Multimodal treatment combining neoadjuvant therapy, laparoscopic subtotal distal pancreatectomy and adjuvant therapy for pancreatic neck-body cancer: Case series

Table 1 Patients baseline information and results of neoadjuvant therapy, n (%)

Characteristic	N = 11
Sex
Female	6 (55)
Male	5 (45)
Age (years), median (range)	55 (41-68)
Blood glucose level
Normal	6 (55)
Diabetes	4 (36)
Impaired glucose tolerance	1 (9)
Before neoadjuvant therapy
Borderline	6 (55)
Locally advanced	5 (45)
Arterial involvement
CA	1 (9)
CA/SMA	5 (45)
CHA/CA	3 (27.3)
CHA/CA/SMA	1 (9.1)
SMA	1 (9.1)
Vein involvement
PV/SMV/SV	8 (73)
PV/SV	3 (27)
Biopsy
Ductal adenocarcinoma	11 (100)
Neoadjuvant therapy regimen
AG	6 (55)
AG + tirelizumab	1 (9)
AG + S-1 + tirelizumab	1 (9)
The mFOLFIRINOX	3 (27)
Neoadjuvant therapy cycle, median (range)	5 (2-6)
Initial CA19-9 (U/mL), median (range)	871 (112-2154)
Preoperative CA19-9 (U/mL), median (range)	24 (6-157)
Initial diameter (cm), median (range)	4.4 (2.8-5.9)
Preoperative diameter (cm), median (range)	2.2 (1.3-4.1)
Neoadjuvant therapy effect
PR	8 (73)
SD	3 (27)
After neoadjuvant therapy
Borderline	8 (73)
Resectable	3 (27)

CA: Celiac artery; SMA: Superior mesenteric artery; CHA: Common hepatic artery; PV: Portal vein; SMV: Superior mesenteric vein; SV: Spleen vein; AG: Albumin-bound paclitaxel and gemcitabine; S-1: Tegafur, gimeracil, and oteracil potassium; mFOLFIRINOX: Modified FOLFIRINOX regimen, including 5-fluorouracil, leucovorin, irinotecan and oxaliplatin; CA19-9: Carbohydrate antigen 19-9; PR: Partial response; SD: Stable disease.

Table 2 Operation details and patient recovery information, n (%)

Characteristic	N = 11
Operation time (minute), median (range)	400 (330-510)
Blood loss (mL), median (range)	300 (100-700)
Collateral circulation	7 (64)
SMA/CA invasion
Yes	0 (0)
No	11 (100)
Pancreatic margin
Positive	0 (0)
Negative	11 (100)
PV/SMV invasion classification
A	0 (0)
B	3 (27)
C	3 (27)
D	5 (45)
Vein reconstruction
Artificial vascular	3 (27)
End-to-end	8 (73)
RAMPS excision plane
Posterior	11 (100)
Complication
No	7 (64)
Intractable ascites	2 (18)
Pancreatic fistula	2 (18)
Postoperative hospital stays (days), median (range)	11 (10-15)

SMA: Superior mesenteric artery; CA: Celiac artery; PV: Portal vein; SMV: Superior mesenteric vein; RAMPS: Radical antegrade modular pancreatosplenectomy.

Table 3 Postoperative pathology data and follow-up results, n (%)

Characteristic	N = 11
Degree of differentiation
High	2 (18)
Medium	4 (36)
Medium-low	3 (27)
Low	2 (18)
Pathological staging
IA	3 (27)
IB	3 (27)
IIA	1 (9)
IIB	4 (36)
R0 resection
Yes	11 (100)
Lymph node harvest, median (range)	16 (11-25)
Positive lymph node
0	7 (64)
11d	1 (9)
8a	2 (18)
8a/9/14p	1 (9.1)
Nerve invasion	7 (64)
Tumor regression grading
0	1 (9)
1	0 (0)
2	7 (64)
3	3 (27)
Postoperative adjuvant therapy
AG + PD-1	1 (9)
Chemoradiotherapy	4 (36)
Gemcitabine	1 (9)
The mFOLFIRINOX	1 (9)
S-1	4 (36)
Blood glucose level
Normal	4 (36)
Diabetes	5 (46)
Impaired glucose tolerance	2 (18)
Follow-up (months), median (range)	15 (8-33)
Recurrence and metastasis
No	8 (73)
Liver	1 (9)
Local and liver	1 (9)
Local and radial bone	1 (9)
Survival state
Death	1 (9)
Survived with tumor	2 (18)
Tumor-free	8 (73)
Median overall survival (month)	20.5
Median disease-free survival (month)	13.3

AG: Albumin-bound paclitaxel and gemcitabine; PD: Pancreaticoduodenectomy; S-1: Tegafur, gimeracil, and oteracil potassium; mFOLFIRINOX: Modified FOLFIRINOX regimen, including 5-fluorouracil, leucovorin, irinotecan and oxaliplatin.