Intention to treat outcomes following management of locally advanced pancreatic ductal adenocarcinoma with curative intent: single centre cohort study.

BACKGROUND

Advances in the management of locally advanced pancreatic ductal adenocarcinoma (LAPDAC) have resulted in only a modest improvement in outcomes. This study highlights treatment pathway and outcomes of the largest contemporary United Kingdom LAPDAC cohort to date.

METHODS

LAPDAC patients between 01/2017-12/2022 were included. Patient and tumour characteristics, surgical and oncological outcomes were collected prospectively. Primary endpoint was overall survival (OS). Secondary endpoints were chemotherapy completion and resection rates, perioperative morbidity and mortality and disease-free survival (DFS).

RESULTS

208 patients were included. 133 patients commenced neoadjuvant treatment (NAT) with 107 patients receiving at least 3 months and 65 completing 6 months. 44/133 (33%) patients were considered for surgery and 25 (19%) underwent resection. 80% of patients underwent venous and/or arterial resection. 52% of patients had R0 resection. 90-day mortality was 12%. Median OS was significantly longer for patients who had resection after NAT (12.6 months vs 30 months, P < 0.001). Median DFS was 7.7 months with a 3-year rate of 14%. Completion of chemotherapy (6 months) was associated with prolonged OS.

CONCLUSIONS

Multimodality therapy that includes surgery can be accomplished in selected patients with LAPDAC and is associated with a median overall survival that approximates earlier stages of disease.