Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer.

BACKGROUND

Margin-negative pancreatectomy provides only chance to cure pancreatic cancer. However, borderline resectable pancreatic cancer (BRPCa) has the risk of incomplete palliative resection.

MATERIALS AND METHODS

We retrospectively reviewed 32 patients with BRPCa who underwent a pancreatectomy following preoperative chemoradiation therapy (CCRT (+)/Px group) and compared these patients with those with resectable pancreatic cancer (RPCa) who underwent pancreatectomy without preoperative CCRT (CCRT (-)/Px group, n=104).

RESULTS

Eighteen patients (56.2%) showed more than 50% significant pathological response to CCRT. The degree of pathological responses showed a positive relationship between final pT stage (p=0.075). More frequent vascular resection (p<0.001), transfusion (p=0.076), and longer operation time were observed in the CCRT(+)/Px group. However, similar R0 resection rates (p=0.272), lower pT stage (p<0.001), smaller number of metastastic lymph nodes (p=0.002), and lower incidence of lymph node metastasis (p=0.032) were noted in the CCRT(+)/Px group. The overall disease-specific survival were similar (median survival, 30.5 months (95% CI; 23.6-37.4) vs. 26.3 months (95% CI; 15.9-36.7), p=0.709), and no statistical differences in cancer recurrence risks were noted between the two groups (p=0.505).

CONCLUSION

Pancreatectomy following preoperative neoadjuvant CCRT can be a potential strategy for margin-negative resection in BRPCa patients.