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Journal of Gastrointestinal Surgery

, Volume 23, Issue 1, pp 112–121 | Cite as

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

  • Ammar A. Javed
  • Michael J. Wright
  • Ayat Siddique
  • Alex B. Blair
  • Ding Ding
  • Richard A. Burkhart
  • Martin Makary
  • John L. Cameron
  • Amol Narang
  • Joseph Herman
  • Lei Zheng
  • Daniel Laheru
  • Matthew J. Weiss
  • Christopher Wolfgang
  • Jin HeEmail author
2018 SSAT Plenary Presentation

Abstract

Introduction

Approximately, 20% of patients with pancreatic ductal adenocarcinoma have resectable disease at diagnosis. Given improvements in locoregional and systemic therapies, some patients with borderline resectable pancreatic cancer (BRPC) can now undergo successful resection. The outcomes of patients with BRPC after neoadjuvant therapy remain unclear.

Methods

A prospectively maintained single-institution database was utilized to identify patients with BRPC who were managed at the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC) between 2013 and 2016. BRPC was defined as any tumor that presented with radiographic evidence of the involvement of the portal vein (PV) or superior mesenteric vein (SMV) that was deemed to be technically resectable (with or without the need for reconstruction), or the abutment (< 180° involvement) of the common hepatic artery (CHA) or superior mesenteric artery (SMA), in the absence of involvement of the celiac axis (CA). We collected data on treatment, the course of the disease, resection rate, and survival.

Results

Of the 866 patients evaluated at the PMDC during the study period, 151 (17.5%) were staged as BRPC. Ninety-six patients (63.6%) underwent resection. Neoadjuvant chemotherapy was administered to 142 patients (94.0%), while 78 patients (51.7%) received radiation therapy in the neoadjuvant setting. The median overall survival from the date of diagnosis, of resected BRPC patients, was 28.8 months compared to 14.5 months in those who did not (p < 0.001). Factors associated with increased chance of surgical resection included lower ECOG performance status (p = 0.011) and neck location of the tumor (p = 0.001). Forty-seven patients with BRPC (31.1%) demonstrated progression of disease; surgical resection was attempted and aborted in 12 patients (7.9%). Eight patients (5.3%) were unable to tolerate chemotherapy; six had disease progression and two did not want to pursue surgery. Lastly, four patients (3.3%) were conditionally unresectable due to medical comorbidities at the time of diagnosis due to comorbidities and failed to improve their status and subsequently had progression of the disease.

Conclusion

After initial management, 31.1% of patients with BRPC have progression of disease, while 63.6% of all patients successfully undergo resection, which was associated with improved survival. Factors associated with increased likelihood of surgical resection include lower ECOG performance status and tumor location in the neck.

Keywords

Borderline pancreatic cancer Neoadjuvant therapy Rate of resectability (Denominator) Survival 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Ammar A. Javed
    • 1
    • 2
  • Michael J. Wright
    • 1
    • 2
  • Ayat Siddique
    • 1
    • 2
  • Alex B. Blair
    • 1
    • 2
  • Ding Ding
    • 2
    • 3
  • Richard A. Burkhart
    • 1
    • 2
  • Martin Makary
    • 1
    • 2
  • John L. Cameron
    • 1
    • 2
  • Amol Narang
    • 2
    • 4
  • Joseph Herman
    • 2
    • 4
  • Lei Zheng
    • 2
    • 3
  • Daniel Laheru
    • 2
    • 3
  • Matthew J. Weiss
    • 1
    • 2
  • Christopher Wolfgang
    • 1
    • 2
  • Jin He
    • 1
    • 2
    Email author
  1. 1.Department of SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.The Pancreatic Cancer Precision Medicine Center of Excellence ProgramThe Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of OncologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of Radiation OncologyThe Johns Hopkins University School of MedicineBaltimoreUSA

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