Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy: A Single-Center Experience

• Published in: Annals of surgical oncology Vol. 31; no. 9; pp. 6180 - 6192
• Main Authors: Theijse, Rutger T., Stoop, Thomas F., Leenart, Philip D., Lutchman, Kishan R. D., Erdmann, Joris I., Daams, Freek, Zonderhuis, Babs M., Festen, Sebastiaan, Swijnenburg, Rutger-Jan, van Gulik, Thomas M., Schoorlemmer, Annuska, Sterk, André L. A., van Dieren, Susan, Fariña, Arantza, Voermans, Rogier P., Wilmink, Johanna W., Kazemier, Geert, Busch, Olivier R., Besselink, Marc G.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2024; Springer Nature B.V
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Female; Follow-Up Studies; Humans; Induction Chemotherapy; Induction therapy; Laparotomy; Male; Medicine; Medicine & Public Health; Metastases; Middle Aged; Morbidity; Mortality; Neoadjuvant Therapy - mortality; Oncology; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreatic Tumors; Patients; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Resection; Pancreatic cancer; Induction therapy; Surgical exploration; Locally advanced
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-024-15591-4

Background The use of surgery in patients with locally advanced pancreatic cancer (LAPC) following induction chemotherapy is increasing. However, most series do not report on the total cohort of patients undergoing surgical exploration; therefore, this single-center study investigates outcomes among all consecutive patients with LAPC who underwent surgical exploration. Methods We conducted a retrospective, single-center analysis including all consecutive patients with LAPC (Dutch Pancreatic Cancer Group criteria) who underwent surgical exploration with curative intent (January 2014–June 2023) after induction therapy. Primary outcomes were resection rate and overall survival (OS) from the time of diagnosis. Results Overall, 127 patients underwent surgical exploration for LAPC, whereby 100 patients (78.7%) underwent resection and 27 patients (21.3%) underwent a non-therapeutic laparotomy due to the extent of vascular involvement ( n  = 11, 8.7%) or occult metastases ( n  = 16, 12.6%). The overall in-hospital/30-day mortality rate was 0.8% and major morbidity was 31.3% (in patients after resection: 1.0% and 33.3%, respectively). The overall 90-day mortality rate was 5.5%, which included 3.1% mortality due to disease progression. Resection was associated with longer median OS {29 months (95% confidence interval [CI] 26–43) vs. 17 months (95% CI 11–26) ; p  < 0.001} compared with patients undergoing non-therapeutic laparotomy, with corresponding 5-year OS rates of 28.4% and 7.7%. In Cox proportional hazard regression analysis, only pancreatic body/tail tumors independently predicted OS (hazard ratio 1.788 [95% CI 1.042–3.068]). Conclusion This single-center series found a resection rate of 78.7% in patients with LAPC selected for surgical exploration, with a low risk of mortality and morbidity in all explored patients and a 5-year OS rate after resection of 28.4%.