@article{Springfeld2023-zi,

title = {Neoadjuvant therapy for pancreatic cancer},

author = {Christoph Springfeld and Cristina R Ferrone and Matthew H G Katz and Philip A Philip and Theodore S Hong and Thilo Hackert and Markus W Büchler and John Neoptolemos},

url = {https://www.nature.com/articles/s41571-023-00746-1.pdf

},

doi = {https://doi.org/10.1038/s41571-023-00746-1},

year  = {2023},

date = {2023-03-01},

urldate = {2023-03-01},

journal = {Nat. Rev. Clin. Oncol.},

abstract = {Patients with localized pancreatic ductal adenocarcinoma (PDAC) 

 are best treated with surgical resection of the primary tumour 

 and systemic chemotherapy, which provides considerably longer 

 overall survival (OS) durations than either modality alone. 

 Regardless, most patients will have disease relapse owing to 

 micrometastatic disease. Although currently a matter of some 

 debate, considerable research interest has been focused on the 

 role of neoadjuvant therapy for all forms of resectable PDAC. 

 Whilst adjuvant combination chemotherapy remains the standard of 

 care for patients with resectable PDAC, neoadjuvant chemotherapy 

 seems to improve OS without necessarily increasing the resection 

 rate in those with borderline-resectable disease. Furthermore, 

 around 20% of patients with unresectable non-metastatic PDAC 

 might undergo resection following 4-6 months of induction 

 combination chemotherapy with or without radiotherapy, even in 

 the absence of a clear radiological response, leading to improved 

 OS outcomes in this group. Distinct molecular and biological 

 responses to different types of therapies need to be better 

 understood in order to enable the optimal sequencing of specific 

 treatment modalities to further improve OS. In this Review, we 

 describe current treatment strategies for the various clinical 

 stages of PDAC and discuss developments that are likely to 

 determine the optimal sequence of multimodality therapies by 

 integrating the fundamental clinical and molecular features of 

 the cancer.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Maggino2023207,

title = {CA19.9 Response and Tumor Size Predict Recurrence Following Post-neoadjuvant Pancreatectomy in Initially Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma},

author = {Laura Maggino and Giuseppe Malleo and Stefano Crippa and Giulio Belfiori and Sara Nobile and Giulia Gasparini and Gabriella Lionetto and Claudio Luchini and Paola Mattiolo and Marco Schiavo-Lena and Claudio Doglioni and Aldo Scarpa and Claudio Bassi and Massimo Falconi and Roberto Salvia},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139743479&doi=10.1245%2fs10434-022-12622-w&partnerID=40&md5=37a355ed15c5f8bfc23e130604180fe8},

doi = {10.1245/s10434-022-12622-w},

issn = {10689265},

year  = {2023},

date = {2023-01-01},

urldate = {2023-01-01},

journal = {Annals of Surgical Oncology},

volume = {30},

number = {1},

pages = {207 – 219},

publisher = {Springer Science and Business Media Deutschland GmbH},

abstract = {Background: Data on recurrence after post-neoadjuvant pancreatectomy are scant. This study investigated the incidence and pattern of recurrence in patients with initially resectable and borderline resectable pancreatic ductal adenocarcinoma who received post-neoadjuvant pancreatectomy. Furthermore, preoperative predictors of recurrence-free survival (RFS) and their interactions were determined. Patients and Methods: Patients undergoing post-neoadjuvant pancreatectomy at two academic facilities between 2013 and 2017 were analyzed using standard statistics. The possible interplay between preoperative parameters was scrutinized including interaction terms in multivariable Cox models. Results: Among 315 included patients, 152 (48.3%) were anatomically resectable. The median RFS was 15.7 months, with 1- and 3-year recurrence rates of 41.9% and 74.2%, respectively. Distant recurrence occurred in 83.3% of patients, with lung-only patterns exhibiting the most favorable prognostic outlook. Normal posttreatment CA19.9, ΔCA19.9 (both in patients with normal and elevated baseline levels), and posttreatment tumor size were associated with RFS. Critical thresholds for ΔCA19.9 and tumor size were set at 50% and 20 mm, respectively. Interaction between ΔCA19.9 and posttreatment CA19.9 suggested a significant risk reduction in patients with elevated values when ΔCA19.9 exceeded 50%. Moreover, posttreatment tumor size interacted with posttreatment CA19.9 and ΔCA19.9, suggesting an increased risk in the instance of elevated posttreatment CA19.9 values and a protective effect associated with CA19.9 response in patients with tumor size >20 mm. Conclusion: Recurrence following post-neoadjuvant pancreatectomy is common. Preoperative tumor size <20 mm, normal posttreatment CA19.9 and ΔCA19.9 > 50% were associated with longer RFS. These variables should not be taken in isolation, as their interaction significantly modulates the recurrence risk. © 2022, The Author(s).},

