Efficacy of neoadjuvant chemoradiotherapy followed by pancreatic resection for older patients with resectable and borderline resectable pancreatic ductal adenocarcinoma |
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| Institution: | 1. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan;2. Department of Radiation Oncology, Faculty of Medicine, Kagawa University, Kagawa, Japan;3. Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan;1. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria;2. Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy;3. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden;4. University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General-, Visceral-, Transplant- and Thoracic Surgery, Frankfurt am Main, Germany;5. Department of General Surgery, Medical University of Vienna, Vienna, Austria;6. Department of Hepatobiliary Surgery, St James''s University Hospital, Leeds, UK;7. Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK;8. Aintree University Hospital, Liverpool, UK;9. Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands;10. Department of General Surgery, Medical University of Graz, Graz, Austria;11. Department of Surgery, Ordensklinikum Linz, Linz, Austria;12. Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria;13. Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria;14. Faculty of Medicine and Health, The University of Sydney, Australia;15. Department of Gastroenterology, AORN Antonio Cardarelli, Naples, Italy;1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA;2. Department of Radiology, John Hopkins University, Baltimore, MD, USA;1. Department of Surgery and Cancer, Imperial College London, Du Cane Rd, London W12 0HS, United Kingdom;2. Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, Du Cane Rd, London W12 0HS, United Kingdom;3. Liver Anaesthesia, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2GW, United Kingdom;4. Liver Unit, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2GW, United Kingdom;5. Centre for Peri-operative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Rd, London W12 0HS, United Kingdom;6. Department of Surgery and Cancer, Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Du Cane Rd, London W12 0HS, United Kingdom |
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| Abstract: | BackgroundThe benefit of preoperative treatment followed by pancreatic resection in older patients with pancreatic ductal adenocarcinoma (PDAC) remains unclear. In this retrospective analysis of prospectively collected data, we evaluated the significance and safety of preoperative treatment followed by curative resection for older PDAC patients.MethodsWe evaluated 122 patients with resectable and borderline resectable PDAC who received neoadjuvant chemoradiotherapy (NACRT) followed by curative resection between 2009 and 2019. Changes in the prognostic nutritional indices during NACRT, surgical outcomes, and prognosis were compared between older (≥75 years, n = 44) and younger patients (<75 years, n = 78).ResultsThe completion rate, adverse event rate, changes in prognostic nutritional indices during NACRT, and prognosis were similar between the groups. In multivariate analysis, an elevated C-reactive protein/albumin ratio (CRP/Alb) ≥ 33.1% during NACRT (p = 0.035) and no postoperative adjuvant chemotherapy (p = 0.041) were identified as significant predictors of overall survival.ConclusionsNACRT followed by pancreatic resection could be safely performed in older patients, with a similar prognosis as that of younger patients, despite an increased frequency of postoperative complications. Elevated CRP/Alb during NACRT and no postoperative adjuvant chemotherapy were poor prognostic factors for older patients. |
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