title: Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.
abstract: OBJECTIVE
  A multicenter survey was conducted to explore the role of adjuvant surgery for initially unresectable pancreatic cancer with a long-term favorable response to non-surgical cancer treatments.
  
  
  METHODS
  Clinical data including overall survival were retrospectively compared between 58 initially unresectable pancreatic cancer patients who underwent adjuvant surgery with a favorable response to non-surgical cancer treatments over 6 months after the initial treatment and 101 patients who did not undergo adjuvant surgery because of either unchanged unresectability, a poor performance status, and/or the patients' or surgeons' wishes.
  
  
  RESULTS
  Overall mortality and morbidity were 1.7 and 47 % in the adjuvant surgery group. The survival curve in the adjuvant surgery group was significantly better than in the control group (p < 0.0001). The propensity score analysis revealed that adjuvant surgery was a significant independent prognostic variable with an adjusted hazard ratio (95 % confidence interval) of 0.569 (0.36-0.89). Subgroup analysis according to the time from initial treatment to surgical resection showed a significant favorable difference in the overall survival in patients who underwent adjuvant surgery over 240 days after the initial treatment.
  
  
  CONCLUSIONS
  Adjuvant surgery for initially unresectable pancreatic cancer patients can be a safe and effective treatment. The overall survival rate from the initial treatment is extremely high, especially in patients who received non-surgical anti-cancer treatment for more than 240 days.
authors: Department of Surgery, Kansai Medical University, Moriguchi, Japan.
authors: Sohei
authors: S
authors: Satoi
authors: Hiroki
authors: H
authors: Yamaue
authors: Kentaro
authors: K
authors: Kato
authors: Shinichiro
authors: S
authors: Takahashi
authors: Seiko
authors: S
authors: Hirono
authors: Shin
authors: S
authors: Takeda
authors: Hidetoshi
authors: H
authors: Eguchi
authors: Masayuki
authors: M
authors: Sho
authors: Keita
authors: K
authors: Wada
authors: Hiroyuki
authors: H
authors: Shinchi
authors: A Hon
authors: AH
authors: Kwon
authors: Satoshi
authors: S
authors: Hirano
authors: Taira
authors: T
authors: Kinoshita
authors: Akimasa
authors: A
authors: Nakao
authors: Hiroaki
authors: H
authors: Nagano
authors: Yoshiyuki
authors: Y
authors: Nakajima
authors: Keiji
authors: K
authors: Sano
authors: Masaru
authors: M
authors: Miyazaki
authors: Tadahiro
authors: T
authors: Takada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents
keywords: adjuvant surgery; chemotherapy; radiotherapy; super-responder; unresectable pancreatic cancer