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Ann Surg. 2019 Apr 2. doi: 10.1097/SLA.0000000000003301. [Epub ahead of print]

Surgery Improves Survival After Neoadjuvant Therapy for Borderline and Locally Advanced Pancreatic Cancer: A Single Institution Experience.

Author information

1
Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
2
Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden.
3
Sapienza University of Rome, Rome, Italy.
4
Department of Gastroenterological Surgery II, Hokkaido University, Faculty of Medicine, Hokkaido, Japan.
5
Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
6
Regional Cancer Center, Stockholm-Gotland, Sweden.
7
Department of Surgery, University of Colorado, Aurora, CO.

Abstract

MINI: The overall survival and the survival after resection of patients with borderline resectable pancreatic cancer or locally advanced pancreatic cancer after neoadjuvant therapy (NAT) are similar. Resected patients had better survival than nonresected, irrespective of the type or whether full-dose NAT was given. For all preoperative values of Ca 19-9, surgical resection had positive impact on survival.

OBJECTIVE:

Neoadjuvant therapy (NAT) has become part of the multimodality treatment for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC).

SUMMARY BACKGROUND DATA:

It is currently uncertain which are the preferable NAT regimens, who benefits from surgery, and whether more aggressive surgical strategy is motivated.

METHODS:

A retrospective cohort analysis was performed for all patients with BRPC/LAPC discussed and planned for NAT at multidisciplinary conference at Karolinska University Hospital from 2010 to 2017.

RESULTS:

Of 233 patients eligible, 168 (72%) received NAT and were reevaluated for possibility of resection. A total of 156 (67%) patients (mean 64 yrs, 53% male) had pancreatic adenocarcinoma, comprising the study group for survival analysis. LAPC was diagnosed in 132 patients (85%), BRPC in 22 (14%), and resectable tumor in 2 (1.3%). Fifty patients (40.3%) received full-dose NAT. Only 54 (34.6%) had FOLFIRINOX. The overall survival among resected patients was similar for BRPC and LAPC (median survival 15.0 vs 14.5 mo, P = 0.4; and 31.9 vs 21.8 mo, P = 0.7, respectively). Resected patients had better survival than nonresected, irrespective of the type or whether full-dose NAT was given (median survival 22.4 vs 12.7 mo; 1-, 3-, and 5-yr survival: 86.4%, 38.9%, 26.9% vs 52.2%, 1.5%, 0%, respectively (P < 0001). For all preoperative values of Ca 19-9, surgical resection had positive impact on survival.

CONCLUSIONS:

All patients with BRPC/LAPC who do not progress during NAT should be considered for surgical resection, irrespective of the type or dose of NAT given. Higher levels of Ca 19-9 should not be considered an absolute contraindication for resection.

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