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

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.