The following is a summary of “Improved outcomes for borderline resectable adenocarcinoma of the pancreas after neoadjuvant chemotherapy in a community cancer center,” published in the December 2022 issue of Surgery by Curto, et al.

Pancreatic adenocarcinomas that are borderline resectable typically have low resection rates and short survival times because they affect the main circulatory systems next to the pancreas. However, improved response and resection rates have been seen with more recent chemotherapy regimens. For a study, researchers sought to find out how neoadjuvant chemotherapy affected the resection rates and overall survival of patients with borderline resectable pancreatic cancer who attended a community cancer program; they conducted a retrospective assessment of those cases.

From January 1, 2015, to December 31, 2019, records of all patients with pancreatic adenocarcinoma were examined to assess the stage at presentation, resectability status, therapy options, surgical resection, and survival. Preoperative imaging revealed the patient’s condition as borderline resectable in accordance with published standards from National Comprehensive Cancer Network (NCCN) Guidelines 2.2021. A standard t-test was used to gather and evaluate the data. The institution’s IRB gave its approval to the study.

A total of 322 individuals were diagnosed with pancreatic ductal adenocarcinoma during the time, of which 151 (47%) were unresectable at the time of presentation, 31 (10%) were locally progressed, 70 (22%) were borderline resectable, 69 (21%) were. The study was based on 36 (51%) of the borderline resectable patients who had neoadjuvant chemotherapy at our facility using either the FOLFIRINOX or gemcitibine/nab-Paclitaxel regimens. In addition, 24 (68%) of the patients with questionable resectability were found to be candidates for surgery after neoadjuvant chemotherapy. On final pathology, 9 (60%) of the 15 patients who had resection at the time of exploration had margin-free resection. When compared to those who did not have surgery, those who had resection had an overall survival increase of 19.6 months (35.4 versus 15.8 mos, P< 0.01). With 0% death at 90 days, the overall morbidity following resection was 46% (33% class 1 or 2, 13% class 3).

Neoadjuvant chemotherapy improved resection rates and overall survival in patients with resected pancreatic adenocarcinoma that was borderline resectable. The approach to treating pancreatic ductal adenocarcinoma was safe and practical in a community-based cancer program.

Reference: americanjournalofsurgery.com/article/S0002-9610(22)00658-4/fulltext