note = {Cited by: 1; All Open Access, Green Open Access, Hybrid Gold Open Access},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Liang2023-xh,

title = {Radical resection combined with intestinal autotransplantation  for locally advanced pancreatic cancer after neoadjuvant therapy:  A report of 36 consecutive cases},

author = {Tingbo Liang and Qi Zhang and Guosheng Wu and Chaoxu Liu and Xueli Bai and Shunliang Gao and Tao Ma and Ke Sun and Senxiang Yan and Wenbo Xiao and Tian'an Jiang and Fangyan Lu and Yuntao Zhang and Yan Shen and Min Zhang and Xiaochen Zhang and Jianzhen Shan},

doi = {10.1097/SLA.0000000000005797},

year  = {2023},

date = {2023-01-01},

urldate = {2023-01-01},

journal = {Ann. Surg.},

abstract = {OBJECTIVE: The aim of this study was to achieve radical resection 

 of locally advanced pancreatic ductal adenocarcinoma (PDAC), and 

 tested the safety and benefits of intestinal autotransplantation 

 in pancreatic surgery. BACKGROUND: PDAC has extremely dismal 

 prognosis. Radical resection was proved to improve prognosis of 

 patients with PDAC; however, locally advanced disease had a very 

 low resection rate currently. We explored and evaluated whether 

 the combination of modern advances in systemic treatment and this 

 microinvasive surgery was feasible in clinical practice. METHODS: 

 Patients diagnosed as PDAC with superior mesenteric artery (SMA) 

 involvement and with or without coeliac trunk involvement were 

 included. Patients were treated with modified-FOLFIRINOX 

 chemotherapy with or without anti-PD-1 antibodies, and were 

 applied to tumor resection combined with intestinal 

 autotransplantation. Data of operative parameters, pathological 

 results, mortality, morbidity, and survival were analyzed. 

 RESULTS: A total of 36 consecutive cases were applied to this 

 strategy and underwent radical resection combined with intestinal 

 autotransplantation. Among these patients, 24 of them received 

 Whipple procedure, eleven patients received total pancreatectomy, 

 and the other one patient received distal pancreatectomy. The 

 median operation time was 539 minutes. Postoperative pathology 

 showed R0 resection rate of 94.4%, and tumor invasion of SMA or 

 SMV was confirmed in 32 patients. The median number of dissected 

 lymph nodes was 43, and 25 patients were positive for lymph nodes 

 metastasis. The median time of Intensive Care Unit stay was four 

 days. Two patients died within 30 days after surgery due to 

 multi-organ failure. The severe postoperative adverse events 

 (equal or higher than grade 3) was observed in 12 out of 36 

 patients, and diarrhea, gastroparesis, and abdominal infection 

 were the most frequent adverse events. Postoperative hospital 

 stay was averagely 34 days. The recurrence-free survival is 13.6 

 months. The median overall survival of patients after diagnosis 

 and after surgery were 21.4 months and 14.5 months, respectively. 

 CONCLUSIONS: Our attempt suggests safety of this modality and may 

 be clinically beneficial for highly-selected patients with PDAC. 

