Textbook outcomes among patients undergoing curative resection of pancreatic ductal adenocarcinoma in the era of neoadjuvant therapy

Background

Neoadjuvant therapy has been the standard care for borderline resectable or locally advanced pancreatic ductal carcinoma (BR/LA PDAC). The textbook outcome (TO) for curative resection after neoadjuvant therapy (NAT) remains understudied.

Method

Patients underwent curative resection for PDAC between 2019 and 2020 were confirmed from the multidisciplinary team (MDT) database prospectively maintained by the Department of Pancreatic Hepatobiliary Surgery of Changhai hospital. TO of patients received NAT was compared to those received upfront surgery (UFS), and multivariate analysis of clinicopathological parameters was performed to explore predictors for TO.

Results

Of 435 patients, 329(76%) patients received UFS whereas 106(24%) patients received NAT. The TO was 82.1% for the NAT cohort, 77.8% for pancreaticoduodenectomy (PD) and 86.8% for distal pancreatectomy (DP). In the UFS cohort, the TO was 73.3% overall, 70.6% for PD and 77.3% for DP. Patients in the NAT cohort had longer time of operation, more intra-operative blood loss and more vascular resection. However, TO of the NAT cohort were not statistically different compared to that in the UFS cohort (p ​= ​0.27 for PD and p ​= ​0.20 for DP). On multivariable analysis, only diabetes-free was predictive for a better TO rate after PD in the UFS cohort(p ​= ​0.003). There were no factors associated with TO after DP in the UFS cohort, nor after PD or DP in the NAT cohort.

Conclusion

As a composite indicator of desired surgical outcome, TO for curative resection after neoadjuvant therapy is similar to that in upfront surgery. All patients with stable or regressed tumors after NAT should be candidates for curative resection in an MDT setting.