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Potential Contribution of Preoperative Neoadjuvant Concurrent Chemoradiation Therapy on Margin-Negative Resection in Borderline Resectable Pancreatic Cancer

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

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 of metastastic 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.

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Acknowledgements

The authors would like to express sincere thanks to all the members of the pancreaticobiliary clinic at our institutions, including Dr. Kyung Sik Kim (Surgery), Myeong-Jin Kim (Radiology), Mi-Suk Park (Radiology), Jae Bock Chung (Gastroenterology), Seung Woo Park (Gastroenterology), Seungmin Bang (Gastroenterology), and Woong Sub Koom (Radiation oncology) for their daily devotion and contributions to treating pancreatic cancer patients in YUHS.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

    Chang Moo Kang, Ho Kyoung Hwang & Woo Jung Lee

  2. Division of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea

    Jeong Youp Park & Si Young Song

  3. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea

    Jeong Youp Park, Hye Jin Choi & Si Young Song

  4. Department of Radiologic Oncology, Yonsei University College of Medicine, Seoul, South Korea

    Jin Sil Sung

  5. Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea

    Yong Eun Chung

  6. Division of Medical Oncology, Yonsei University College of Medicine, Seoul, South Korea

    Hye Jin Choi

  7. Department of Pathology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

    Hyunki Kim

  8. Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, South Korea

    Chang Moo Kang, Yong Eun Chung, Jeong Youp Park, Jin Sil Sung, Ho Kyoung Hwang, Hye Jin Choi, Si Young Song & Woo Jung Lee

  9. Young Yonsei Panceatic Tumor Study Group, Seoul, South Korea

    Chang Moo Kang, Yong Eun Chung, Jeong Youp Park, Ho Kyoung Hwang, Hye Jin Choi & Hyunki Kim

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  1. Chang Moo Kang
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Correspondence to Hyunki Kim or Woo Jung Lee.

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Kang, C.M., Chung, Y.E., Park, J.Y. et al. Potential Contribution of Preoperative Neoadjuvant Concurrent Chemoradiation Therapy on Margin-Negative Resection in Borderline Resectable Pancreatic Cancer. J Gastrointest Surg 16, 509–517 (2012). https://doi.org/10.1007/s11605-011-1784-3

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  • DOI: https://doi.org/10.1007/s11605-011-1784-3

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