title: Resection after neoadjuvant therapy for locally advanced, "unresectable" pancreatic cancer.
abstract: BACKGROUND
  For pancreatic cancer, complete macroscopic resection in combination with chemotherapy is the only potentially curative treatment. Many patients present with locally advanced cancers deemed unresectable. We sought to assess the results of exploration after neoadjuvant therapy for locally advanced possibly unresectable pancreatic cancer.
  
  
  METHODS
  From a prospective database, all consecutive patients undergoing operation from October 2001 to December 2009 after neoadjuvant therapy for locally advanced pancreatic cancer were identified. Main criteria for "unresectability" were infiltration of the celiac axis or superior mesenteric artery. Resection rates, perioperative results, and survival were analyzed.
  
  
  RESULTS
  Of 257 patients, 199 (77.4%) had received neoadjuvant chemoradiation, and 58 (22.6%) chemotherapy only. Of 257 patients, 120 (46.7%) underwent successful resection, whereas 137 patients underwent exploration only; 47 (39.2%) multivisceral and 45 (37.5%) vascular resections (12 arterial reconstructions) were performed. There were 6 (5%) ypT0 neoplasms, 36 (30.0%) R0, 61 (50.8%) R1, and 16 (13.3%) R2 resections. The median follow-up of surviving patients (n = 22) was 22 months. Median postoperative survival was greater after resection (12.7 months) than after exploration alone (8.8 months; P < .0001). Median postoperative survival was 24.6 months after R0, 11.9 months after R1, and 8.9 months after R2 resection. The 3-year survival rate after R0 resection was 24%. To determine survival after start of neoadjuvant therapy, 3.7 months (median) have to be added.
  
  
  CONCLUSIONS
  In locally advanced, unresectable pancreatic cancer, R0/R1 resections can be achieved in up to 40% of patients who undergo operation after neoadjuvant therapy. In these cases, survival rates are similar to those observed for initially resectable pancreatic cancer.
authors: Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: Oliver
authors: O
authors: Strobel
authors: Viktoria
authors: V
authors: Berens
authors: Ulf
authors: U
authors: Hinz
authors: Werner
authors: W
authors: Hartwig
authors: Thilo
authors: T
authors: Hackert
authors: Frank
authors: F
authors: Bergmann
authors: Jürgen
authors: J
authors: Debus
authors: Dirk
authors: D
authors: Jäger
authors: Markus W
authors: MW
authors: Büchler
authors: Jens
authors: J
authors: Werner
mesh_terms: D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate