Predictive factors of actual 5‐y recurrence‐free survival after upfront surgery for resectable pancreatic cancer

The present study investigated the prognostic factors associated with actual 5‐y recurrence‐free survival (RFS) after upfront surgery for resectable pancreatic cancer (R‐PC) in patients who were deemed not to require neoadjuvant treatment.Between 2007 and 2016, 316 patients who underwent pancreatectomy for radiologically R‐PC were retrospectively reviewed to evaluate the predictors of actual 5‐y RFS. Predictors were identified using logistic regression analysis of preoperative evaluable factors. The cutoff values for continuous variables were determined based on a minimum p‐value approach (model 1) or the value that maximized the rate of 5‐y RFS survivors (model 2).Fifty‐one patients (16.1%) achieved a 5‐y RFS. A tumor size ≤23 mm, the absence of serosal invasion on computed tomography (CT), and Neutrophil‐to‐Lymphocyte Ratio <1.0, were significantly associated with the 5‐y RFS in model 1. A Prognostic Nutritional Index ≥58 and the absence of serosal invasion and extrapancreatic nerve plexus invasion on CT were significantly associated with 5‐y RFS in model 2. Only six (11.8%, model 1) and four (7.8%, model 2) patients had all three prognostic factors, and their 5‐y RFS rates were 83.3% and 100%, respectively.A modest number of patients who underwent upfront surgery achieved 5‐y RFS, but only ~10% of them could be identified preoperatively. Based on these results, almost all R‐PC patients are forced to undergo neoadjuvant treatment in daily practice.