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Optimal timing of surgical resection after neoadjuvant chemoradiation in borderline and locally advanced pancreatic ductal adenocarcinoma

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AHBPS

Annals of Hepato-Biliary-Pancreatic Surgery

www.ahbps.org S92

Optimal timing of surgical resection after neoadjuvant chemoradiation in borderline and locally advanced pancreatic ductal adenocarcinoma

Munseok CHOI

1

, Sung Hyun KIM

2,3

, Ho Kyoung HWANG

2,3

, Woo Jung LEE

2,3

, Chang Moo KANG*

,2,3

1

Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea

2

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

3

Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea

BP-OP-3-5

Introduction: For patients with pancreatic ductal adenocarcinoma (PDAC), the optimal time interval between neoadjuvant chemo- radiation to surgical resection has not been well established. We aimed to study the impact of optimal surgical resection timing after neoadjuvant chemoradiation (Neo-CT/RT) on long-term oncological outcome in borderline and locally advanced PDAC.

Methods: From June 2006 to April 2019, among the 175 patients who underwent pancreatectomy following Neo-CT/RT, the study enrolled 79 patients who underwent surgical resection after Neo-CT/RT for borderline and locally advanced PDAC. The entire cohort was divided into three groups according to the time interval between the last date or neoadjuvant chemoradiation and the surgical re- section; group A (0–5 weeks), group B (5–10 weeks), and group C (> 10 weeks). Long-term outcomes were compared between the three groups.

Results: There were 30 patients in group A, 37 patients in group B, and 12 patients in group C. Patients in group B were significant- ly more likely to experience a vascular resection than group A and C ( p = 0.005). In disease-free survival, there was no significant difference between the three groups (p = 0.075). Patients in group B showed better overall survival than other groups (p = 0.041). In multivariate analysis, N2 stage and time interval more than ten weeks were correlated with worse overall survival (HR 7.935, 95% con- fidence interval [CI] 1.772-35.538, p = 0.007, HR 3.492, 95% CI 1.717-7.102, p = 0.001).

Conclusions: For borderline and locally advanced PDAC, surgical resection within ten weeks from the end of the Neo-CT/RT is asso- ciated with better overall survival, suggesting time interval should be concerned for better oncologic outcome in a patient with Neo- CT/RT in borderline and locally advanced PDAC. Further study is mandatory.

pISSN: 2508-5778ㆍeISSN: 2508-5859

Ann Hepatobiliary Pancreat Surg 2021;25 Suppl 1:S92 https://doi.org/10.14701/ahbps.BP-OP-3-5

Corresponding Author: Chang Moo KANG (cmkang@yuhs.ac) Presenter: Munseok CHOI (cms2598@yuhs.ac)

Copyright Ⓒ The Korean Association of Hepato-Biliary-Pancreatic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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