Premium
Neoadjuvant therapy versus upfront surgery for early‐stage left‐sided pancreatic adenocarcinoma: A propensity‐matched analysis from a national cohort of distal pancreatectomies
Author(s) -
Nassour Ibrahim,
Adam Mohamed A.,
Kowalsky Stacy,
Al Masri Samer,
Bahary Nathan,
Singhi Aatur D.,
Lee Kenneth,
Zureikat Amer,
Paniccia Alessandro
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26267
Subject(s) - medicine , hazard ratio , neoadjuvant therapy , stage (stratigraphy) , adenocarcinoma , pancreatectomy , propensity score matching , pancreatic cancer , confidence interval , retrospective cohort study , folfirinox , distal pancreatectomy , pancreas , surgery , oncology , nat , gastroenterology , cancer , oxaliplatin , breast cancer , colorectal cancer , paleontology , biology , computer network , computer science
Background There are limited data on the efficacy of neoadjuvant therapy (NAT) for early‐stage distal pancreas adenocarcinoma (PDAC). Previous studies focused on adenocarcinoma of the head of the pancreas or dealt with borderline and locally advanced tumors of the body and tail. Methods This is a retrospective study of the National Cancer Database between 2006 and 2015. A propensity‐matched analysis was performed to compare overall survival estimates between NAT and upfront resection (UR) groups. Results A total of 5003 distal pancreatectomies for PDAC were identified, of whom 408 (9%) received NAT. After 1:1 matching, 353 NAT patients were compared with 353 UR patients. NAT was associated with lower 90‐day mortality. There were no differences in the number of lymph nodes retrieved, or length of stay. With matching, the NAT group had higher median overall survival compared with UR (33.0 vs. 27.0 months; p = 0.009) and adjusted overall survival (hazard ratio = 0.63, 95% confidence interval = 0.51‐0.77; p < 0.001). Conclusion The receipt of NAT followed by distal pancreatectomy for early‐stage distal PDAC is associated with improved overall survival compared with UR. This study supports the use of NAT in the multimodal therapy paradigm of early‐stage adenocarcinoma of the body and tail of the pancreas.