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Neoadjuvant Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Borderline Resectable Pancreatic Cancer Potentially Improves Survival and Facilitates Surgery

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Accumulation of evidence suggests that neoadjuvant chemotherapy improves the outcomes of borderline resectable pancreatic cancer (BRPC). Gemcitabine plus nab-paclitaxel (GnP) has been widely accepted as systemic chemotherapy for unresectable pancreatic cancer and reportedly results in remarkable tumor shrinkage. This study was performed to evaluate the safety and efficacy of neoadjuvant chemotherapy using neoadjuvant GnP for BRPC.

Methods

The medical records of 57 patients who underwent treatment of BRPC from 2010 to 2017 were retrospectively reviewed. The patient characteristics and short- and intermediate-term outcomes were compared between the GnP and upfront surgery (UFS) groups.

Results

The GnP group comprised 31 patients and the UFS group comprised 26 patients. The patient characteristics were comparable with the exception of a higher prevalence of arterial involvement in the GnP group. Twenty-seven of the 31 patients (87%) in the GnP group and all 26 patients in the UFS group underwent resection. The GnP group showed a significantly shorter operation time (429 vs. 509.5 min, p = 0.0068), less blood loss (760 vs. 1324 ml, p = 0.0115), and a higher R0 resection rate (100% vs. 77%, p = 0.0100) than the UFS group. Postoperative complications and hospital stay were comparable between the two groups, and no treatment-related mortality occurred in either group. Both the disease-free survival and overall survival times were significantly longer in the GnP group (p = 0.0018 and p = 0.0024, respectively).

Conclusions

Neoadjuvant GnP is a safe and effective treatment strategy for BRPC. It potentially improves patients’ prognosis and facilitates surgical procedures.

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Acknowledgment

This study was supported by Grants-in-Aid for Scientific Research (KAKENHI; #16K10601).

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Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yoshihiro Miyasaka MD, PhD, Takao Ohtsuka MD, PhD, Ryuichiro Kimura MD, Ryota Matsuda MD, Yasuhisa Mori MD, PhD, Kohei Nakata MD, PhD & Masafumi Nakamura MD, PhD

  2. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Ryota Matsuda MD & Yoshinao Oda MD, PhD

  3. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Daisuke Kakihara MD, PhD

  4. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Nao Fujimori MD, PhD & Takamasa Ohno MD, PhD

Authors
  1. Yoshihiro Miyasaka MD, PhD
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  2. Takao Ohtsuka MD, PhD
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  3. Ryuichiro Kimura MD
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  4. Ryota Matsuda MD
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  5. Yasuhisa Mori MD, PhD
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  6. Kohei Nakata MD, PhD
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  7. Daisuke Kakihara MD, PhD
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  8. Nao Fujimori MD, PhD
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  9. Takamasa Ohno MD, PhD
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  10. Yoshinao Oda MD, PhD
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  11. Masafumi Nakamura MD, PhD
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Corresponding author

Correspondence to Masafumi Nakamura MD, PhD.

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Disclosures

Yoshihiro Miyasaka, Takao Ohtsuka, Ryuichiro Kimura, Ryota Matsuda, Yasuhisa Mori, Kohei Nakata, Daisuke Kakihara, Nao Fujimori, Takamasa Ohno, Yoshinao Oda, and Masafumi Nakamura declare no conflicts of interest related to this article.

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Miyasaka, Y., Ohtsuka, T., Kimura, R. et al. Neoadjuvant Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Borderline Resectable Pancreatic Cancer Potentially Improves Survival and Facilitates Surgery. Ann Surg Oncol 26, 1528–1534 (2019). https://doi.org/10.1245/s10434-019-07309-8

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  • DOI: https://doi.org/10.1245/s10434-019-07309-8

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