Relationship between surgical R0 resectability and findings of peripancreatic vascular invasion on CT imaging after neoadjuvant S-1 and concurrent radiotherapy in patients with borderline resectable pancreatic cancer
Sho Yasuta,
Tatsushi Kobayashi,
Hidetoshi Aizawa,
Shinichiro Takahashi,
Masafumi Ikeda,
Masaru Konishi,
Motohiro Kojima,
Hirofumi Kuno,
Katsuhiko Uesaka,
Soichiro Morinaga,
Atsushi Miyamoto,
Hirochika Toyama,
Norihisa Takakura,
Keishi Sugimachi,
Wataru Takayama
Affiliations
Sho Yasuta
Department of Hepato-biliary Pancreatic Surgery, National Cancer Center Hospital East
Tatsushi Kobayashi
Department of Diagnostic Radiology, National Cancer Center Hospital East
Hidetoshi Aizawa
Department of Surgery, Jichi Medical University Saitama Medical Center
Shinichiro Takahashi
Department of Hepato-biliary Pancreatic Surgery, National Cancer Center Hospital East
Masafumi Ikeda
Department of Hepato-biliary Pancreatic Oncology, National Cancer Center Hospital East
Masaru Konishi
Department of Hepato-biliary Pancreatic Surgery, National Cancer Center Hospital East
Motohiro Kojima
Division of Pathology, National Cancer Center Hospital East
Hirofumi Kuno
Department of Diagnostic Radiology, National Cancer Center Hospital East
Katsuhiko Uesaka
Department of Hepato-biliary Pancreatic Surgery, Shizuoka Cancer Center Hospital
Soichiro Morinaga
Department of Hepato-Biliary and Pancreatic Surgery, Kanagawa Cancer Center
Atsushi Miyamoto
Department of Hepato-Biliary-Pancreatic Surgery, National Hospital Organization Osaka National Hospital
Hirochika Toyama
Department of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine
Norihisa Takakura
Department of Surgery, Fukuyama City Hospital
Keishi Sugimachi
Department of Hepato-Biliary-Pancreatic Surgery, National Hospital Organization Kyusyu Cancer Center
Wataru Takayama
Department of Hepato-Biliary-Pancreatic Surgery, Chiba Cancer Center
Abstract Background Borderline resectable pancreatic cancer (BRPC) is frequently associated with positive surgical margins and a poor prognosis because the tumor is in contact with major vessels. This study evaluated the relationship between the margin-negative (R0) resection rate and findings indicating peripancreatic vascular invasion on multidetector computed tomography (MDCT) imaging after neoadjuvant chemoradiotherapy (NACRT) in patients with BRPC. Methods Twenty-nine BRPC patients who underwent laparotomy after neoadjuvant S-1 with concurrent radiotherapy were studied retrospectively. Peripancreatic major vessel invasion was evaluated based on the length of tumor-vessel contact on MDCT. The R0 resection rates were compared between the progression of vascular invasion (PVI) group and the non-progression of vascular invasion (NVI) group. Results There were 3 patients with partial responses (10%), 25 with stable disease (86%), and 1 with progressive disease (3%) according to the RECISTv1.1 criteria. Regarding vascular invasion, 9 patients (31%) were classified as having PVI, and 20 patients (69%) were classified as having NVI. Of the 29 patients, 27 (93%) received an R0 resection, and all the PVI patients received an R0 resection (9/9; R0 resection rate = 100%) while 90% (18/20) of the NVI patients underwent an R0 resection. The exact 95% confidence interval of risk difference between those R0 resection rates was − 10.0% [− 31.7–20.4%]. Conclusions Patients with BRPC after NACRT achieved high R0 resection rates regardless of the vascular invasion status. BRPC patients can undergo R0 resections unless progressive disease is observed after NACRT. Trial registration UMIN-CTR, UMIN000009172 . Registered 23 October 2012
