THE IMPACT OF NEOADJUVANT THERAPY ON VASCULAR RESECTION IN PANCREATIC DUCTAL ADENOCARCINOMA
Andrew B. Crocker*1, Dany Barrak1, Steven E. Hopkins2, Brian Egleston1, Sanjay S. Reddy1
1Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA; 2Lewis Katz School of Medicine at Temple University, Philadelphia, PA
Introduction
In the management of pancreatic ductal adenocarcinoma (PDAC) approximately 40% of patients present with locally advanced lesions requiring vascular resection intraoperatively. While the need for vascular resection has been associated with increased postoperative complications and decreased overall survival in the literature, the impact of neoadjuvant therapy on the likelihood of vascular resection remains largely understudied. In this trial we investigate the impact of pre-operative factors and neoadjuvant therapy type on the risk of vascular resection in PDAC.
Methods:
140 patients who underwent major pancreatic resection for PDAC between 2010 and 2020 were included in this study. Within this group 34 required vascular resection. This cohort was subdivided by patients who received total neoadjuvant therapy (TNT) defined as both neoadjuvant systemic chemotherapy and chemoradiotherapy (n=49), single modality neoadjuvant therapy (SMNT) defined as receipt of either neoadjuvant systemic chemotherapy or chemoradiotherapy (n = 43), or surgery first (n=48). Logistic regression models were used to analyze vascular resection risk factors and treatment variables, while Cox proportional hazards models were used for survival analyses.
Results:
Among patients with vascular resection, we observed worse overall survival (HR:1.71 95% CI: 0.69-4.27) and disease-free survival (HR 1.33 95% CI: 0.81-2.19.). Within neoadjuvant treatment groups there was no statistically significant reduction in vascular resection with 29.1% of patients who received TNT requiring vascular resection, 20.9% of SMNT patients, and 22.5% of surgery first patients. Initial Ca 19-9 was lower among patients who underwent vascular resection with a mean of 872.5 vs 428.8 (p=0.077). Pre-operative comorbidities including smoking status, diabetes, HTN, HLD, and age at diagnosis were not associated with risk of vascular resection.
Conclusions:
Similar to nationally published data, we observed worse overall and disease-free survival among those with vascular resection during major pancreatic resection for PDAC. Contrary to expectations, neoadjuvant therapy did not significantly reduce or impact the risk of vascular resection. Notably, additional study is warranted to further quantify risk factors that may reduce the need for vascular resection intra-operatively, as this has a strong association with poorer survival metrics.
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