Neoadjuvant therapy versus upfront surgery for early‐stage left‐sided pancreatic adenocarcinoma: A propensity‐matched analysis from a national cohort of distal pancreatectomies
Ibrahim Nassour, Mohamed A. Adam, Stacy J. Kowalsky, Samer Al Masri, Nathan Bahary, Aatur D. Singhi, Kenneth Lee, Amer H. Zureikat, Alessandro Paniccia
Abstract
BACKGROUND: There are limited data on the efficacy of neoadjuvant therapy (NAT) for early-stage distal pancreas adenocarcinoma (PDAC). Previous studies focused on adenocarcinoma of the head of the pancreas or dealt with borderline and locally advanced tumors of the body and tail. METHODS: This is a retrospective study of the National Cancer Database between 2006 and 2015. A propensity-matched analysis was performed to compare overall survival estimates between NAT and upfront resection (UR) groups. RESULTS: A total of 5003 distal pancreatectomies for PDAC were identified, of whom 408 (9%) received NAT. After 1:1 matching, 353 NAT patients were compared with 353 UR patients. NAT was associated with lower 90-day mortality. There were no differences in the number of lymph nodes retrieved, or length of stay. With matching, the NAT group had higher median overall survival compared with UR (33.0 vs. 27.0 months; p = 0.009) and adjusted overall survival (hazard ratio = 0.63, 95% confidence interval = 0.51-0.77; p < 0.001). CONCLUSION: The receipt of NAT followed by distal pancreatectomy for early-stage distal PDAC is associated with improved overall survival compared with UR. This study supports the use of NAT in the multimodal therapy paradigm of early-stage adenocarcinoma of the body and tail of the pancreas.