<p>Comparison of neoadjuvant therapy and upfront surgery in resectable pancreatic cancer: a meta-analysis and systematic review</p>

Abstract

ObjectiveThe role of neoadjuvant therapy (NAT) in resectable pancreatic cancer (RPC) remains controversial. Therefore, this meta-analysis was performed to compare the clinical differences between NAT and upfront surgery in RPC.Materials and methodsA systematic literature search was performed in PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials databases. Only patients with RPC who underwent tumor resection and received adjuvant or neoadjuvant treatment were enrolled. The OR or HR and 95% CIs were calculated employing fixed-effects or random-effects models. The HR and its 95% CI were extracted from each article that provided survival curve. Publication bias was estimated using funnel plots and Egger’s regression test.ResultsIn total, eleven studies were included with 9,386 patients. Of these patients, 2,508 (26.7%) received NAT. For patients with RPC, NAT resulted in an increased R0 resection rate (OR=1.89; 95% CI=1.26–2.83) and a reduced positive lymph node rate (OR=0.34; 95% CI=0.31–0.37) compared with upfront surgery. Nevertheless, patients receiving NAT did not exhibit a significantly increased overall survival (OS) time (HR=0.91; 95% CI=0.79–1.05).ConclusionIn patients with RPC, R0 resection rate and positive lymph node rate after NAT were superior to those of patients with upfront surgery. The NAT group exhibited no significant effect on OS time when compared with the upfront surgery group. However, this conclusion requires more clinical evidence to improve its credibility.

Effect of neoadjuvant radiotherapy on survival of non-metastatic pancreatic ductal adenocarcinoma: a SEER database analysis

“…center, erlangen university hospital, Germany, Tohoku university school of medicine, Japan, and others. The results showed that the R0 resection rate was improved in patients of resectable PDAC treated with neoadjuvant radiotherapy, but the overall survival time of the patients was not significantly increased [20]. Combined with the results of this study, the overall survival of surgery plus chemotherapy is significantly better than neoadjuvant radiotherapy and adjuvant radiotherapy, so it is recommended that patients with T1-3N0M0 should choose surgery plus chemotherapy as the priority.…”

Effect of neoadjuvant radiotherapy on survival of non-metastatic Pancreatic Ductal Adenocarcinoma: A SEER Database Analysis

“…A meta-analysis published in 2019 included 11 clinical studies involving 2666 patients from the university of Texas southwestern medical center, Montefiore medical center, erlangen university hospital, Germany, Tohoku university school of medicine, Japan, and others. The results showed that the R0 resection rate was improved in patients of resectable PDAC treated with neoadjuvant radiotherapy, but the overall survival time of the patients was not significantly increased 20 . Combined with the results of this study, the overall survival of surgery plus chemotherapy is significantly better than neoadjuvant radiotherapy and adjuvant radiotherapy, so it is recommended that patients with T1-3N0M0 should choose surgery plus chemotherapy as the priority.…”

Open and Minimal Approaches to Pancreatic Adenocarcinoma

“…As eluded to above, pancreatic surgery is evolving with surgical approaches being modified in patients who have received neoadjuvant treatment [42][43][44]. These preoperative regimens are principally being used for patients with borderline resectable or locally advanced PDAC [45], although the use of these strategies is attracting growing attention in patients with resectable disease, too [42], as discussed above [30].…”