 However, experience of multidisciplinary pancreatic cancer care 

 and intestinal transplantation is warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Van_den_Broek2023-od,

title = {Video grading of pancreatic anastomoses during robotic  pancreatoduodenectomy to assess both learning curve and the risk  of pancreatic fistula - A post hoc analysis of the LAELAPS-3  training program},

author = {Bram L J Broek and Maurice J W Zwart and Bert A Bonsing and Olivier R Busch and Jacob L Dam and Ignace H J T Hingh and Melissa E Hogg and Misha D Luyer and J S D Mieog and Luna A Stibbe and Kosei Takagi and T C K Tran and Roeland F Wilde and Herbert J 3rd Zeh and Amer H Zureikat and Bas Groot Koerkamp and Marc G Besselink and Dutch Pancreatic Cancer Group},

doi = {10.1097/SLA.0000000000005796},

year  = {2023},

date = {2023-01-01},

urldate = {2023-01-01},

journal = {Ann. Surg.},

abstract = {OBJECTIVE: To assess the learning curve of pancreaticojejunostomy 

 during robotic pancreatoduodenectomy(RPD) and to predict the risk 

 of postoperative pancreatic fistula(POPF) by using the objective 

 structured assessment of technical skills(OSATS) score, taking 

 the fistula risk score into account. SUMMARY BACKGROUND DATA: RPD 

 is a challenging procedure that requires extensive training and 

 confirmation of adequate surgical performance. Video grading, 

 modified for RPD, of the pancreatic anastomosis could assess the 

 learning curve of RPD and predict the risk of POPF. METHODS: 

 Post-hoc assessment of patients prospectively included in four 

 Dutch centers in a nationwide LAELAPS-3 training program for RPD. 

 Video grading of the pancreaticojejunostomy was performed by two 

 graders using OSATS (attainable scores 12-60). The main outcomes 

 were the combined OSATS of the two graders and POPF (grade B/C). 

 CUSUM analyzed a turning point in the learning curve for surgical 

 skill. Logistic regression determined the cut-off for OSATS. 

 Patients were categorized for POPF risk (i.e. low, intermediate, 

 high) based on the updated alternative fistula risk scores 

 (uaFRS). RESULTS: Videos from 153 pancreatic anastomoses were 

 included. Median OSATS score was 48 (IQR 41-52) points and with a 

 turning point at 33 procedures. POPF occurred in 39 patients 

 (25.5%). An OSATS score below 49, present in 77 patients 

 (50.3%), was associated with an increased risk of POPF, OR 4.0},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Sattari2022-eg,

title = {Laparoscopic versus open pancreatoduodenectomy in patients with  periampullary tumors: A systematic review and meta-analysis},

author = {Shahab Aldin Sattari and Ali Reza Sattari and Martin A Makary and Chen Hu and Jin He},

doi = {10.1097/SLA.0000000000005785},

year  = {2022},

date = {2022-12-01},

urldate = {2022-12-01},

journal = {Ann. Surg.},

abstract = {OBJECTIVE: To conduct a systematic review and meta-analysis of 

 randomized controlled trials (RCTs) compared laparoscopic 

 pancreatoduodenectomy (LPD) versus open pancreatoduodenectomy 

 (OPD) in patients with periampullary tumors. SUMMARY BACKGROUND 

 DATA: LPD has gained attention; however, its safety and efficacy 

 versus OPD remain debatable. METHODS: We searched PubMed, and 

 Embase. Primary outcomes were the length of hospital stay (LOS) 

 (day), Clavien-Dindo grade$geq$Ⅲ complications, and 90-day 

 mortality. Secondary outcomes were blood loss (BL) (ml), blood 

 transfusion (BT), duration of operation (minute), readmission, 

 reoperation, comprehensive complication index (CCI) score, bile 

 leak, gastro- or duodenojejunostomy leak, postoperative 

 pancreatic fistula, postpancreatectomy hemorrhage, delayed 

 gastric emptying, surgical site infection (SSI), intraabdominal 

 infection, number of harvested lymph nodes, and R0 resection. 

 Pooled odds ratio (OR) or mean difference (MD) of data were 

 calculated using the random-effect model. The GRADE approach was 

 used for grading the level of evidence. RESULTS: Four RCTs 

 yielding 818 patients were included, of which 411 and 407 

 patients underwent LPD and OPD, respectively. The meta-analysis 

 concluded that two approaches were similar, except in the LPD group, the LOS tended to be shorter (MD=-2.54 [-5.17, 0.09},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kaslow2022-tl,

title = {Natural history of stage IV pancreatic cancer. Identifying  survival benchmarks for curative-intent resection in patients  with synchronous liver-only metastases},

author = {Sarah R Kaslow and Greg D Sacks and Russell S Berman and Ann Y Lee and Camilo Correa-Gallego},

