Abstract
Abstract Aims To compare resection and survival outcomes of CRT and immediate surgery in patients with resectable and borderline resectable pancreatic cancer Methods In compliance with PRISMA statement standards, electronic databases were searched to identify all randomised controlled trials (RCTs) investigating outcomes of neoadjuvant CRT versus immediate surgery in patients with resectable and borderline resectable pancreatic cancer. Two treatment strategies were compared using direct comparison meta-analysis model. Random effects modelling was applied to calculate pooled outcome data. The risks of Type1 or Type2 error in the meta-analysis model were assessed using trial sequential analysis (TSA) model. The certainty of evidence was assessed using GRADE system. Results 400 patients from 4 RCTs were included. When resectable and borderline resectable diseases were analysed together, neoadjuvant CRT resulted in higher R0 resection rate (RR: 1.55, P=0.004), longer overall survival (MD: 3.75, P=0.009) but lower overall resection rate (RR: 0.83, P=0.008). When resectable and borderline resectable diseases were analysed separately, neoadjuvant CRT improved R0 resection rate (RR: 3.72, P=0.004) and overall survival (MD: 6.64, P=0.004) in patients with borderline resectable pancreatic cancer but it did not improve R0 resection rate (RR: 1.18, P=0.13) and overall survival (MD: 0.94, P=0.57) in patients with resectable pancreatic cancer. Conclusions Evidence from RCTs suggests that neoadjuvant CRT improves R0 resection rate and overall survival in patients with borderline resectable pancreatic cancer but not in patients with resectable pancreatic cancer. Nevertheless, the best available evidence does not include the contemporary chemotherapy regimens; therefore, more definite conclusions would depend on the results of future RCTs.
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