Neoadjuvant Chemotherapy vs Surgery First in a Rural Population With Resectable Pancreatic Cancer: Oncologic,...

Area of Science:

• Surgical Oncology
• Gastrointestinal Oncology
• Neoadjuvant Therapy

Background:

• Neoadjuvant chemotherapy (NAT) is under investigation for resectable pancreatic cancer.
• Comparing NAT to up-front surgery (UFS) is crucial for treatment decisions.

Purpose of the Study:

• To compare overall survival between NAT and UFS in a general population of patients with resectable pancreatic head cancer.
• To identify patient and tumor factors influencing NAT receipt and survival.

Main Methods:

• Prospective database query of 83 patients undergoing pancreaticoduodenectomy for resectable pancreatic adenocarcinoma (2019-2023).
• Comparison of demographics, clinical factors, Area Deprivation Index (ADI), and distance traveled between NAT and UFS groups.
• Kaplan-Meier and Cox Regression analyses for overall survival.

Main Results:

• One-third of patients received NAT; no significant survival difference was observed between NAT and UFS groups at 1, 3, or overall follow-up.
• ADI and distance traveled did not influence NAT receipt or survival.
• Age and performance status were the only factors significantly associated with survival on multivariate analysis.

Conclusions:

• No significant difference in early mortality or overall survival between neoadjuvant chemotherapy and up-front surgery for resectable pancreatic cancer.
• Treatment decisions for resectable pancreatic cancer should consider individual patient factors beyond neoadjuvant therapy versus upfront surgery.