Abstract
725 Background: Although pancreatic cancer (PC) is unfavorable clinical entity, the prognosis of resectable PC has been improving due to perioperative chemotherapy. Meanwhile, the prognosis of unresectable (UR) PC remains poor. In highly selected patients, however, conversion surgery (CS) has been performed with good outcome. Indication criteria of CS remain unestablished because the number of patients who underwent CS was very small in each institution. Methods: From 2014 to 2018, 485 consecutive patients with UR-PC who received modified FOLFIRINOX (mFFX) / Gemcitabine Nab-Paclitaxel (GnP) chemotherapy were reviewed. Among them, patients with disease control for more than 8 months were enrolled and divided into two groups; patients who underwent CS (CS group) and patients who did not undergo CS (non-CS group). We compared clinical characteristics and survival outcomes between groups. Our surgical indications were as follows: 1) Decreasing trend in CA19-9, 2) With response for chemotherapy in image, 3) Disease control more than 8 months, 4) Decision in Cancer board as for metastatic cases. Results: In UR-PC patients, 358 patients had distant metastasis (MPC) and 127 patients had locally advanced (LA) PC. The overall survival (OS), progression free survival (PFS) and conversion rate of LAPC were significantly better than MPC (OS; 21 vs. 13 months, PFS; 12 vs. 7 months, Conversion rate; 16 vs. 5 %, p < 0.001). Chemotherapy regimen (mFFX/GnP) had no significant difference in survival outcome. Between CS group (n = 39) with non-CS group (n = 160), age, sex, body mass index, location of lesion, CEA, CA19-9, regimen of chemotherapy and histology had no significant differences. The median survival time of CS group was significantly better than that of non-CS group (OS; NA vs. 21 months, p < 0.001, PFS; 24 vs. 14 months, p = 0.01). In CS group, median operative duration was 509 minutes, blood loss was 735 ml, hospital stay was 26 days, and there was no 90-days mortality case. Conclusions: In our retrospective study, CS for UR-PC can be safely performed, and among carefully selected patients, reasonable short and long term outcomes can be obtained without acceptable morbidity rate.
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