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. 2024 Sep;31(9):6180-6192.
doi: 10.1245/s10434-024-15591-4. Epub 2024 Jul 2.

Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy: A Single-Center Experience

Rutger T Theijse  1   2 , Thomas F Stoop  1   2 , Philip D Leenart  1   2 , Kishan R D Lutchman  1   2 , Joris I Erdmann  1   2 , Freek Daams  2   3 , Babs M Zonderhuis  2   3 , Sebastiaan Festen  4 , Rutger-Jan Swijnenburg  1   2   3 , Thomas M van Gulik  1   2 , Annuska Schoorlemmer  1   2 , André L A Sterk  1   2 , Susan van Dieren  1 , Arantza Fariña  2   5 , Rogier P Voermans  2   6   7 , Johanna W Wilmink  2   8 , Geert Kazemier  2   3 , Olivier R Busch  1   2 , Marc G Besselink  9   10 ; For HPB-Amsterdam
Affiliations

Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy: A Single-Center Experience

Rutger T Theijse et al. Ann Surg Oncol. 2024 Sep.

Abstract

Background: The use of surgery in patients with locally advanced pancreatic cancer (LAPC) following induction chemotherapy is increasing. However, most series do not report on the total cohort of patients undergoing surgical exploration; therefore, this single-center study investigates outcomes among all consecutive patients with LAPC who underwent surgical exploration.

Methods: We conducted a retrospective, single-center analysis including all consecutive patients with LAPC (Dutch Pancreatic Cancer Group criteria) who underwent surgical exploration with curative intent (January 2014-June 2023) after induction therapy. Primary outcomes were resection rate and overall survival (OS) from the time of diagnosis.

Results: Overall, 127 patients underwent surgical exploration for LAPC, whereby 100 patients (78.7%) underwent resection and 27 patients (21.3%) underwent a non-therapeutic laparotomy due to the extent of vascular involvement (n = 11, 8.7%) or occult metastases (n = 16, 12.6%). The overall in-hospital/30-day mortality rate was 0.8% and major morbidity was 31.3% (in patients after resection: 1.0% and 33.3%, respectively). The overall 90-day mortality rate was 5.5%, which included 3.1% mortality due to disease progression. Resection was associated with longer median OS {29 months (95% confidence interval [CI] 26-43) vs. 17 months (95% CI 11-26); p < 0.001} compared with patients undergoing non-therapeutic laparotomy, with corresponding 5-year OS rates of 28.4% and 7.7%. In Cox proportional hazard regression analysis, only pancreatic body/tail tumors independently predicted OS (hazard ratio 1.788 [95% CI 1.042-3.068]).

Conclusion: This single-center series found a resection rate of 78.7% in patients with LAPC selected for surgical exploration, with a low risk of mortality and morbidity in all explored patients and a 5-year OS rate after resection of 28.4%.

Keywords: Induction therapy; Locally advanced; Pancreatic cancer; Resection; Surgical exploration.

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Figures

Fig. 1
Fig. 1
a Overall survival from diagnosis in the explored cohort (n = 127). b Overall survival from diagnosis resection (n = 100) versus non-therapeutic laparotomy (n = 27).
See this image and copyright information in PMC

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