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

Abstract

Objective: To report the outcomes of surgical resection of borderline resectable (BL) and locally advanced (LA) ‘unresectable' pancreatic cancer after neoadjuvant chemotherapy. Methods: A review of a prospectively maintained database for pancreatic resections was undertaken to identify patients undergoing resection for BL and LA pancreatic cancer after neoadjuvant chemotherapy between January 2007 and December 2012. Clinicopathological, surgical and survival outcomes were analyzed. Results: A total of 45 patients with LA (n = 34) or BL cancer (n = 11) underwent surgery after a mean (± SD) of 7 ± 4 preoperative chemotherapy cycles. Ninety-day mortality was 6.7%, and overall morbidity was 33.3%. An R0 resection was achieved in 34 patients, and 4 patients showed a complete pathological response. Overall median postoperative survival was 17 months (21 after the start of neoadjuvant treatment). Overall and disease-free survival was 74.9 and 43.6% at 1 year and 21.2 and 10.3% at 3 years, respectively. In BL cancer patients, the 3-year survival was significantly higher compared to that of LA cancer patients (p = 0.02). Conclusions: Curative intent resection in BL and LA cancer patients after neoadjuvant chemotherapy can be achieved with reasonable mortality and morbidity and an encouraging 3-year survival. After neoadjuvant therapy, resection provides a better overall survival for BL compared to LA cancer patients.

Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy?

“…Previous studies have demonstrated a resection rate of 25‐50% among patients with borderline resectable disease following NT, with a favorable R0 resection achieved in greater than 80% of patients . We demonstrate a similar resection rate of 55% following NT, with a R0 resection rate of 76.3%.…”

Systematic review and meta-analysis of contemporary pancreas surgery with arterial resection

“…In the present series, the weighted average of R0 resection in arterial resection patients within the neoadjuvant subgroup was 92% compared with 50%, in the patients undergoing arterial resection without neoadjuvant chemotherapy (p < 0.001). Although neoadjuvant chemotherapy was not associated with prolonged long-term survival, our analysis suggests that it is crucial for achieving negative resection margins in this setting [12,14,59]. It has to be emphasized that in the analysis of neoadjuvant therapy, cohorts were grouped according to the predominantly administered therapy.…”

Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases

“…There are no significant changes for selection of patients for PBD in the period of the study. PBD is indicated for patients with high serum bilirubin (> 10 mg%) with high liver enzymes, renal impairment, or associated cholangitis[ 16 , 30 , 31 ].…”