Operation Alone for Resectable Pancreatic Adenocarcinoma: Should We Operate if Multimodal Treatment Is Off the Table?

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Pancreatic ductal adenocarcinoma (PDAC) is typically treated with surgery and multimodal therapy.
• Some patients cannot undergo multimodal therapy, and data on surgery alone are limited.

Purpose of the Study:

• To evaluate the benefit of upfront surgical resection without adjuvant therapy for resectable PDAC.
• To compare outcomes of isolated surgical intervention versus no operation in early-stage PDAC.

Main Methods:

• Analysis of the National Cancer Database (2010-2016) for patients with resectable PDAC (clinical stage II or less).
• Comparison of patients undergoing upfront resection versus those refusing operation.
• Propensity score matching to control for patient selection bias.

Main Results:

• Upfront resection was performed in 6.1% of patients; 1.2% refused operation.
• Propensity matching created 471 balanced pairs.
• Median overall survival (OS) was 14.09 months with surgery versus 6.34 months without (p < 0.001).
• 1-year OS rates were 56% (surgery) vs 26% (no surgery).
• R0 resection (negative margin) significantly improved median OS (17.87 months) compared to non-R0 resection (7.56 months).

Conclusions:

• Upfront surgical resection, even without multimodal therapy, improves outcomes for early-stage PDAC compared to no surgery.
• The survival benefit of surgery is contingent upon achieving a negative resection margin (R0).