Impact of preoperative chemotherapy on surgical results in 139 patients with locally advanced pancreatic cancer.

Autor:	Petrikowski M; Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany., Fahlbusch T; Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany., Reinacher-Schick A; Department of Hematology and Oncology with Palliative Medicine, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany., Kucinskaite G; Department of Radiology and Nuclear Medicine, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany., Tannapfel A; Institute of Pathology, Ruhr-University Bochum, Bochum, Germany., Uhl W; Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany., Belyaev O; Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
Jazyk:	angličtina
Zdroj:	Hepatobiliary surgery and nutrition [Hepatobiliary Surg Nutr] 2024 Jun 01; Vol. 13 (3), pp. 460-471. Date of Electronic Publication: 2024 Mar 11.
DOI:	10.21037/hbsn-23-426
Abstrakt:	Background: The establishment of preoperative chemotherapy (PCT) with FOLFIRINOX and gemcitabine/nab-paclitaxel in recent years has enabled resectability in many patients with initially locally advanced pancreatic cancer (LAPC). Nevertheless, information about the impact of PCT on surgical results is scarce. Methods: All patients with initial LAPC who received surgery after chemotherapy at the high-volume centre for pancreatic surgery of St. Josef-Hospital Bochum between 2015 and 2022 were included in this retrospective cohort analysis. Results: A total of 139 patients underwent surgery after pre-treatment with FOLFIRINOX (76.3%), gemcitabine/nab-paclitaxel (11.5%), both (5.8%) and other regimens (6.5%). Eighty-five tumors (61.2%) were resectable after PCT. R0 resection was achieved in 92.9%, R1 in 7.1% and R2 in 0% of cases. Fifty-four tumors were still not resectable at the time of surgery. Surgical results of the patients did not show increased postoperative mortality and morbidity compared to the literature data. Postoperative 30-day mortality was 1.4%. Rates for pancreas-specific complications [postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and others] were not increased. POPF occurred in 10.5% and DGE in 26.3% after pancreaticoduodenectomy. After distal pancreatectomy, POPF was detected in 37.5% and DGE in 12.5%. Median postoperative survival (31 vs. 13 months) and overall survival after initial diagnosis (40 vs. 20 months) were significantly longer in resected patients (P<0.001). Postoperative recurrence-free survival in resected patients amounted to 12 months. Conclusions: This study underlines that PCT allows resectability of primarily unresectable patients with LAPC without increasing perioperative mortality and morbidity. It may lead to a significant prolongation of recurrence-free and overall survival in resected patients after PCT. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-23-426/coif). The authors have no conflicts of interest to declare. (2024 Hepatobiliary Surgery and Nutrition. All rights reserved.)
Databáze:	MEDLINE
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