Potential Contribution of Preoperative Neoadjuvant Concurrent Chemoradiation Therapy on Margin-Negative Resection in Borderline Resectable Pancreatic Cancer

Background: Margin-negative pancreatectomy provides only chance to cure pancreatic cancer. However, borderline resectable pancreatic cancer (BRPCa) has the risk of incomplete palliative resection. Materials and Methods: We retrospectively reviewed 32 patients with BRPCa who underwent a pancreatectomy following preoperative chemoradiation therapy (CCRT (+)/Px group) and compared these patients with those with resectable pancreatic cancer (RPCa) who underwent pancreatectomy without preoperative CCRT (CCRT (-)/Px group, n = 104). Results: Eighteen patients (56. 2%) showed more than 50% significant pathological response to CCRT. The degree of pathological responses showed a positive relationship between final pT stage (p = 0. 075). More frequent vascular resection (p < 0. 001), transfusion (p = 0. 076), and longer operation time were observed in the CCRT(+)/Px group. However, similar R0 resection rates (p = 0. 272), lower pT stage (p < 0. 001), smaller number of metastastic lymph nodes (p = 0. 002), and lower incidence of lymph node metastasis (p = 0. 032) were noted in the CCRT(+)/Px group. The overall disease-specific survival were similar (median survival, 30. 5 months (95% CI; 23. 6-37. 4) vs. 26. 3 months (95% CI; 15. 9-36. 7), p = 0. 709), and no statistical differences in cancer recurrence risks were noted between the two groups (p = 0. 505). Conclusion: Pancreatectomy following preoperative neoadjuvant CCRT can be a potential strategy for margin-negative resection in BRPCa patients.