title: Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy.
abstract: BACKGROUND
  Neoadjuvant treatment frequently is performed in unresectable/borderline resectable pancreatic cancer. The aim of this study was to retrospectively compare postoperative outcomes and survival of patients who underwent pancreatectomy after neoadjuvant treatment for locally advanced/borderline resectable pancreatic cancer (neoadjuvant treatment group) with those of patients with resectable disease who underwent upfront surgery.
  
  
  METHODS
  Between 2000 and 2008, there were 403 patients who underwent pancreatic cancer resection, 41 (10.1%) patients after neoadjuvant treatment for initially unresectable tumors and 362 (89.9%) patients had upfront surgery. Univariate and multivariable analyses were performed.
  
  
  RESULTS
  Mortality/morbidity rates were similar in the 2 groups. Nodal metastases were significantly lower in the neoadjuvant treatment group (31.7% vs 86.2%; P < .001). A complete pathologic response was observed in 13.6% after neoadjuvant treatment. Median disease-specific survival from resection was 35 and 27 months in the neoadjuvant treatment and upfront groups, respectively (P = .74). In the neoadjuvant treatment group survival rates were similar in N0/N1 patients.
  
  
  CONCLUSIONS
  Postoperative mortality and morbidity do not significantly increase after neoadjuvant treatment. Neoadjuvant treatment in locally advanced pancreatic cancer can lead to an objective pathologic response, but this does not significantly improve survival after resection.
authors.affiliation: Department of Surgery, Policlinico GB Rossi, University of Verona, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Barugola
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.forename: Paola
authors.initials: P
authors.lastname: Capelli
authors.forename: Mirko
authors.initials: M
authors.lastname: D'Onofrio
authors.forename: Paolo
authors.initials: P
authors.lastname: Pederzoli
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome