Impact of Neoadjuvant Therapy on Survival Following Margin-Positive Resection for Pancreatic Cancer

Introduction A positive microscopic margin (R1) following resection of pancreatic ductal adenocarcinoma (PDAC) can occur in up to 80% of patients and is associated with reduced survival and increased recurrence. Our aim was to characterize the impact of neoadjuvant therapy (NAT) on survival and recu...

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Bibliographic Details
Published in:Annals of surgical oncology 2021-11, Vol.28 (12), p.7759-7769
Main Authors: Chopra, Asmita, Zenati, Mazen, Hogg, Melissa E., Zeh, Herbert J., Bartlett, David L., Bahary, Nathan, Zureikat, Amer H., Beane, Joal D.
Format: Article
Language:English
Subjects:
Adenocarcinoma
Cancer therapies
Lymph nodes
Medicine
Medicine & Public Health
Oncology
Pancreatic cancer
Pancreatic Tumors
Patients
Surgery
Surgical Oncology
Survival
Survival analysis
Tumors
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Summary:Introduction A positive microscopic margin (R1) following resection of pancreatic ductal adenocarcinoma (PDAC) can occur in up to 80% of patients and is associated with reduced survival and increased recurrence. Our aim was to characterize the impact of neoadjuvant therapy (NAT) on survival and recurrence in patients with PDAC following an R1 resection. Methods A retrospective analysis of patients with PDAC who underwent pancreatectomy from 2008 to 2017 was performed. Patients were staged according to the American Joint Committee on Cancer 8th edition and stratified based on resection margin (R0 vs. R1) and treatment sequence (NAT vs. surgery first [SF]). Conditional survival analysis was performed using Cox regression and inverse probability weighted estimates. Results Among 580 patients, 59% received NAT and 41% underwent SF. On final pathology, the NAT cohort had smaller tumors and less lymph node (LN) positivity ( p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-021-10175-y