Neoadjuvant therapy is associated with lower margin positivity rates after Pancreaticoduodenectomy in T1 and T2 pancreatic head cancers: An analysis of the National Cancer Database

Present status and perspective of perioperative chemotherapy for patients with resectable pancreatic cancer in Japan

“…Neoadjuvant chemotherapy was found to lower positive margin rates from 21.8 to 15.5% (p < 0.0001), and when radiotherapy was added this rate dropped to 13.4%. Positive margins were associated with worse overall survival (14.9 vs. 23.9 months; HR 1.702, p < 0.0001) (35).…”

Neoadjuvant therapy for resectable pancreatic cancer: a narrative review

“…[57] Another large-volume retrospective study involving 8472 patients showed that neoadjuvant chemoradiotherapy had a significantly lower positive margin rate compared with neoadjuvant chemotherapy only, but no survival difference was seen. [58] Studies have revealed that radiotherapy can induce EMT and increase distant metastasis in patients with locally advanced PDAC. [59,60] Cerullo et al [44] found neoadjuvant radiation was associated with shorter OS.…”

“…[66] Another large-volume retrospective study reported a similar result; NAT expressed advantages in R0 resection rate, lymph node status, and pathologic T stage. [58,65] A meta-analysis of randomized controlled trials showed that under a similar resection rate, NAT increased the likelihood of margin negative (R0) resection and negative lymph nodes. [73] Nearly all studies showed better R0 resection rates and lower lymph node metastases, and a small proportion of them showed statistical differences.…”

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“…Given the high positive margin rate and associated poorer overall survival outcomes of patients with borderline resectable PDAC, Neoadjuvant Therapy (NAT), consisting of preoperative chemotherapy with or without radiation, is now the standard of care [5,6]. Despite high positive margin rates in resectable PDAC patients, however, there are no current recommendations for the use of NAT and practice is widely variable.To address this clinical problem, authors Greco, Langan, et al performed a study comparing margin positivity rates in PDAC patients who did and did not receive NAT, published Surgery Open Science in December 2020 [7]. The National Cancer Database (NCDB), extracting data from 2004-2014, was chosen due to its ability to study surgical margins as well as long term survival outcomes.…”

“…To address this clinical problem, authors Greco, Langan, et al performed a study comparing margin positivity rates in PDAC patients who did and did not receive NAT, published Surgery Open Science in December 2020 [7]. The National Cancer Database (NCDB), extracting data from 2004-2014, was chosen due to its ability to study surgical margins as well as long term survival outcomes.…”