Efficacy of Neoadjuvant Chemotherapy in Distal Pancreatectomy with En Bloc Celiac Axis Resection (DP-CAR) for Locally Advanced Pancreatic Cancer

Yoshiya, Shohei; Fukuzawa, Kengo; Inokuchi, Shoichi; Kosai‐Fujimoto, Yukiko; Sanefuji, Kensaku; Iwaki, Kentaro; Motohiro, Akira; Itoh, Shinji; Harada, Noboru; Ikegami, Toru; Yoshizumi, Tomoharu; Mori, Masaki

doi:10.1007/s11605-019-04324-8

Cited by 32 publications

(32 citation statements)

References 21 publications

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“…Our clinically relevant POPF rate after DP in neoadjuvant group was high (33.3%), but there are reports that percentage of clinically relevant POPF after DP with CA resection after neoadjuvant chemotherapy is 32% to 40%, comparable to our reports. [ 24 , 38 ] Clinically relevant POPF after conventional open DP at our institution was also 3.7%, [ 39 ] which is comparable to upfront DP in this study (4.3%). Neoadjuvant treatment may have influenced the incidence of POPF.…”

Section: Discussionsupporting

confidence: 69%

Arterial resection during pancreatectomy for pancreatic ductal adenocarcinoma with arterial invasion

et al. 2020

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Section: Discussionsupporting

confidence: 69%

Arterial resection during pancreatectomy for pancreatic ductal adenocarcinoma with arterial invasion

et al. 2020

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“…Patients were commonly female (54%, 2885/5328) in their seventh decade of life (weighted mean age 62 years, CI 60.4–63.6). Tumour location was reported in 20 studies [ 6 , 7 , 8 , 26 , 29 , 37 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 53 , 54 ] and was predominantly the pancreatic head or neck (79%, 2478/3147) ( Table S1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Most patients received Gemcitabine-based NAT (24 studies [ 6 , 7 , 8 , 25 , 26 , 27 , 28 , 29 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ], 62%, 851/1382). Fluoropyrimidines (20%, 282/1382) and FOLFIRINOX (13%, 182/1382) based regimens were not uncommon, however, platinum-based and plant alkaloid regimens were rare (7% 97/1382 and 2% 23/1382 respectively) ( Table S3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Distant recurrence referred to recurrence present in distant organs. RFS rate was defined as the proportion of patients who had no confirmed recurrence of cancer and included the terms progression-free survival and disease-free survival [ 26 ]. Time to first recurrence represented the interval following resection that the first recurrence of disease was observed and was calculated by the mean RFS [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

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Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis

Ratnayake

Savastyuk

Nayar

et al. 2020

JCM

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Background: Neoadjuvant therapy (NAT) represents a paradigm shift in the management of patients with pancreatic ductal adenocarcinoma (PDAC) with perceived benefits including a higher R0 rate. However, it is unclear whether NAT affects the sites and patterns of recurrence after surgery. This review seeks to compare sites and patterns of recurrence after resection between patients undergoing upfront surgery (US) or after NAT. Methods: The EMBASE, SCOPUS, PubMed, and Cochrane library databases were systematically searched to identify eligible studies that compare recurrence patterns between patients who had NAT (followed by resection) with those that had US. The primary outcome included site-specific recurrence. Results: 26 articles were identified including 4986 patients who underwent resection. Borderline resectable pancreatic cancer (BRPC, 47% 1074/2264) was the most common, followed by resectable pancreatic cancer (RPC 42%, 949/2264). The weighted overall recurrence rates were lower among the NAT group, 63.4% vs. 74% (US) (OR 0.67 (CI 0.52–0.87), p = 0.006). The overall weighted locoregional recurrence rate was lower amongst patients who received NAT when compared to US (12% vs 27% OR 0.39 (CI 0.22–0.70), p = 0.004). In BRPC, locoregional recurrence rates improved with NAT (NAT 25.8% US 37.7% OR 0.62 (CI 0.44–0.87), p = 0.007). NAT was associated with a lower weighted liver recurrence rate (NAT 19.4% US 30.1% OR 0.55 (CI 0.34–0.89), p = 0.023). Lung and peritoneal recurrence rates did not differ between NAT and US cohorts (p = 0.705 and p = 0.549 respectively). NAT was associated with a significantly longer weighted mean time to first recurrence 18.8 months compared to US (15.7 months) (OR 0.18 (CI 0.05–0.32), p = 0.015). Conclusion: NAT was associated with lower overall recurrence rate and improved locoregional disease control particularly for those with BRPC. Although the burden of liver metastases was less, there was no overall effect upon distant metastatic disease.

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“…Another recent retrospective study (141) compared the outcomes of patients receiving (n = 11) or not (n = 9) various regimens of neoadjuvant chemotherapy (mainly GEM-nab-PTX). Despite the small number of patients, those who received neoadjuvant chemotherapy had significantly less arterial invasion (p = 0.025), lymphatic invasion (p < 0.0001), and vascular invasion (p = 0.035) with significantly higher recurrence-free and overall survival rates.…”

Section: Monocentric Studiesmentioning

confidence: 99%

Vascular Resection for Pancreatic Cancer: 2019 French Recommendations Based on a Literature Review From 2008 to 6-2019

Delpero

Sauvanet

2020

Front. Oncol.

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Efficacy of Neoadjuvant Chemotherapy in Distal Pancreatectomy with En Bloc Celiac Axis Resection (DP-CAR) for Locally Advanced Pancreatic Cancer

Cited by 32 publications

References 21 publications

Arterial resection during pancreatectomy for pancreatic ductal adenocarcinoma with arterial invasion

Arterial resection during pancreatectomy for pancreatic ductal adenocarcinoma with arterial invasion

Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis

Vascular Resection for Pancreatic Cancer: 2019 French Recommendations Based on a Literature Review From 2008 to 6-2019

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