ABSTRACT
Objective:To evaluate the impact of neoadjuvant chemotherapy on long-term prognosis of patients with borderline resectable pancreatic cancer (BRPC) treated with combined allograft revascularization.Methods:The data of patients with BRCP who were treated at Beijing Chaoyang Hospital, Capital Medical University from March 2016 to March 2021 were retrospectively analysed. Of 52 patients who underwent radical surgery combined with allograft revascularization in this study, there were 24 males and 28 females, aged (60.3±10.6) years old. These patients were divided into two groups based on whether they received neoadjuvant chemotherapy before surgery. There were 19 patients in the neoadjuvant chemotherapy group and 33 patients in the vascular replacement group. Outpatient clinic and telephone follow-up were used. The clinical data and prognostic differences between the two groups were then analysed.Results:Of 52 patients who underwent surgery successfully, 14 patients (26.9%) developed postoperative complications. The incidence of postoperative pancreatic fistula was significantly lower in the neoadjuvant chemotherapy group than the vascular replacement group (0 vs. 21.2%, P<0.05). The median survivals were 15 and 13 months in the neoadjuvant chemotherapy and the vascular replacement groups, respectively, with a significant difference in cumulative postoperative survival between the two groups ( P=0.039). For patients with BRPC, CA19-9>400 U/ml ( RR=4.540, 95% CI: 2.332-8.836, P<0.001) was an independent risk factor for long-term survival after surgery. Conclusions:Neoadjuvant chemotherapy reduced the incidence of postoperative pancreatic fistula and improved survival prognosis in patients with BRPC. A high preoperative serum CA19-9 level was an independent risk factor for long-term survival in patients with BRPC.
ABSTRACT
Borderline resectable pancreatic cancer is a special subtype between resectable and unresectable pancreatic cancer. Although the tumor is technically suitable for resection, there is increased risk of positive margin after surgery. At present, there is no optimal diagnostical criteria and treatment options for borderline resectable pancreatic cancer. With the popularization of the concept of multidisciplinary diagnosis and treatment, neoadjuvant therapy has been widely used in borderline resectable pancreatic cancer, and received good outcomes in some centers. However, for patients with borderline resectable pancreatic cancer who are not sensitive to radiotherapy and chemotherapy, long time of neoadjuvant therapy may delay the best time for surgery. This article summarized the definition, classification criteria and the latest diagnosis and treatment progress of borderline resectable pancreatic cancer, and discussed the comprehensive treatment mode suitable for this kind of patients combined with the clinical experience of our center.