Upfront surgery in borderline resectable pancreatic cancer

Abstract

Introduction: The definition of Borderline resectable pancreatic cancer (BRPC) is evolving. In general BRPC is considered when high rate of margin positivity is possible without neoadjuvant therapy. Though neoadjuvant therapy is emerging in BPRC there is still role of upfront surgery in some patients with BRPC. Aim: The aim of the present study was to study the surgical feasibility and perioperative outcomes in patients with BRPC undergoing upfront surgery. Material and methods: The study was done from data collected from prospectively maintained database between 2013 to 2018. Patients with pancreatic and periampullary tumors who were classified BRPC according to NCCN 2018 classification. In addition solid tumor contact of tumors to PV/SMV of less than 180 degrees were also included as BRPC. Tumors with abutment of PV and SMV with thrombosis or obliteration of lumen were excluded. The surgical feasibility, complication and R0 resection rate was studied. Results: A total of 22 patients were included in the study. Eleven (11/22, 50%) patients underwent vascular resection. In 5 (5/22, 22.7%) patients pancreaticoduodenectomy could be done without the need for vascular resection. In 6 (6/22, 27%) patients palliative therapy was done due to metastatic disease (2) or locally advanced disease (4).Of the 11 patients who underwent vascular resections Grade A pancreatic fistula was seen in 3 (3/11), Grade B pancreatic fistula 1(1/11) Delayed gastric emptying in 3 (3/11) and wound infection in 2 (2/11) There was no mortality. The resection margin was positive in 3 patients (3/16, 18%). Conclusion: Upfront vascular resection is possible in carefully selected patients with good resectability and R0 resection rates.