title: Neoadjuvant treatment in pancreatic cancer: Evidence-based medicine? A systematic review and meta-analysis.
abstract: Neoadjuvant treatment in non-metastatic pancreatic cancer (PaC) has the theoretical advantages of downstaging the tumor, sterilizing any present systemic undetectable disease, selecting patients for surgery and administering therapy to each patient. The aim of this systematic review is to analyze the state of the art on neoadjuvant protocols for non-metastatic PaC. A literature search over the last 10 years was conducted, and papers had to be focused on resectable, borderline resectable (BLR) or locally advanced (LA) histo- or cytologically proven PaC; to be prospective studies or prospectively collected databases; to report percentage of protocol achievement and survival data at least in an intention-to-treat (ITT) analysis. Twelve studies were eligible for systematic review. Studies included a total of 624 patients: 248 resectable, 268 BLR, 71 LA and 37 non-specified. All studies were included for meta-analysis. ITT overall survival (OS) was 16.7 months (95% CI 15.16-18.26 months); for resected patients OS was 22.78 months (95% CI 20.42-25.16), and for eventually non-resected patients it was 9.89 months (95% CI 8.84-10.96). Neoadjuvant approaches for resectable, BLR and LA PaC are spreading. Outcomes tend to be better outside an RCT context, but strong evidences are lacking. Actually such treatments should be performed only in a randomized clinical trial setting.
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Angelo
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy. laura.antolino@uniroma1.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Antolino
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Sirimarco
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kazemi Nava
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: De Siena
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.|Digestive Surgery and Liver Transplantation Unit, Nice University Hospital, Nice, France.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Petrucciani
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Valabrega
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Aurello
authors.affiliation: Division of General Surgery, Department of Medical and Surgical Sciences and Translational Medicine, UOC Chirurgia 3, Sapienza University, St. Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery / Q000628:therapy*
keywords: Borderline; Neoadjuvant therapy; Pancreatic cancer; Resectable; Surgery; Survival