Conversion Surgery for Unresectable Pancreatic Cancer Treated With FOLFIRINOX or Gemcitabine Plus Nab-paclitaxel

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Chemotherapy advances have improved conversion surgery (CS) for unresectable pancreatic cancer (uPC).
• The efficacy of CS following FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (GnP) in uPC requires further demonstration.

Purpose of the Study:

• To evaluate the success rate and efficacy of conversion surgery (CS) in patients with unresectable pancreatic cancer (uPC).
• To identify factors contributing to successful CS.
• To compare CS efficacy between locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC).

Main Methods:

• Retrospective review of 318 patients with uPC receiving FFX or GnP as first-line chemotherapy.
• Analysis of efficacy in the CS group (complete resection post-chemotherapy) versus the non-CS group.
• Identification of contributing factors for achieving CS and comparison between LAPC and MPC.

Main Results:

• Conversion surgery (CS) was achieved in 4.3% of all patients (13.3% LAPC, 2.1% MPC).
• Factors for CS included LAPC, no liver metastasis, low CA19-9, and chemotherapy response.
• CS group showed significantly better overall survival (32.9 vs. 11.3 months) and improved post-conversion survival (27.6 months overall, 43.8 months LAPC, 21.3 months MPC).

Conclusions:

• Conversion surgery (CS) is achievable in a subset of unresectable pancreatic cancer (uPC) patients, particularly LAPC.
• Successful CS significantly improves long-term prognosis, even in some metastatic cases.
• Factors like disease stage and response to chemotherapy are crucial for successful CS.