Evaluation of Short- and Long-Term Outcomes After Resection in Patients with Locally Advanced versus (Borderline) Resectable Pancreatic Cancer

Abstract

Objective: To evaluate short and long-term outcomes after pancreatectomy in patients with locally advanced pancreatic cancer (LAPC) compared with patients with (borderline) resectable pancreatic cancer [(B)RPC]. Background: Selected patients diagnosed with LAPC are increasingly undergoing resection after induction chemotherapy. To evaluate the benefit of this treatment approach, it is helpful to compare outcomes in resected patients with primary LAPC to outcomes in resected patients with primary (B)RPC. Methods: Two prospectively maintained nationwide databases were used for this study. Patients with (B)RPC undergoing upfront tumor resection and patients with resected LAPC after induction therapy were included. Outcomes were postoperative pancreas-specific complications, 90-day mortality, pathologic outcomes, disease-free interval, and overall survival. Results: Overall, 879 patients were included; 103 with LAPC (12%) and 776 with (B)RPC (88%). Patients with LAPC had a lower World Health Organization performance score and ageadjusted Charlson Comorbidity Index. Postoperative pancreas-specific complications were comparable between groups, except delayed gastric emptying grade C, which occurred more often in patients with LAPC (9% vs 3%, P = 0.03). Ninety-day mortality was comparable. About half of the patients in both groups [54% in LAPC vs 48% in (B)RPC, P = 0.21] had a radical resection (R0). Disease-free interval was 13 months in both groups (P = 0.12) and overall survival from the date of diagnosis was 24 months in patients with LAPC and 19 months in patients with (B)RPC (P = 0.34). Conclusions: In our nationwide prospective databases, pancreas-specific complications, mortality, and survival in patients with LAPC after pancreatectomy are comparable with those undergoing resection for (B)RPC. These outcomes suggest that postoperative morbidity and mortality after tumor resection in carefully selected patients with LAPC are acceptable.