Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

Image credit: Zaky, AM, Wolfgang, CL, Weiss, MJ, et al. (2016). Tumor-vessel relationships in pancreatic ductal adenocarcinoma at multidetector CT: different classification systems and their influence on treatment planning. RadioGraphics; 37(1):93-112

The following study was recently published in the Journal of Gastrointestinal Surgery by Ammar A. Javed and colleagues in September 2018. Below is a summary of the article.

Localized pancreatic cancer can be classified into resectable, borderline resectable and locally advanced lesions based on the degree of involvement of adjacent blood vessels (portal vein, superior mesenteric artery and celiac artery). Borderline resectable tumors are those that have limited invasion of the vessels and, while surgically resectable, carry a high risk of positive margins at the time of resection (see prior Nikki Mitchell Foundation article on margin status). Chemotherapy available for pancreatic cancer has improved significantly over the last decade. With effective therapies now available, a majority of patients with borderline resectable disease now receive preoperative chemotherapy. The authors sought to evaluate the outcomes of patients undergoing surgery for borderline resectable pancreatic cancer at a single high-volume center.

The authors identified 151 patients from their multidisciplinary clinic who were diagnosed with borderline resectable pancreatic cancer. 142 (94.0%) patients received chemotherapy and 78 (51.7%) received radiation therapy. Ninety-six (63.6%) were able to undergo surgery, while 12 (7.9%) patients were taken to the operating room but their procedure was aborted due to extensive disease. 47 (31.1%) of patients unfortunately had progression of disease and were deemed to be unresectable at follow up. Patients who underwent surgery had a median overall survival of 28.8 months as compared to 13.5 months in those who did not receive surgery.

Take home points:

  • Multidisciplinary management is vital for borderline resectable pancreatic cancer.
  • Resection of borderline resectable pancreatic cancer is safe when performed by experienced surgeons at a high volume institution.
  • The rate of resection in patients with borderline pancreatic cancer is approximately 65%.
  • Surgical resection of borderline resectable pancreatic cancer is associated with improved overall survival.
  • Disease progression while receiving chemotherapy is the most frequent reason for unresectability.

You can read the entire article here.

A special thanks for this summary by Michael Wright, Department of Surgery, Johns Hopkins School of Medicine and Dr. Ammar Javed for his support.

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