Benjamin P T Loveday1, Nathan Zilbert2, Pablo E Serrano3, Koji Tomiyama4, Amélie Tremblay4, Adrian M Fox5, Maja Segedi6, Martin O'Malley7, Ayelet Borgida8, Teresa Bianco8, Sean Creighton9, Anna Dodd9, Adriana Fraser9, Malcolm Moore10, John Kim11, Sean Cleary12, Carol-Anne Moulton2, Paul Greig2, Alice C Wei2, Steven Gallinger2, Neesha Dhani13, Ian D McGilvray14. 1. Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; Department of Surgery, University of Auckland, Auckland, New Zealand. 2. Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; University of Toronto, Toronto, Canada. 3. Department of Surgery, McMaster University, Hamilton, Canada. 4. Department of Surgery, University Health Network, University of Toronto, Toronto, Canada. 5. St-Vincent Hospital, University of Melbourne, Melbourne, Australia. 6. Department of Surgery, University of British Columbia, Vancouver, Canada. 7. Joint Department of Medical Imaging, University of Toronto, Toronto, Canada. 8. Ontario Pancreas Cancer Study, Mount Sinai Hospital, Toronto, Canada. 9. McCain Center for Pancreas Cancer, Princess Margaret Cancer Centre, Toronto, Canada. 10. University of Toronto, Toronto, Canada; BC Cancer Agency, Vancouver, Canada. 11. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada. 12. Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; University of Toronto, Toronto, Canada; Department of Surgery, Mayo Clinic, Rochester MN, USA. 13. University of Toronto, Toronto, Canada; Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada. 14. Department of Surgery, University Health Network, University of Toronto, Toronto, Canada; University of Toronto, Toronto, Canada. Electronic address: ian.mcgilvray@uhn.ca.
Abstract
BACKGROUND: Stage 3 pancreatic ductal adenocarcinoma (PDAC) is defined by arterial involvement. This study objective was to evaluate outcomes for patients with stage 3 PDAC with potentially reconstructable arterial involvement, considered for neoadjuvant therapy (NAT) and pancreatic resection, and to compare outcomes following arterial (AR) and non-arterial resection (NAR). METHODS: This study included patients from 2009 to 2016 with biopsy-proven stage 3 PDAC who were offered NAT before surgical exploration. AR was performed if required to achieve R0 resection. Time to event outcomes were analysed from diagnosis date. RESULTS: 87/89 patients (97.8%) received NAT (chemotherapy 41.6%, chemotherapy/radiotherapy 56.2%). 46/89 (51.7%) underwent exploration; 31 underwent resection (AR n = 20, NAR n = 11). AR patients had longer operative time (681 vs. 563 min, p = 0.006) and more blood loss (1600 vs. 575 mL, p = 0.0004), with no difference for blood transfusion, pancreatic fistula, length of stay, reoperation, or mortality. R0 rate was 30/31. Post-resection 90-day mortality was 3.2%. Median overall survival was statistically comparable between the AR and NAR groups (19.7 vs. 28.4 months, p = 0.41). CONCLUSIONS: AR had comparable clinical and oncologic outcomes to NAR. Following careful selection and non-progression after NAT, major AR may cautiously be considered if required to obtain a negative resection margin.
BACKGROUND: Stage 3 pancreatic ductal adenocarcinoma (PDAC) is defined by arterial involvement. This study objective was to evaluate outcomes for patients with stage 3 PDAC with potentially reconstructable arterial involvement, considered for neoadjuvant therapy (NAT) and pancreatic resection, and to compare outcomes following arterial (AR) and non-arterial resection (NAR). METHODS: This study included patients from 2009 to 2016 with biopsy-proven stage 3 PDAC who were offered NAT before surgical exploration. AR was performed if required to achieve R0 resection. Time to event outcomes were analysed from diagnosis date. RESULTS: 87/89 patients (97.8%) received NAT (chemotherapy 41.6%, chemotherapy/radiotherapy 56.2%). 46/89 (51.7%) underwent exploration; 31 underwent resection (AR n = 20, NAR n = 11). AR patients had longer operative time (681 vs. 563 min, p = 0.006) and more blood loss (1600 vs. 575 mL, p = 0.0004), with no difference for blood transfusion, pancreatic fistula, length of stay, reoperation, or mortality. R0 rate was 30/31. Post-resection 90-day mortality was 3.2%. Median overall survival was statistically comparable between the AR and NAR groups (19.7 vs. 28.4 months, p = 0.41). CONCLUSIONS: AR had comparable clinical and oncologic outcomes to NAR. Following careful selection and non-progression after NAT, major AR may cautiously be considered if required to obtain a negative resection margin.
Authors: Georgios Gemenetzis; Alex B Blair; Minako Nagai; William R Burns; Christopher L Wolfgang; Jin He; Vincent P Groot; Ding Ding; Ammar A Javed; Richard A Burkhart; Elliot K Fishman; Ralph H Hruban; Matthew J Weiss; John L Cameron; Amol Narang; Daniel Laheru; Kelly Lafaro; Joseph M Herman; Lei Zheng Journal: Ann Surg Oncol Date: 2021-08-27 Impact factor: 5.344