Annals of Surgical Oncology

, Volume 21, Issue 5, pp 1530–1537

Extended Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer Demonstrates Promising Postoperative Outcomes and Survival

  • J. Bart Rose
  • Flavio G. Rocha
  • Adnan Alseidi
  • Thomas Biehl
  • Ravi Moonka
  • John A. Ryan
  • Bruce Lin
  • Vincent Picozzi
  • Scott Helton
Hepatobiliary Tumors

DOI: 10.1245/s10434-014-3486-z

Cite this article as:
Rose, J.B., Rocha, F.G., Alseidi, A. et al. Ann Surg Oncol (2014) 21: 1530. doi:10.1245/s10434-014-3486-z

Abstract

Background

The optimum approach to neoadjuvant therapy for patients with borderline resectable pancreatic cancer is undefined. Herein we report the outcomes of an extended neoadjuvant chemotherapy regimen in patients presenting with borderline resectable adenocarcinoma of the pancreatic head.

Methods

Patients identified as having borderline resectable pancreatic head cancer by American Hepato-Pancreato-Biliary Association/Society of Surgical Oncology consensus criteria from 2008 to 2012 were tracked in a prospectively maintained registry. Included patients were initiated on a 24-week course of neoadjuvant chemotherapy. Medically fit patients who completed neoadjuvant treatment without radiographic progression were offered resection with curative intent. Clinicopathologic variables and surgical outcomes were collected retrospectively and analyzed.

Results

Sixty-four patients with borderline resectable pancreatic cancer started neoadjuvant therapy. Thirty-nine (61 %) met resection criteria and underwent operative exploration with curative intent, and 31 (48 %) were resected. Of the resected patients, 18 (58 %) had positive lymph nodes, 15 (48 %) required en-bloc venous resection, 27 (87 %) had a R0 resection, and 3 (10 %) had a complete pathologic response. There were no postoperative deaths at 90 days, 16 % of patients had a severe complication, and the 30-day readmission rate was 10 %. The median overall survival of all 64 patients was 23.6 months, whereas that of unresectable patients was 15.4 months. Twenty-five of the resected patients (81 %) are still alive at a median follow-up of 21.6 months.

Conclusions

Extended neoadjuvant chemotherapy is well tolerated by patients with borderline resectable pancreatic head adenocarcinoma, selects a subset of patients for curative surgery with low perioperative morbidity, and is associated with favorable survival.

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • J. Bart Rose
    • 1
  • Flavio G. Rocha
    • 1
  • Adnan Alseidi
    • 1
  • Thomas Biehl
    • 1
  • Ravi Moonka
    • 1
  • John A. Ryan
    • 1
  • Bruce Lin
    • 2
  • Vincent Picozzi
    • 2
  • Scott Helton
    • 1
  1. 1.Section of General, Thoracic and Vascular Surgery, Department of SurgeryVirginia Mason Medical CenterSeattleUSA
  2. 2.Section of Medical Oncology, Department of MedicineVirginia Mason Medical CenterSeattleUSA