doi = {10.1097/SLA.0000000000005753},

year  = {2022},

date = {2022-11-01},

urldate = {2022-11-01},

journal = {Ann. Surg.},

volume = {Publish Ahead of Print},

publisher = {Ovid Technologies (Wolters Kluwer Health)},

abstract = {OBJECTIVE: To evaluate long-term oncologic outcomes of patients 

 with stage IV pancreatic ductal adenocarcinoma (PDAC) and 

 identify survival benchmarks for comparison when considering 

 resection in these patients. SUMMARY BACKGROUND DATA: Highly 

 selected cohorts of patients with liver-oligometastatic pancreas 

 cancer have reported prolonged survival following resection. The 

 long-term impact of surgery in this setting remains undefined 

 due to a lack of appropriate control groups. METHODS: We 

 identified patients with clinical stage IV PDAC with synchronous 

 liver metastases within our cancer registry. We estimated 

 overall survival (OS) among various patient subgroups using the 

 Kaplan-Meier method. To mitigate immortal time bias, we analyzed 

 long-term outcomes of patients who survived beyond 12 months 

 (landmark time) from diagnosis. RESULTS: We identified 241 

 patients. Median OS was 7 months (95%CI 5-9), both overall and for patients with liver-only metastasis (n=144). Ninety patients 

 (38% of liver-only; 40% of whole cohort) survived at least 12 

 months; those who received chemotherapy in this subgroup had a 

 median OS of 26 months (95%CI 17-39). Of these patients, those 

 with resectable or borderline resectable primary tumors and resectable liver-only metastasis (n=9, 4%) had a median OS of 

 39 months (95%CI 13-NR). CONCLUSIONS: The 4% of our cohort 

 that were potentially eligible for surgery experienced a 

 prolonged survival compared to all-comers with stage IV disease. 

 Oncologic outcomes of patients undergoing resection of 

 metastatic pancreas cancer should be assessed in the context of 

 the expected survival of patients potentially eligible for 

 surgery and not relative to all patients with stage IV disease.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Takahashi2022E510,

title = {Neoadjuvant S-1 With Concurrent Radiotherapy Followed by Surgery for Borderline Resectable Pancreatic Cancer: A Phase II Open-label Multicenter Prospective Trial (JASPAC05)},

author = {Shinichiro Takahashi and Izumi Ohno and Masafumi Ikeda and Masaru Konishi and Tatsushi Kobayashi and Tetsuo Akimoto and Motohiro Kojima and Soichiro Morinaga and Hirochika Toyama and Yasuhiro Shimizu and Atsushi Miyamoto and Moriaki Tomikawa and Norihisa Takakura and Wataru Takayama and Satoshi Hirano and Takehito Otsubo and Masato Nagino and Wataru Kimura and Keishi Sugimachi and Katsuhiko Uesaka},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139571403&doi=10.1097%2fSLA.0000000000004535&partnerID=40&md5=c1aa99be218b6cfe07848d2dd18b3598},

doi = {10.1097/SLA.0000000000004535},

issn = {00034932},

year  = {2022},

date = {2022-01-01},

urldate = {2022-01-01},

journal = {Annals of Surgery},

volume = {276},

number = {5},

pages = {E510 – E517},

publisher = {Wolters Kluwer Health},

abstract = {Objective: This study assessed whether neoadjuvant chemoradiotherapy (CRT) with S-1 increases the R0 resection rate in BRPC. Summary of Background Data: Although a multidisciplinary approach that includes neoadjuvant treatment has been shown to be a better strategy for BRPC than upfront resection, a standard treatment for BRPC has not been established. Methods: A multicenter, single-arm, phase II study was performed. Patients who fulfilled the criteria for BRPC received S-1 (40 mg/m2 bid) and concurrent radiotherapy (50.4 Gy in 28 fractions) before surgery. The primary endpoint was the R0 resection rate. At least 40 patients were required, with a 1-sided α = 0.05 and β = 0.05 and expected and threshold values for the primary endpoint of 30% and 10%, respectively. Results: Fifty-two patients were eligible, and 41 were confirmed to have definitive BRPC by a central review. CRT was completed in 50 (96%) patients and was well tolerated. The rate of grade 3/4 toxicity with CRT was 43%. The R0 resection rate was 52% among the 52 eligible patients and 63% among the 41 patients who were centrally confirmed to have BRPC. Postoperative grade III/IV adverse events according to the Clavien-Dindo classification were observed in 7.5%. Among the 41 centrally confirmed BRPC patients, the 2-year overall survival rate and median overall survival duration were 58% and 30.8 months, respectively. Conclusions: S-1 and concurrent radiotherapy seem to be feasible and effective at increasing the R0 resection rate and improving survival in patients with BRPC. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.},

