SSAT - Neoadjuvant Therapy Followed by Surgical Resection for Borderline Resectable Pancreatic Cancer With Artery Involvement

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Neoadjuvant Therapy Followed by Surgical Resection for Borderline Resectable Pancreatic Cancer With Artery Involvement
Hiroki Yamaue^*, Seiko Hirono, Manabu Kawai, Ken-Ichi Okada, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata

Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan

Background: It has been still controversial to perform surgical resection with borderline resectable pancreatic cancer with artery involvement (BR-A), because an aggressive surgery leads to high morbidity and mortality with low R0 rate for the BR-A patients. In this study, we evaluated whether or not neoadjuvant therapy followed by surgical resection improves survival benefits for the patients with BR-A pancreatic cancer.
Methods: There were 138 patients with BR-A among 330 pancreatic cancer patients underwent surgical resection at Wakayama Medical University Hospital. We compared clinicopathological factors between 38 BR-A patients with neoadjuvant therapy followed by surgical resection and 100 BR-A patients with upfront surgery to evaluate the clinical impacts of neoadjuvant therapy.
Results: The overall survival (OS) of BR-A patients was significantly shorter than that of the patients with borderline resectbale pancreatic cancer with portal vein/ superior mesenteric vein (PV/SMV) involvement (n=76) and resectable pancreatic cancer (n=105) who underwent surgical resection (median OS: 13.6 vs. 20.6 months, P<0.001). The OS of BR-A patient with neoadjuvant therapy followed by surgical resection was significantly longer than those with upfront surgery (median OS: 20.2 vs. 12.9 months, P=0.047). Multivariate analysis showed that older age (P=0.027), pathological PV/SMV invasion (P=0.031), moderated or poor differentiated tumor (P=0.008), positive lymph node ratio ≧0.1 (P=0.018), and no postoperative adjuvant chemotherapy (P<0.001) were independent poor prognostic factors for BR-A patients who underwent surgical resection.
Conclusions: Neoadjuvant treatment might bring the clinical benefits for BR-A patients, and it has been strongly needed to develop the appropriate regimen of neoadjuvant therapy and postoperative adjuvant therapy for longer survival in the patients with BR-A pancreatic cancer.

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