The role of neoadjuvant chemotherapy in patients with primary resectable pancreatic cancer: A retrospective cohort study

Background. Currently available data on the efficacy and indications for neoadjuvant chemotherapy in patients with primary resectable pancreatic cancer are contradictory and not clearly defined.

Aim. To conduct a comparative assessment of the effectiveness of neoadjuvant chemotherapy and primary surgical treatment followed by adjuvant chemotherapy in patients with primary resectable pancreatic cancer.

Materials and methods. In our study, the efficacy of neoadjuvant chemotherapy was retrospectively evaluated in 45 patients and in 153 patients with primary surgical treatment and subsequent adjuvant chemotherapy.

Results. With a median follow-up of 41.7 months. Both, recurrence free survival in the group of patients receiving neoadjuvant chemotherapy followed by surgical treatment (n=33; 73%) and in the group with surgical treatment and subsequent adjuvant chemotherapy (13.9 and 19.5 months; p=0.35) and overall survival (28.4 months vs 33.7 months; p=0.29) were no different. The CA level of 19.9>500 IU/ml in the neoadjuvant chemotherapy group was observed in 20 (44.4%) patients. At the same time, surgical treatment was performed only in 11 (55%) patients. At the same time, at the CA 19.9 level <500 IU/ml, at the end of neoadjuvant chemotherapy, surgical treatment was not performed in only 3 (12%) patients (p=0.005).

Conclusion. The long-term results of treatment of patients with primary resectable pancreatic cancer, whose first stage was neoadjuvant chemotherapy, practically do not differ from the group whose treatment began with surgery. Treatment of patients with an initially high (>500 IU/ml) level of CA 19.9 is preferable to start with neoadjuvant chemotherapy. Patients who may have doubts about the likelihood of adjuvant chemotherapy (general condition, social adaptation, place of residence), it is also preferable to start treatment with neoadjuvant chemotherapy. It is necessary to change the algorithm of examination of patients, especially those with a level of CA 19.9>500 IU/ml, to exclude a greater prevalence, for example, performing diagnostic laparoscopy to exclude metastases in the peritoneum.