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Efficacy of Neoadjuvant Chemotherapy in Distal Pancreatectomy with En Bloc Celiac Axis Resection (DP-CAR) for Locally Advanced Pancreatic Cancer

  • Shohei YoshiyaEmail author
  • Kengo Fukuzawa
  • Shoichi Inokuchi
  • Yukiko Kosai-Fujimoto
  • Kensaku Sanefuji
  • Kentaro Iwaki
  • Akira Motohiro
  • Shinji Itoh
  • Noboru Harada
  • Toru Ikegami
  • Tomoharu Yoshizumi
  • Masaki Mori
Original Article
  • 78 Downloads

Abstract

Backgrounds

Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) is an extended surgical procedure for patients with locally advanced cancer of the pancreatic body and tail. Recently, the usability of neoadjuvant chemotherapy (NAC) in pancreatic cancer was reported. The purpose of this study was to clarify the impact of NAC on surgical outcomes and prognosis in DP-CAR patients.

Methods

This study retrospectively reviewed 20 consecutive patients who underwent DP-CAR at a single institution.

Results

Eleven of 20 patients (55.0%) received NAC. Their first regimens were gemcitabine (GEM) plus nab-PTX (n = 7, 63.6%), GEM plus S-1 (n = 3, 27.3%), and GEM (n = 1, 9.1%). Although two patients converted to a second regimen, none abandoned NAC due to adverse effects or could not undergo a planned procedure for disease progression. There were no significant differences in intraoperative variables, morbidity, including pancreatic fistula and delayed gastric emptying, and mortality between patients with and without NAC; however, patients with NAC had a significantly lower proportion of arterial invasion (p = 0.025), lymphatic invasion (p < 0.0001), and vascular invasion (p = 0.035). There were no significant differences in the induction rate of adjuvant chemotherapy (p = 0.201). The recurrence-free survival and overall survival rates in patients with NAC were significantly higher than in patients without NAC (p = 0.041 and p = 0.018, respectively).

Conclusion

DP-CAR following NAC was associated with a preferable prognosis and had no negative effect on surgical outcomes. Therefore, NAC in DP-CAR patients might be a beneficial and safe therapeutic strategy.

Keywords

Neoadjuvant chemotherapy DP-CAR Appleby Pancreatic cancer 

Abbreviations

AC

Adjuvant chemotherapy

BR

Borderline resectable disease

CHA

Common hepatic artery

CA

Celiac axis

CT

Computed tomography

DGE

Delayed gastric emptying

DP-CAR

Distal pancreatectomy with en bloc celiac axis resection

GDA

Gastroduodenal artery

GEM

Gemcitabine

GS

Gemcitabine plus S-1

LGA

Left gastric artery

MST

Mean survival time

NAC

Neoadjuvant chemotherapy

NCCN

The National Comprehensive Cancer Network

PDAC

Pancreatic ductal adenocarcinoma

PF

Pancreatic fistula

PTX

Paclitaxel

PV

Portal vein

SMA

Superior mesenteric artery

UICC

Union for International Cancer Control

UR

Unresectable disease

Notes

Acknowledgments

We thank H. Nikki March, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Author Contributions

S.Y. participated in the study conception and design, analysis, and drafting of the article.

K.F. participated in the study conception and design and critical revision of the manuscript.

S.I., Y.F., K.S, K.I., S.I., N.H., T.I., and T.Y. participated in the acquisition of data, analysis, and interpretation of data.

M.M participated in the critical revision of the manuscript.

Compliance with Ethical Standards

All patients provided written informed consent, and the study protocol was approved by the Ethical Committee of Oita Red Cross Hospital (IRB No. 189).

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Shohei Yoshiya
    • 1
    • 2
    Email author
  • Kengo Fukuzawa
    • 2
  • Shoichi Inokuchi
    • 1
    • 2
  • Yukiko Kosai-Fujimoto
    • 1
    • 2
  • Kensaku Sanefuji
    • 2
  • Kentaro Iwaki
    • 2
  • Akira Motohiro
    • 2
  • Shinji Itoh
    • 1
  • Noboru Harada
    • 1
  • Toru Ikegami
    • 1
  • Tomoharu Yoshizumi
    • 1
  • Masaki Mori
    • 1
  1. 1.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of SurgeryOita Red Cross HospitalOitaJapan

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