Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1785
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
Processing time: 109 Days and 1.4 Hours
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.
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.
Our aims were to investigate the efficacy and safety of laparoscopic radical resection following NACT for PDAC.
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.
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.
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.
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.