Medline ® Abstract for Reference 120
of 'Initial chemotherapy and radiation for nonmetastatic, locally advanced, unresectable and borderline resectable, exocrine pancreatic cancer'
Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer.
Kang CM, Chung YE, Park JY, Sung JS, Hwang HK, Choi HJ, Kim H, Song SY, Lee WJ
J Gastrointest Surg. 2012 Mar;16(3):509-17. Epub 2011 Dec 20.
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 ofmetastastic 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.
Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.