higher than that of those who did not receive adjuvant chemotherapy, although the difference was not statistically significant (median survival, 47 vs. 15 months; p = 0.485). Three patients who received neoadjuvant chemotherapy had a survival period of 13-23.5 months. Surgery with lymphadenectomy, adjuvant therapy, and neoadjuvant therapy are thought to help improve survival outcomes. Modern treatment approaches for conventional pancreatic ductal adenocarcinoma could be applied to pancreatic carcinosarcoma.

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References

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