Pancreatic Body and Tail Adenocarcinoma: Upfront Resection Versus Neoadjuvant Therapy, A Contemporary Analysis.

Abstract

Objectives: There is a paucity of data regarding the use of neoadjuvant therapy in pancreatic body or tail ductal adenocarcinomas. Given the differing tumor biology and aggressive nature of pancreatic body or tail adenocarcinomas, patients presenting with these tumors may benefit from upfront resection.

Methods: A retrospective cohort study was performed analyzing patients who underwent distal pancreatectomy for pancreatic ductal adenocarcinoma between January 2013 and June 2022. Patients who underwent upfront resection were compared with those who underwent neoadjuvant therapy.

Results: Forty-one patients underwent upfront distal pancreatectomy, whereas 40 patients underwent neoadjuvant therapy before curative intent resection. Neoadjuvant therapy did not improve overall survival (37 vs 34 months, P = 0.962) or disease-free survival (13 vs 15 months, P = 0.414), as compared with upfront resection. There was no significant difference in the rate or R 0 resection or postoperative outcomes.

Conclusion: No significant improvement in survival was demonstrated for patients undergoing neoadjuvant therapy for pancreatic ductal adenocarcinoma of the pancreatic body or tail when compared with upfront resection. Considering the potential for disease progression given the more aggressive tumor biology of pancreatic body and tail adenocarcinomas, appropriate surgical candidates should be offered upfront resection to provide the best chance of survival and cure.