Locally Advanced Pancreatic Cancer

Abstract

Our approach to patients with LA/BR PDAC, which includes prolonged preoperative chemotherapy, is associated with a high incidence of LN-negative disease and excellent OS. After surgical resection, HP treatment response, perineural invasion, and SMAD4 status should help determine who should receive adjuvant therapy in this select subset of patients.

Resection of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinomas after Neoadjuvant Chemotherapy

“…However, at final pathological analysis, our study demonstrates an invasion of the venous and arterial walls in only 45 and 37% of resected specimens in line with what was reported in other series [28,29,30]. Kadera et al [6] reported in their cohort of 49 BL and LA cancer patients that only 1 out of 3 patients who underwent venous resection had a true vascular invasion on final pathology. This relatively low rate of invasion could reflect the efficacy of the preoperative treatment to sterilize the leading edge of tumor extension.…”

“…The current study demonstrates a higher rate of venous and arterial vascular resections when compared with similar published reports [6,7]. This is mainly related to the anatomical location of tumors in our study.…”

“…Some studies reported that the use of prolonged preoperative chemotherapy and/or radiochemotherapy can lead to the reduction in tumor size and number of lymph node metastases as well as to an increase in the rate of margin negative curative resections [6,33]. Strobel et al [7] in their cohort of 120 resected LA tumors after neoadjuvant treatment reported a 35% R0 resection rate with 50% N0 disease.…”

“…However, in a few dedicated centers for pancreatic cancer, reports of resection in LA disease after successful neoadjuvant therapy have emerged with encouraging results in a limited number of very selected patients. Several studies [5,6,7,8] and two systematic reviews [9,10] suggest that for these patients the use of neoadjuvant treatment is associated with local disease control, eradication of lymph node metastases and sterilization of involved surgical margins, thus converting unresectable to resectable disease. Very few studies have analyzed the outcomes in patients operated on for BL cancer, and even fewer data exist regarding surgical outcomes in LA cancer patients, considered by most surgeons to be unresectable regardless of the effects of chemotherapy.…”

“…In addition, assessment of the radiological response to preoperative treatment is difficult at best and correlates poorly with intraoperative findings [11]. Available reports use various definitions for BL and LA disease and discriminate poorly between the two categories of patients who might have different disease behavior [6,7,9,10]. The aim of the current study is to analyze and compare the postoperative outcomes after curative intent resection of BL and LA pancreatic cancer in patients receiving neoadjuvant chemotherapy with the intention to convert unresectable to resectable disease.…”