Systemic Treatment Followed by Radical Resection Combined With Intestinal Autotransplantation for Locally Advanced...

To assess the efficacy of this approach and establish the criteria that identify patients with locally advanced pancreatic cancer (LAPC) who may achieve survival benefits from radical resection combined with intestinal autotransplantation (RRCIA).

Surgical resection for LAPC remains challenging and is associated with high morbidity and mortality, especially for surgery with major arterial reconstruction. We previously showed the feasibility and safety of RRCIA after systemic treatment.

A retrospectively observational and prospectively validated study with 3 cohorts was conducted using multiple treatments. Overall survival (OS) and progression-free survival (PFS) were compared for both analyses. Propensity-score matching (PSM) and stabilized inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.

Among 208 patients with LAPC, we identified 48 who underwent systemic treatment followed by RRCIA. Using PSM and stabilized IPTW analyses, we observed that patients who underwent RRCIA had better overall and PFS compared with patients who did not have surgery (PSM cohort: median OS: 25.8 vs 14.2 months, P = 0.0031, and IPTW cohort: median OS: 23.2 vs 15.4 months, P = 0.0069) and PFS (PSM cohort: median PFS: 13.3 vs 7.0 months, P = 0.0246, and IPTW cohort: median OS: 13.3 vs 8.8 months, P = 0.002). Further prospective analysis showed that patients who received systemic treatment, followed by RRCIA, were associated with improved OS and PFS compared with patients who were eligible but did not receive RRCIA (median OS: 22.6 vs 18.2 months, P = 0.035; median PFS: 13.2 vs 10.3 months, P = 0.0412). Moreover, the stratified and multivariable analysis demonstrated that preoperative carbohydrate antigen 19-9 normalization and duration of initial treatment over 8 cycles were predictors for the precise selection of patients who would benefit from RRCIA. Meanwhile, adjuvant therapy after RRCIA was a significant factor in improving survival.

This study suggests that RRCIA appears to be effective and associated with improved outcomes for patients with LAPC with favorable responses to systemic treatment. Patients with LAPC Should have at least 8 cycles of systemic treatment and carbohydrate antigen 19-9 normalization to be considered for RRCIA.