Evaluation of local recurrence after pancreaticoduodenectomy for borderline resectable pancreatic head cancer with neoadjuvant chemotherapy: Can the resection level change after chemotherapy?

Abstract

BACKGROUND:

Neoadjuvant treatment has significant survival benefits for patients with pancreatic cancer. However, local recurrence remains a serious issue, even after neoadjuvant treatment. This study investigated local recurrence after pancreaticoduodenectomy and determined the optimal resection level after neoadjuvant treatment.

METHODS:

This retrospective study analyzed consecutive patients who underwent pancreaticoduodenectomy for borderline resectable pancreatic cancer after 4 cycles of neoadjuvant treatment-gemcitabine plus nab-paclitaxel between April 2015 and March 2020. Patients with borderline resectable-artery pancreatic cancer were classified according to the dissection level around the artery: level 3 group, hemi-, or whole circumferential arterial nerve plexus was dissected; and level 2 group, the nerve plexus was preserved.

RESULTS:

Fifty-six patients with borderline resectable-artery pancreatic cancer underwent pancreaticoduodenectomy after neoadjuvant treatment (level 3 group, n = 40; level 2 group, n = 16). The resection level in the level 2 group was changed based on post-neoadjuvant treatment computed tomography images or intraoperative frozen section diagnosis. The overall and local recurrence rates were significantly higher in the level 2 group than in the level 3 group (overall recurrence, 93.8% vs 70.0%; P = .037) (local recurrence, 50.0% vs 5.0%; P < .001). Ten patients experienced local recurrence, of which 8 belonged to the level 2 group. Among them, 4 patients were confirmed as cancer-negative by surgical margin analysis or intraoperative frozen section diagnosis but experienced recurrence around the arteries.

CONCLUSION:

For treating borderline resectable-artery pancreatic cancer, changing the resection level based on post-neoadjuvant treatment computed tomography images increased the risk of local recurrence. All patients with borderline resectable-artery should undergo level 3 dissection, regardless of the response to neoadjuvant treatment.

• Authors: Kosuke Kobayashi, Yoshihiro Ono, Shoki Sato, Tomotaka Kato, Atsushi Oba, Takafumi Sato, Hiromichi Ito, Yosuke Inoue, Manabu Takamatsu, Akio Saiura, Yu Takahashi
• Journal: Surgery (Surgery) Vol. 173 Issue 5 Pg. 1220-1228 (05 2023) ISSN: 1532-7361 [Electronic] United States
• PMID: 36424197 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Topics

• Humans
• Neoadjuvant Therapy (methods)
• Pancreaticoduodenectomy
• Retrospective Studies
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Pancreatic Neoplasms (drug therapy, surgery)
• Pancreatic Neoplasms