Abstract
BackgroundSeveral studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head. Data concerning NAT for PDAC located in pancreatic body or tail are lacking.MethodsPost hoc analysis of an international multicenter retrospective cohort of distal pancreatectomy for PDAC in 34 centers from 11 countries (2007–2015). Patients who underwent resection after NAT were matched (1:1 ratio), using propensity scores based on baseline characteristics, to patients who underwent upfront resection. Median overall survival was compared using the stratified log-rank test.ResultsAmong 1236 patients, 136 (11.0%) received NAT, most frequently FOLFIRINOX (25.7%). In total, 94 patients receiving NAT were matched to 94 patients undergoing upfront resection. NAT was associated with less postoperative major morbidity (Clavien–Dindo ≥ 3a, 10.6% vs. 23.4%, P = 0.020) and pancreatic fistula grade B/C (9.6% vs. 21.3%, P = 0.026). NAT did not improve overall survival [27 (95% CI 14–39) versus 31 months (95% CI 19–42), P = 0.277], as compared with upfront resection. In a sensitivity analysis of 251 patients with radiographic tumor involvement of splenic vessels, NAT (n = 37, 14.7%) was associated with prolonged overall survival [36 (95% CI 18–53) versus 20 months (95% CI 15–24), P = 0.049], as compared with upfront resection.ConclusionIn this international multicenter cohort study, NAT for resected PDAC in pancreatic body or tail was associated with less morbidity and pancreatic fistula but similar overall survival in comparison with upfront resection. Prospective studies should confirm a survival benefit of NAT in patients with PDAC and splenic vessel involvement.
Highlights
Several studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head
1236 patients who underwent distal pancreatectomy for PDAC were included for subsequent analysis
Provision of NAT was associated with improved short-term surgical outcomes, without differences in median overall survival (27 vs. 28 months) when compared with upfront surgery
Summary
Several studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head. About 15% of cases of resectable pancreatic ductal adenocarcinoma (PDAC) are located in the pancreatic body or tail.[1,2] The current standard approach in these patients is distal pancreatectomy with splenectomy followed by adjuvant chemotherapy. Neoadjuvant chemo (radio) therapy (NAT) has been explored as an alternative regimen which may downstage tumors leading to increased rates of R0 resection and improved survival.[7,9,10] a higher proportion of patients will complete NAT than adjuvant chemotherapy.[9] Following promising initial reports concerning NAT for unresectable or locally advanced tumors only,[11] the potential of NAT for resectable PDAC is increasingly being studied.[10,12,13]
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