Treatment tactics for patients with borderline resectable and locally advanced pancreatic cancer

Abstract

Objective – to evaluate the outcomes of extended pancreatic resections in the treatment of patients with borderline resectable and locally advanced pancreatic cancer and to identify strategies for improving the effectiveness of these procedures.

Materials and methods. Between 2010 and 2023, a total of 874 pancreatic resections were performed for patients with pancreatic adenocarcinoma: 142 distal pancreatosplenectomies (16.2%), 706 pancreaticoduodenectomies (80.8%), and 26 total pancreatectomies (3.0%). The cohort included 388 females (44.4%) and 486 males (55.6%), with a mean age of 57.7±10.5 years (range: 22 – 81). Extended pancreatic resections were conducted in 202 (23.1%) patients, comprising 130 extended pancreaticoduodenectomies (64.4%), 58 extended distal pancreatosplenectomies (28.7%), and 14 extended total pancreatectomies (6.9%). A total of 144 (71.3%) patients underwent pancreatic resections with venous resections, 13 (6.4%) with arterial resections, 3 (1.5%) with combined vascular resections, and 42 (20.8%) with resections of adjacent organs.

Results. Postoperative complications were observed in 248 patients (36.9%) in the standard resection group and in 84 patients (41.6%) in the extended resection group (χ²=1.4; p=0.22), with no statistically significant difference. The mortality rate was 2.6%, with 23 deaths: 16 (2.4%) after standard pancreatic resections and 7 (3.5%) after extended pancreatic resections, indicating no statistically significant difference (χ²=0.71; p=0.39). Implementation of a personalized treatment algorithm increased the median survival of patients with borderline resectable and locally advanced pancreatic head cancer from 19 to 28 months (χ²=1.7; p=0.18) and the five‑year survival from 22% to 28.5%. For patients with pancreatic cancer of the body and tail, median survival increased from 22 to 36 months (χ²=1.78; p=0.18) and five‑year survival from 24% to 34% (χ²=1.78; p=0.18).

Conclusions. The results suggest that morbidity and mortality after extended pancreatic resections are comparable to those observed after standard pancreatic resections. Extended resections are feasible and can increase the number of patients eligible for radical surgery. Implementation of the developed treatment algorithm was associated with improved median survival in patients with borderline resectable and locally advanced pancreatic cancer.