Highlights
- •Neoadjuvant chemotherapy for borderline resectable cancer leads to improved overall survival.
- •Outcomes in a community cancer center for borderline pancreatic cancer.
- •Morbidity and mortality for pancreaticoduodenectomy in borderline resectable pancreatic cancer.
- •Comparable resection rate and margin free resection rates in a community cancer center for borderline pancreatic cancer.
Abstract
Background
Borderline resectable adenocarcinoma of the pancreas involves the major vascular structures
adjacent to the pancreas and has traditionally led to poor resection rates and survival.
Newer chemotherapy regimens have demonstrated improved response and resection rates.
We performed a retrospective review of borderline resectable pancreatic cancers who
presented to a community cancer program to determine the effect of neoadjuvant chemotherapy
to improve resection rates and overall survival.
Methods
Records of all patients diagnosed with adenocarcinoma of the pancreas from January
1, 2015 to December 31, 2019 were reviewed to determine stage at presentation, resectablility
status, treatment methods, surgical resection and survival. Borderline resectable
status was determined by preoperative imaging in agreement with published criteria
from the National Comprehensive Cancer Network (NCCN) Guidelines 2.2021. Data was
collected and analyzed by standard t-test. This study was approved by the institution's IRB.
Results
During this time period 322 patients were diagnosed with ductal adenocarcinoma of
the pancreas of which 151 (47%) were unresectable, 31 (10%) were locally advanced,
70 (22%) were borderline resectable, and 69 (21%) were resectable at the time of presentation.
36 (51%) of the borderline resectable patients underwent neoadjuvant chemotherapy
at our institution with either FOLFIRINOX or gemcitibine/nab-Paclitaxel regimens and
served as the basis for this analysis. After neoadjuvant chemotherapy 24 (68%) of
the borderline-resectable patients were deemed suitable for surgical exploration.
At exploration, 15 (64%) were resected with 9 (60%) achieving margin-free resection
on final pathology. The overall survival of those that underwent resection was increased
by 19.6 months compared to those that did not undergo surgery (35.4 versus 15.8 mos,
p < 0.01). Overall morbidity after resection was 46% (33% class 1 or 2, 13% class
3) with 0% mortality at 90 days.
Conclusions
Use of neoadjuvant chemotherapy for borderline resectable adenocarcinoma of the pancreas
results in improved resection rates and overall survival in resected patients. This
management strategy for ductal adenocarcinoma of the pancreas is safe and feasible
in a community-based cancer program.
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Article info
Publication history
Published online: November 04, 2022
Accepted:
October 13,
2022
Received in revised form:
October 3,
2022
Received:
April 1,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
