Delays to surgery following chemoradiotherapy lead to poorer oncologic outcomes in patients with localized pancreatic adenocarcinoma

Background: Although neoadjuvant chemoradiotherapy (NCRT) and surgery are accepted as treatments for pancreatic ductal adenocarcinoma (PDAC), some authors have highlighted the risks of delaying surgery. Our objective was to analyze the impact of prolonging the time interval between NCRT and surgery (NCRT-TTS) in PDAC.

Methods: Patients treated with NCRT and pancreatoduodenectomy (PD) were identified. Clinical, histopathological variables were analyzed on whether NCRT-TTS was greater or less 50 days Five- and 10-year overall survival (OS) and disease-free survival (DFS) were analyzed depending on whether the delay was greater than 50 days or not.

Results: 100 (8.3%) of 120 eligible patients underwent PD: 61 male, median age of 63.7 years. In 71 (71%) patients the median NCRT-TTS was 39 (24-50) days and in 29 (29%) 61 days. There were no differences between the two groups except for CA 19-9 levels, the incidence of cholangitis, ASA score, intraoperative blood transfusions and degree of histopathologic response (all p< 0.001). Median DFS when the NCRT-TTS was less than 50 days was higher than when the interval exceeded 50 days - 51.0 months (95% CI 20.3-81.6) vs 17.0 months (95% CI 10.9-23.0); HR (95% CI 1.08-3.46), p=0.026. Five-year DFS was higher in the subgroup with the NCRT-TTS of less than 50 days compared to the group with an interval of more than 50 days - 43.5% vs 23.65% (HR 1.812 95% CI 1.001-3.280), p= 0.050 Conclusions. An increase in the NCRT-TTS > 50 days is associated with poorer OS and DFS in patients with localized PDAC treated with NCRT and PD.

CITA DEL ARTÍCULO  Rev Esp Enferm Dig. 2022 Nov 22. doi: 10.17235/reed.2022.9256/202