Clinical outcomes of pancreatic ductal adenocarcinoma resection following neoadjuvant chemoradiation therapy vs. chemotherapy.
OBJECTIVE
We compared the clinical outcomes of pancreatic ductal adenocarcinoma (PDAC) resection after neoadjuvant chemoradiation therapy (NACRT) vs. chemotherapy (NAC).


METHODS
The study population comprised 81 patients with UICC stage T3/4 PDAC, treated initially by NACRT with S-1 in 40 and by NAC with gemcitabine + S-1 in 41. This was followed by pancreatectomy with routine nerve plexus resection in 35 of the patients who had received NACRT and 32 of those who had received NAC. We compared the survival curves and clinical outcomes of these two groups.


RESULTS
The rates of clinical response, surgical resectability, and margin-negative resection were similar. The NACRT group patients had significantly higher rates of Evans stage ≥IIB tumors (29 vs. 0 %, respectively, p = 0.010) and negative lymph nodes (49 vs. 16 %, respectively, p = 0.021) than the NAC group patients. There was no difference in disease-free survival between the groups, but the disease-specific survival of the NAC group patients was better than that of the NACRT group patients (p = 0.034). Patients undergoing pancreatectomy with nerve plexus resection following NACRT had significantly higher rates of intractable diarrhea and ascites but consequently received significantly less adjuvant chemotherapy and therapeutic chemotherapy for relapse.


CONCLUSIONS
NACRT followed by pancreatectomy with nerve plexus resection is superior for achieving local control, but postoperative diarrhea and ascites may prohibit continuation of adjuvant chemotherapy or chemotherapy for relapse (UMIN4148).
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan. satoi@hirakata.kmu.ac.jp.
Sohei
S
Satoi
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Hiroaki
H
Yanagimoto
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Tomohisa
T
Yamamoto
Departments of Pathology, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Chisato
C
Ohe
Departments of Pathology, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Chika
C
Miyasaka
Departments of Pathology, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Yoshiko
Y
Uemura
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Satoshi
S
Hirooka
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
So
S
Yamaki
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Hironori
H
Ryota
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Taku
T
Michiura
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Kentaro
K
Inoue
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Yoichi
Y
Matsui
Departments of Radiology, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Noboru
N
Tanigawa
Departments of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Masanori
M
Kon
D000328:Adult; D000368:Aged; D001201:Ascites; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003967:Diarrhea; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D010094:Oxonic Acid / Q000008:administration & dosage; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D005641:Tegafur / Q000008:administration & dosage; D016896:Treatment Outcome; D000093542:Gemcitabine
D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine
Neoadjuvant chemoradiation; Neoadjuvant chemotherapy; Pancreatic ductal adenocarcinoma