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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2023.977    [Accepted]
Clinical Outcomes of Surgery After Neoadjuvant Chemotherapy in Locally Advanced Pancreatic Ductal Adenocarcinoma
Yoo Na Lee1 , Min Kyu Sung1, Dae Wook Hwang1, Yejong Park1, Bong Jun Kwak1, Woohyung Lee1, Ki Byung Song1, Jae Hoon Lee1, Changhoon Yoo2, Kyu-Pyo Kim2, Heung-Moon Chang2, Baek-Yeol Ryoo2, Song Cheol Kim1,3
1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Brain Korea 21 Plus, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence  Song Cheol Kim ,Tel: 82-2-3010-3936, Fax: 82-2-2045-4232, Email: drksc@amc.seoul.kr
Received: August 28, 2023;  Accepted: June 10, 2024.  Published online: June 19, 2024.
ABSTRACT
Purpose
Clinical outcomes of surgery after neoadjuvant chemotherapy have not been investigated for locally advanced pancreatic cancer (LAPC), despite well-established outcomes in borderline resectable pancreatic cancer (BRPC). This study aimed to investigate the clinical outcomes of patients with LAPC who underwent curative resection following neoadjuvant chemotherapy.
Materials and Methods
We retrospectively reviewed the records of patients diagnosed with pancreatic adenocarcinoma between January 2017 and December 2020.
Results
Among 1,358 patients, 260 underwent surgery following neoadjuvant chemotherapy. Among 356 LAPC patients, 98 (27.5%) and 147 (35.1%) of 418 BRPC patients underwent surgery after neoadjuvant chemotherapy. Compared to resectable pancreatic cancer (resectable PC) with upfront surgery, both LAPC and BRPC exhibited higher rates of venous resection (28.6% vs. 49.0% vs. 4.0%), arterial resection (30.6% vs. 6.8% vs. 0.5%) and greater estimated blood loss (260.5 vs. 213.1 vs. 70.4 mL). However, hospital stay, readmission rates and postoperative pancreatic fistula rates (Grade B or C) did not differ significantly between LAPC, BRPC, and resectable PC. Overall and relapse-free survival did not differ significantly between LAPC and BRPC patients. The median overall survival was 37.3 months for LAPC and 37.0 months for BRPC. The median relapse-free survival was 22.7 months for LAPC and 26.0 months for BRPC.
Conclusion
Overall survival time and postoperative complications in LAPC patients who underwent curative resection following neoadjuvant chemotherapy showed similar results to those of BRPC patients. Further research is needed to identify specific sub-populations of LAPC patients who benefit most from conversion surgery and to minimize postoperative complications.
Key words: Pancreatic cancer, neoadjuvant chemotherapy, locally advanced pancreatic cancer, borderline resectable pancreatic cancer
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