The experience of neoadjuvant chemotherapy versus upfront surgery in resectable pancreatic cancer: a cross sectional study.

Abstract

BACKGROUND:

Upfront resection (UR) followed by adjuvant chemotherapy remains the standard treatment for resectable pancreatic cancer. There is increasing evidence suggesting favourable outcomes toward neoadjuvant chemotherapy (NAC) followed by surgery.

METHODS:

All clinical staging with resectable pancreatic cancer patients treated at a tertiary medical centre from 2013 to 2020 were identified. The baseline characteristics, treatment course, surgery outcome and survival results of UR or NAC were compared.

RESULTS:

Finally, in 159 resectable patients, 46 patients (29%) underwent NAC and 113 patients (71%) received UR. In NAC, 11 patients (24%) did not receive resection, 4 (36.4%) for comorbidity, 2 (18.2%) for patient refusal and 2 (18.2%) for disease progression. In UR, 13 patients (12%) were unresectable intraoperatively; 6 (46.2%) for locally advanced and 5 (38.5%) for distant metastasis. Overall, 97% of patients in NAC and 58% of patients in UR completed adjuvant chemotherapy. As of data cut-off, 24 patients (69%) in NAC and 42 patients (29%) in UR were still tumour free. The median recurrence-free survival in NAC, UR with adjuvant chemotherapy and without adjuvant chemotherapy were 31.3 months (95% CI, 14.4-not estimable), 10.6 months (95% CI, 9.0-14.3) and 8.5 months (95% CI, 5.8-11.8), P =0.036; and the median overall survival in each group were not reached (95% CI, 29.7-not estimable), 25.9 months (95% CI, 21.1-40.5) and 21.7 months (12.0-32.8), P =0.0053. Based on initial clinical staging, the median overall survival of NAC was not significantly different from UR with a tumour less than or equal to 2 cm, P =0.29. NAC patients had a higher R0 resection rate (83% versus 53%), lower recurrence rate (31% versus 71%) and harvested median number lymph node (23 versus 15).

CONCLUSION:

This study demonstrates that NAC is superior to UR in resectable pancreatic cancer with better survival.

• Authors: Yung-Yeh Su, Ying-Jui Chao, Chih-Jung Wang, Ting-Kai Liao, Ping-Jui Su, Chien-Jui Huang, Nai-Jung Chiang, Yu-Ting Yu, Hong-Ming Tsai, Li-Tzong Chen, Yan-Shen Shan
• Journal: International journal of surgery (London, England) (Int J Surg) Vol. 109 Issue 9 Pg. 2614-2623 (Sep 01 2023) ISSN: 1743-9159 [Electronic] United States
• PMID: 37300888 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

Topics

• Humans
• Neoadjuvant Therapy (methods)
• Cross-Sectional Studies
• Pancreatic Neoplasms (drug therapy, surgery)
• Chemotherapy, Adjuvant (methods)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Pancreatic Neoplasms