Surgical strategies for locally advanced pancreatic cancer following gemcitabine plus S-1-based chemoradiotherapy.

BACKGROUND

In this study, we present our institution's treatment outcomes and surgical strategies for patients with localized pancreatic ductal adenocarcinoma (PDAC).

METHODS

The study retrospectively reviewed clinical data of 397 patients with localized PDAC who were enrolled in a gemcitabine and S-1 based chemoradiotherapy (GS-CRT) protocol between September 2011 and March 2023. Following GS-CRT, pancreatectomy was performed and concomitant vascular resection with subsequent reconstruction was done, if required, in order to achieve R0 resection margins.

RESULT: From the 397 patients, 366 (92.2 %) completed the GS-CRT. A total of 359 patients were adequately re-evaluated after GS-CRT and categorized as having resectable (R; n = 77), borderline resectable with superior mesenteric vein/portal vein involvement (BR-PV; n = 40), borderline resectable with arterial involvement (BR-A; n = 94), or unresectable locally advanced (UR-LA; n = 148) tumors, respectively. From these, 202 patients with R (n = 63), BR-PV (n = 31), BR-A (n = 56) and UR-LA (n = 52) PDAC underwent curative-intent pancreatectomy. The R0 resection rates and median survival times for disease-specific survival (DSS) according to resectability were favorable: 98.4 %, 93.5 %, 92.9 %, and 80.8 %, and 62.7, 66.1, 41.8, and 36.2 months, respectively. Prognostic factors for DSS among the 202 resected patients included performance status, pre-operative carbohydrate antigen 19-9 and carcinoembryonic antigen serum levels, pre-operative tumor resectability, pathological T factor and receipt of adjuvant chemotherapy. In the resected UR-LA patients, adjuvant chemotherapy was a significant prognostic factor of survival outcomes.

CONCLUSIONS

GS-CRT followed by pancreatectomy is feasible and a beneficial treatment strategy for PDAC. Therefore, a safe and reliable surgical approach that ensures R0 resection margins and enables subsequent adjuvant chemotherapy is essential.