Impact of preoperative chemotherapy on surgical results in 139 patients with locally advanced pancreatic cancer.

IF 6.1 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Hepatobiliary surgery and nutrition Pub Date : 2024-06-01 Epub Date: 2024-03-11 DOI:10.21037/hbsn-23-426

Marvin Petrikowski, Tim Fahlbusch, Anke Reinacher-Schick, Giedre Kucinskaite, Andrea Tannapfel, Waldemar Uhl, Orlin Belyaev

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Abstract

Background: The establishment of preoperative chemotherapy (PCT) with FOLFIRINOX and gemcitabine/nab-paclitaxel in recent years has enabled resectability in many patients with initially locally advanced pancreatic cancer (LAPC). Nevertheless, information about the impact of PCT on surgical results is scarce.

Methods: All patients with initial LAPC who received surgery after chemotherapy at the high-volume centre for pancreatic surgery of St. Josef-Hospital Bochum between 2015 and 2022 were included in this retrospective cohort analysis.

Results: A total of 139 patients underwent surgery after pre-treatment with FOLFIRINOX (76.3%), gemcitabine/nab-paclitaxel (11.5%), both (5.8%) and other regimens (6.5%). Eighty-five tumors (61.2%) were resectable after PCT. R0 resection was achieved in 92.9%, R1 in 7.1% and R2 in 0% of cases. Fifty-four tumors were still not resectable at the time of surgery. Surgical results of the patients did not show increased postoperative mortality and morbidity compared to the literature data. Postoperative 30-day mortality was 1.4%. Rates for pancreas-specific complications [postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), and others] were not increased. POPF occurred in 10.5% and DGE in 26.3% after pancreaticoduodenectomy. After distal pancreatectomy, POPF was detected in 37.5% and DGE in 12.5%. Median postoperative survival (31 vs. 13 months) and overall survival after initial diagnosis (40 vs. 20 months) were significantly longer in resected patients (P<0.001). Postoperative recurrence-free survival in resected patients amounted to 12 months.

Conclusions: This study underlines that PCT allows resectability of primarily unresectable patients with LAPC without increasing perioperative mortality and morbidity. It may lead to a significant prolongation of recurrence-free and overall survival in resected patients after PCT.

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术前化疗对 139 例局部晚期胰腺癌患者手术效果的影响。

背景：近年来，使用 FOLFIRINOX 和吉西他滨/纳布紫杉醇的术前化疗（PCT）的确立，使许多初诊为局部晚期胰腺癌（LAPC）的患者得以切除胰腺癌。然而，有关 PCT 对手术效果影响的信息却很少：方法：将2015年至2022年期间在波鸿圣约瑟夫医院胰腺外科高容量中心接受化疗后手术的所有初治局部晚期胰腺癌患者纳入这项回顾性队列分析：共有139名患者在接受FOLFIRINOX（76.3%）、吉西他滨/纳布紫杉醇（11.5%）、两种方案（5.8%）和其他方案（6.5%）预处理后接受了手术。85个肿瘤（61.2%）在PCT治疗后可切除。92.9%的病例实现了R0切除，7.1%的病例实现了R1切除，0%的病例实现了R2切除。54例肿瘤在手术时仍无法切除。与文献数据相比，患者的手术结果显示术后死亡率和发病率并没有增加。术后30天死亡率为1.4%。胰腺特异性并发症[术后胰瘘（POPF）、胃排空延迟（DGE）、胰腺切除术后出血（PPH）及其他]的发生率没有增加。胰十二指肠切除术后发生 POPF 的比例为 10.5%，发生 DGE 的比例为 26.3%。胰腺远端切除术后，37.5%的患者出现 POPF，12.5%的患者出现 DGE。切除胰腺的患者术后中位生存期（31 个月对 13 个月）和初次诊断后的总生存期（40 个月对 20 个月）明显更长（结论：PCT 可以帮助诊断胰腺癌：本研究强调，PCT 可使主要无法切除的 LAPC 患者得以切除，同时不会增加围手术期的死亡率和发病率。PCT可显著延长切除患者的无复发生存期和总生存期。

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来源期刊

Hepatobiliary surgery and nutrition Multiple-

自引率

10.00%

发文量

392

期刊介绍： Hepatobiliary Surgery and Nutrition (HBSN) is a bi-monthly, open-access, peer-reviewed journal (Print ISSN: 2304-3881; Online ISSN: 2304-389X) since December 2012. The journal focuses on hepatopancreatobiliary disease and nutrition, aiming to present new findings and deliver up-to-date, practical information on diagnosis, prevention, and clinical investigations. Areas of interest cover surgical techniques, clinical and basic research, transplantation, therapies, NASH, NAFLD, targeted drugs, gut microbiota, metabolism, cancer immunity, genomics, and nutrition and dietetics. HBSN serves as a valuable resource for professionals seeking insights into diverse aspects of hepatobiliary surgery and nutrition.