Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2022; 14(9): 1785-1797
Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1785
Efficacy and safety of laparoscopic radical resection following neoadjuvant therapy for pancreatic ductal adenocarcinoma: A retrospective study
Yong-Gang He, Xiao-Bing Huang, Yu-Ming Li, Jing Li, Xue-Hui Peng, Wen Huang, Yi-Chen Tang, Lu Zheng
Yong-Gang He, Xiao-Bing Huang, Yu-Ming Li, Jing Li, Xue-Hui Peng, Wen Huang, Yi-Chen Tang, Lu Zheng, Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
Author contributions: He YG and Huang XB, Zheng L contributed to the conception and design of the study and drafted the manuscript; Zheng L, Li YM, Peng XH, Li J, Huang W and Tang YC contributed to the analysis and interpretation of the data and revised the manuscript; Zheng L, Li YM, and He YG participated in the clinical treatment operation and literature research; and all authors read and approved the final manuscript.
Supported by Chongqing Municipal Science and Technology Talent Project, No. csct2017jcyj-yszxX0002; Chongqing Municipal Science and Technology Innovation Project for Social Undertakings and People’s Livelihood Guarantee, No. cstc2018jscx-mszdX0012; and the Natural Science Foundation of Chongqing, No. cstc2021jcyj-msxmX0991.
Institutional review board statement: This retrospective observational study was approved by the Medical Ethics Committee of our hospital and was conducted in accordance with the Declaration of Helsinki and the International Ethical Guidelines for Biomedical Research Involving Human Subjects (2022-r177-01).
Informed consent statement: Written informed consent was obtained from all the patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The authors declare that all the data have been provided in the article and that there are no supplemental data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lu Zheng, Doctor, MD, PhD, Academic Editor, Chief Doctor, Deputy Director, Director, Doctor, Surgeon, Surgical Oncologist, Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, No. 183 Xinqiao High Street, Shapingba District, Chongqing 400037, China. xqyyzl1@163.com
Received: May 23, 2022
Peer-review started: May 23, 2022
First decision: July 6, 2022
Revised: July 16, 2022
Accepted: August 15, 2022
Article in press: August 15, 2022
Published online: September 15, 2022
ARTICLE HIGHLIGHTS
Research background

Multiple studies have demonstrated that neoadjuvant chemotherapy (NACT) can prolong the overall survival of pancreatic ductal adenocarcinoma (PDAC) patients. However, most studies have focused on open surgery following NACT.

Research motivation

Despite the development of surgical instruments and minimally invasive techniques, laparoscopic techniques have been increasingly applied in pancreatic surgery. However, most reported cases of PDAC patients underwent open surgery after NACT. At present, we performed laparoscopic radical resection of PDAC after NACT.

Research objectives

Our aims were to investigate the efficacy and safety of laparoscopic radical resection following NACT for PDAC.

Research methods

We retrospectively analyzed the clinical data of 15 patients with pathologically confirmed PDAC who received NACT followed by laparoscopic radical surgery in our hospital from December 2019 to April 2022. All patients underwent abdominal contrast-enhanced computed tomography (CT) and positron emission tomography-CT before surgery to accurately assess tumor stage and exclude distant metastasis.

Research results

All 15 patients with PDAC were successfully converted to surgical resection after NACT, including 8 patients with pancreatic head cancer and 7 patients with pancreatic body and tail cancer. Among them, 13 patients received the nab-paclitaxel plus gemcitabine regimen (gemcitabine 1000 mg/m2 plus nab-paclitaxel 125 mg/m2 on days 1, 8, and 15 every 4 wk), and 2 patients received the modified FOLFIRINOX regimen (intravenous oxaliplatin 68 mg/m2, irinotecan 135 mg/m2, and leucovorin 400 mg/m2 on day 1 and fluorouracil 400 mg/m2 on day 1, followed by a 46-h continuous infusion of fluorouracil 2400 mg/m2). After each treatment cycle, abdominal CT, tumor markers, and circulating tumor cell (CTC) counts were reviewed to evaluate the treatment efficacy. All 15 patients achieved partial remission. The surgical procedures included laparoscopic pancreaticoduodenectomy (LPD, n = 8) and laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS, n = 7). One patient with pancreatic head carcinoma was found to have portal vein involvement during the operation, and LPD combined with vascular resection and reconstruction was performed. One patient developed grade B postoperative pancreatic fistula after L-RAMPS, and one patient experienced jaundice after LPD. None of the patients died after surgery.

Research conclusions

Laparoscopic radical resection of PDAC after neoadjuvant therapy is safe and effective if it is performed by a surgeon with rich experience in LPD and L-RAMPS in a large center of pancreatic surgery.

Research perspectives

With the increased clinical application of NACT, many studies have indicated that by shrinking the primary tumor and reducing vascular invasion and micrometastatic lesions, NACT for PDAC can increase the resectability rate, lower the incidence of postoperative complications, and ultimately prolong survival and improve prognosis. Most reported cases of pancreatic cancer patients underwent open surgery after NACT. LPD has certain advantages, such as less trauma, quick recovery, less bleeding, and a good postoperative quality of life. Therefore, laparoscopic surgery after NACT for PDAC has certain advantages.