Role of Conversion Surgery for Unresectable Pancreatic Cancer After Long-Term Chemotherapy

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Unresectable pancreatic cancer (UR-PC) presents a significant clinical challenge with a generally poor prognosis.
• Conversion surgery is explored as a strategy to improve outcomes in UR-PC, but its definitive benefit remains debated.
• This study investigates the clinical utility and impact of conversion surgery in UR-PC patients.

Purpose of the Study:

• To evaluate the clinical benefits of conversion surgery in patients with unresectable pancreatic cancer.
• To determine survival outcomes for UR-PC patients undergoing conversion surgery versus those receiving only chemotherapy.
• To identify prognostic factors influencing survival in UR-PC patients undergoing conversion surgery.

Main Methods:

• A cohort of UR-PC patients referred for potential resection was evaluated between January 2008 and June 2017.
• Resectability was assessed using multimodal imaging after a minimum of 6 months of chemotherapy.
• Conversion surgery was reserved for patients achieving R0 resection eligibility.

Main Results:

• Out of 90 evaluated patients, only 22 (24.4%) underwent conversion surgery, with an R0 resection rate of 72.7%.
• Patients who underwent conversion surgery demonstrated significantly longer median survival (21.3 months) compared to unresected patients (12.6 months).
• Microvascular invasion was a significant adverse predictor for recurrence-free survival and overall survival.

Conclusions:

• Conversion surgery, following extended neoadjuvant chemotherapy, is associated with improved long-term survival in select UR-PC patients.
• Microvascular invasion is a critical negative prognostic factor in this patient group.
• Adjuvant treatment strategies are warranted for UR-PC patients with microvascular invasion to improve outcomes.