note = {Cited by: 15},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Yamaguchi20221043,

title = {Results of a Phase II Study on the Use of Neoadjuvant Chemotherapy (FOLFIRINOX or GEM/nab-PTX) for Borderline-resectable Pancreatic Cancer (NUPAT-01)},

author = {Junpei Yamaguchi and Yukihiro Yokoyama and Tsutomu Fujii and Suguru Yamada and Hideki Takami and Hiroki Kawashima and Eizaburo Ohno and Takuya Ishikawa and Osamu Maeda and Hiroshi Ogawa and Yasuhiro Kodera and Masato Nagino and Tomoki Ebata},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85131108074&doi=10.1097%2fSLA.0000000000005430&partnerID=40&md5=70120cfb2fbb9a0715bafde548ac56cb},

doi = {10.1097/SLA.0000000000005430},

issn = {00034932},

year  = {2022},

date = {2022-01-01},

urldate = {2022-01-01},

journal = {Annals of Surgery},

volume = {275},

number = {6},

pages = {1043 – 1049},

publisher = {Lippincott Williams and Wilkins},

abstract = {Objective:Given the frequent adverse events with multidrug chemotherapy, not only the survival benefit but also the feasibility of using neoadjuvant chemotherapy to treat pancreatic cancer need to be clarified.Summary of Background Data:Although the development of multidrug chemotherapy regimens has improved the survival outcomes of patients with unresectable pancreatic cancer, the benefits of these treatments in the neo-adjuvant setting remain controversial.Methods:Patients with borderline-resectable pancreatic cancer were enrolled and randomly assigned to receive neoadjuvant chemotherapy with either FOLFIRINOX or gemcitabine with nab-paclitaxel (GEM/nab-PTX). After the completion of chemotherapy, patients underwent surgical resection when feasible. This study (NUPAT-01) was a randomized phase II trial, and the primary endpoint was the R0 resection rate.Results:Fifty-one patients were enrolled in this study [FOLFIRINOX (n = 26) and GEM/nab-PTX (n = 25)]. A total of 84.3% (n = 43/51) of the patients eventually underwent surgery, and R0 resection was achieved in 67.4% (n = 33/ 51) of the patients. Adverse events (grade >3) due to neoadjuvant treatment were observed in 45.1% of the patients (n = 23/51), and major surgical complications occurred in 30.0% (n = 13/43), with no mortality noted. The intention-to-treat analysis showed that the 3-year overall survival rate was 54.7%, with a median survival time of 39.4 months, and a significant difference in overall survival was not observed between the FOLFIRINOX and GEM/nab-PTX groups.Conclusions:These results indicate that neoadjuvant chemotherapy with FOLFIRINOX or GEM/nab-PTX is feasible and well tolerated, achieving an R0 resection rate of 67.4%. The survival of patients was even found to be favorable in the intention-to-treat analysis. © 2022 Lippincott Williams and Wilkins. All rights reserved.},

note = {Cited by: 2},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{GHANEH2022,

title = {Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX, or chemoradiotherapy in patients with borderline resectable pancreatic cancer (ESPAC5): a four-arm, multicentre, randomised, phase 2 trial},

author = {Paula Ghaneh and Daniel Palmer and Silvia Cicconi and Richard Jackson and Christopher Michael Halloran and Charlotte Rawcliffe and Rajaram Sripadam and Somnath Mukherjee and Zahir Soonawalla and Jonathan Wadsley and Ahmed Al-Mukhtar and Euan Dickson and Janet Graham and Long Jiao and Harpreet S Wasan and Iain S Tait and Andreas Prachalias and Paul Ross and Juan W Valle and Derek A O'Reilly and Bilal Al-Sarireh and Sarah Gwynne and Irfan Ahmed and Kate Connolly and Kein-Long Yim and David Cunningham and Thomas Armstrong and Caroline Archer and Keith Roberts and Yuk Ting Ma and Christoph Springfeld and Christine Tjaden and Thilo Hackert and Markus W Büchler and John P Neoptolemos},

