Abstract
Background
Neoadjuvant treatment before resection for pancreatic adenocarcinoma having contact
with the splenomesentericoportal venous axis could improve the results of extended
pancreatectomies. We compared the outcomes of upfront (UR) and resection after neoadjuvant
chemotherapy (NAC) for pancreatic adenocarcinoma.
Methods
We retrospectively reviewed clinical data of patients who underwent pancreaticoduodenectomy
with venous resection for pancreatic adenocarcinoma between January 1, 2006, and December
31, 2020. Operative, pathologic, and survival outcomes were compared between upfront
and resection after neoadjuvant chemotherapy.
Results
Of the 169 patients, 55 patients underwent preoperative chemotherapy and 114 underwent
upfront. No differences were found in operative time, morbidity, and mortality between
the 2 groups. At pathologic examination, patients who underwent resection after neoadjuvant
chemotherapy had a significantly smaller tumor size, higher rate of R0 resection,
less lymph node involvement, and a lower rate of pathologic venous invasion (P < .05). The median overall survival was 27.96 months, and the overall survival rates
at 1, 3, 5, and 10 years were 82%, 39%, 22%, and 11%, respectively. Multivariate Cox
analysis found neoadjuvant treatment (hazard ratio: 0.60; 95% confidence interval:
0.38–0.97; P = .03), and intraoperative transfusion (hazard ratio: 2.25; 95% confidence interval:
1.47–3.46; P = .0002) as independent prognostic factors for overall survival. A dose-dependent
effect of perioperative transfusion on overall survival was found (no transfusion, =
2 red blood cells, >2 red blood cells; median overall survival 41.1 months vs 27.01
months vs 19.4 months; P = .0003).
Conclusion
Neoadjuvant chemotherapy improves the pathologic and survival outcomes of pancreaticoduodenectomy
with venous resection for pancreatic adenocarcinomas. The dose-dependent effect of
perioperative transfusion on overall survival warrants further investigation.
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Article info
Publication history
Published online: February 26, 2022
Accepted:
January 11,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
