AB062. SOH24AB_178. The optimal timing of surgery post neo-adjuvant therapy for pancreatic cancer: a systematic review
General Surgery Session I

AB062. SOH24AB_178. The optimal timing of surgery post neo-adjuvant therapy for pancreatic cancer: a systematic review

Aine O’Neill1, Paul Cromwell2, Ailbhe O’Driscoll-Collins1, Kevin Conlon2

1Department of Surgery, Royal College of Surgeons Ireland, Dublin, Ireland; 2Department of Surgery, St Vincent’s University Hospital, Dublin, Ireland

Background: At diagnosis only 15–20% of patients with pancreatic adenocarcinoma are eligible for upfront surgical resection. Neoadjuvant therapy (NAT) comprised of chemotherapy ± radiotherapy has emerged as a promising strategy helping to downstage the primary tumour, increase likelihood of surgical resection and improve survival. In light of NAT’s increased utilisation within the treatment paradigm, we conducted a systematic review to determine the optimum timing of surgery post NAT for pancreatic adenocarcinoma.

Methods: PubMed, EMBASE, Cochrane Library and Web of Science were systematically searched for all relevant articles evaluating the NAT to surgery (NAT-S) interval in patients with pancreatic cancer. Outcomes between patients undergoing surgical resection within 10–12 weeks of NAT were compared to those undergoing surgery following interval prolongation. Primary outcome of interest was overall survival (OS). Secondary outcomes included R0 resection and pathological complete response (pCR) rates. Risk of bias assessment was conducted using methodological index for nonrandomized studies (MINORS) tool.

Results: Three retrospective observational studies were included. All reported an increase in OS with increasing NAT-S interval. A single study reported upon R0 resection rates and concluded that NAT-S interval prolongation was associated with a significant increase in R0 resection rates (NAT-S 25 weeks, 90%, P=0.017). pCR rate demonstrated a similar trend. Meta-analysis was not possible due to significant interstudy heterogeneity.

Conclusions: NAT-S interval prolongation is associated with superior OS and increased R0 resection and pCR rates. Due to dearth of available literature additional prospective and randomised controlled trials are required to further elucidate this association prior to implementation of any clinical practice change.

Keywords: Neoadjuvant therapy (NAT); pancreatic adenocarcinoma; pancreaticoduodenectomy; surgery; time interval

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-24-ab062
Cite this abstract as: O’Neill A, Cromwell P, O’Driscoll-Collins A, Conlon K. AB062. SOH24AB_178. The optimal timing of surgery post neo-adjuvant therapy for pancreatic cancer: a systematic review. Mesentery Peritoneum 2024;8:AB062.

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