url = {https://www.sciencedirect.com/science/article/pii/S246812532200348X},

doi = {https://doi.org/10.1016/S2468-1253(22)00348-X},

issn = {2468-1253},

year  = {2022},

date = {2022-01-01},

urldate = {2022-01-01},

journal = {The Lancet Gastroenterology & Hepatology},

abstract = {Summary 

Background 

Patients with borderline resectable pancreatic ductal adenocarcinoma have relatively low resection rates and poor survival despite the use of adjuvant chemotherapy. The aim of our study was to establish the feasibility and efficacy of three different types of short-course neoadjuvant therapy compared with immediate surgery. 

Methods 

ESPAC5 (formerly known as ESPAC-5f) was a multicentre, open label, randomised controlled trial done in 16 pancreatic centres in two countries (UK and Germany). Eligible patients were aged 18 years or older, with a WHO performance status of 0 or 1, biopsy proven pancreatic ductal adenocarcinoma in the pancreatic head, and were staged as having a borderline resectable tumour by contrast-enhanced CT criteria following central review. Participants were randomly assigned by means of minimisation to one of four groups: immediate surgery; neoadjuvant gemcitabine and capecitabine (gemcitabine 1000 mg/m2 on days 1, 8, and 15, and oral capecitabine 830 mg/m2 twice a day on days 1–21 of a 28-day cycle for two cycles); neoadjuvant FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, folinic acid given according to local practice, and fluorouracil 400 mg/m2 bolus injection on days 1 and 15 followed by 2400 mg/m2 46 h intravenous infusion given on days 1 and 15, repeated every 2 weeks for four cycles); or neoadjuvant capecitabine-based chemoradiation (total dose 50·4 Gy in 28 daily fractions over 5·5 weeks [1·8 Gy per fraction, Monday to Friday] with capecitabine 830 mg/m2 twice daily [Monday to Friday] throughout radiotherapy). Patients underwent restaging contrast-enhanced CT at 4–6 weeks after neoadjuvant therapy and underwent surgical exploration if the tumour was still at least borderline resectable. All patients who had their tumour resected received adjuvant therapy at the oncologist's discretion. Primary endpoints were recruitment rate and resection rate. Analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN, 89500674, and is complete. 

Findings Between Sept 3, 2014, and Dec 20, 2018, from 478 patients screened, 90 were randomly assigned to a group (33 to immediate surgery, 20 to gemcitabine plus capecitabine, 20 to FOLFIRINOX, and 17 to capecitabine-based chemoradiation); four patients were excluded from the intention-to-treat analysis (one in the capecitabine-based chemoradiotherapy withdrew consent before starting therapy and three [two in the immediate surgery group and one in the gemcitabine plus capecitabine group] were found to be ineligible after randomisation). 44 (80%) of 55 patients completed neoadjuvant therapy. The recruitment rate was 25·92 patients per year from 16 sites; 21 (68%) of 31 patients in the immediate surgery and 30 (55%) of 55 patients in the combined neoadjuvant therapy groups underwent resection (p=0·33). R0 resection was achieved in three (14%) of 21 patients in the immediate surgery group and seven (23%) of 30 in the neoadjuvant therapy groups combined (p=0·49). Surgical complications were observed in 29 (43%) of 68 patients who underwent surgery; no patients died within 30 days. 46 (84%) of 55 patients receiving neoadjuvant therapy were available for restaging. Six (13%) of 46 had a partial response. Median follow-up time was 12·2 months (95% CI 12·0–12·4). 1-year overall survival was 39% (95% CI 24–61) for immediate surgery, 78% (60–100) for gemcitabine plus capecitabine, 84% (70–100) for FOLFIRINOX, and 60% (37–97) for capecitabine-based chemoradiotherapy (p=0·0028). 1-year disease-free survival from surgery was 33% (95% CI 19–58) for immediate surgery and 59% (46–74) for the combined neoadjuvant therapies (hazard ratio 0·53 [95% CI 0·28–0·98]},

keywords = {},

pubstate = {published},

tppubtype = {article}

}