Upfront surgery versus neoadjuvant chemotherapy for borderline resectable pancreatic carcinoma with venous encasement more than 180 degree, comparative study

BackgroundPancreatic cancer is considered the seventh cause of cancer-related death worldwide, and has low resection rate and a poor prognosis. Surgical resection to achieve R0 followed by adjuvant chemotherapy is the treatment of choice. Borderline resectable pancreatic cancer (BRPC) is technically difficult tumor with high risk of non-radical resection R1 and early postoperative recurrence.A neoadjuvant chemotherapy in BRPC instead of upfront surgical resection has advantages of increase R0 resection rate, treatment of undetected micro metastases and decrease postoperative pancreatic fistula. ObjectiveComparing the short-term outcome between upfront surgery and neoadjuvant chemotherapy for borderline resectable pancreatic carcinoma for venous encasement only as regards the ability to do R0 resection, early surgical complications and the progression rate of the disease DesignProspective cohort. Patients and methodsPatients age between 20-70, with only venous encasement (no arterial encasement) with encasement>180 degrees and a segment of venous encasement not more than 2 cm were included.Patients with an arterial encasement, distant metastasis, and not fit for chemotherapy were excluded. ResultsThe upfront surgery group has higher resection rate (75%) with portal/SMV reconstruction needed in one-third of the cases (33.3%) while the neoadjuvant chemotherapy group has higher progression rate (55%) and low resection rate (only 20%). No significant difference between the groups as regards the complication rate (morbidity and mortality), R1 resection(margin invasion), blood loss or time of surgery. ConclusionUpfront surgery can be done in selected patients with BR-PDAC to avoid the progression of the disease with no statistically significant difference as regards the short-term complications in comparison to the neoadjuvant group.