OBJECTIVES: We evaluated whether neoadjuvant therapy followed by surgical resection improves the clinical outcome for patients with borderline resectable pancreatic cancer with radiologic artery involvement (BRPC-A). METHODS: We reviewed 143 BRPC-A patients from among 330 pancreatic cancer patients, including 111 potentially resectable pancreatic cancer patients and 76 borderline resectable pancreatic cancer with portal/superior mesenteric vein involvement patients, who underwent surgery at Wakayama Medical University Hospital. We compared the clinicopathological factors of 40 BRPC-A patients treated with neoadjuvant therapy followed by surgery and those of 103 BRPC-A patients treated with upfront surgery. RESULTS: The R0 rate and progression-free survival of BRPC-A patients who received neoadjuvant therapy and subsequent surgical resection were significantly better compared to those who received upfront surgery (R0: P = 0.041; progression-free survival: P = 0.033), but overall survival was not significantly different. A multivariate analysis showed that intraoperative transfusion (P = 0.007), moderately or poorly differentiated pathological adenocarcinoma (P = 0.019), and failure to complete postoperative adjuvant therapy (P < 0.001) independently predicted a poor prognosis for BRPC-A patients who underwent surgical resection. CONCLUSIONS: Neoadjuvant treatment followed by surgery might provide clinical benefits for BRPC-A patients; however, the establishment of the most appropriate neoadjuvant therapy is needed by further studies.
OBJECTIVES: We evaluated whether neoadjuvant therapy followed by surgical resection improves the clinical outcome for patients with borderline resectable pancreatic cancer with radiologic artery involvement (BRPC-A). METHODS: We reviewed 143 BRPC-A patients from among 330 pancreatic cancerpatients, including 111 potentially resectable pancreatic cancerpatients and 76 borderline resectable pancreatic cancer with portal/superior mesenteric vein involvement patients, who underwent surgery at Wakayama Medical University Hospital. We compared the clinicopathological factors of 40 BRPC-A patients treated with neoadjuvant therapy followed by surgery and those of 103 BRPC-A patients treated with upfront surgery. RESULTS: The R0 rate and progression-free survival of BRPC-A patients who received neoadjuvant therapy and subsequent surgical resection were significantly better compared to those who received upfront surgery (R0: P = 0.041; progression-free survival: P = 0.033), but overall survival was not significantly different. A multivariate analysis showed that intraoperative transfusion (P = 0.007), moderately or poorly differentiated pathological adenocarcinoma (P = 0.019), and failure to complete postoperative adjuvant therapy (P < 0.001) independently predicted a poor prognosis for BRPC-A patients who underwent surgical resection. CONCLUSIONS: Neoadjuvant treatment followed by surgery might provide clinical benefits for BRPC-A patients; however, the establishment of the most appropriate neoadjuvant therapy is needed by further studies.
Authors: Bikram Shrestha; Yifei Sun; Farzana Faisal; Victoria Kim; Kevin Soares; Alex Blair; Joseph M Herman; Amol Narang; Avani S Dholakia; Lauren Rosati; Amy Hacker-Prietz; Linda Chen; Daniel A Laheru; Ana De Jesus-Acosta; Dung T Le; Ross Donehower; Nilofar Azad; Luis A Diaz; Adrian Murphy; Valerie Lee; Elliot K Fishman; Ralph H Hruban; Tingbo Liang; John L Cameron; Martin Makary; Matthew J Weiss; Nita Ahuja; Jin He; Christopher L Wolfgang; Chiung-Yu Huang; Lei Zheng Journal: Cancer Med Date: 2017-06-21 Impact factor: 4.452
Authors: E Versteijne; J A Vogel; M G Besselink; O R C Busch; J W Wilmink; J G Daams; C H J van Eijck; B Groot Koerkamp; C R N Rasch; G van Tienhoven Journal: Br J Surg Date: 2018-04-30 Impact factor: 6.939