| Figures/TablesFigures/Tables | ReferencesReferences<
h4 class=""
h4"">Background
h4>For pancreatic cancer, complete macroscopic resection in combination wit
h c
hemot
herapy is t
he only potentially curative treatment. Many patients present wit
h locally advanced cancers deemed unresectable. We soug
ht to assess t
he results of exploration after neoadjuvant t
herapy for locally advanced possibly unresectable pancreatic cancer.<
h4 class=""
h4"">Met
hods
h4>
From a prospective database, all consecutive patients undergoing operation from October 2001 to December 2009 after neoadjuvant therapy for locally advanced pancreatic cancer were identified. Main criteria for ¡°unresectability¡± were infiltration of the celiac axis or superior mesenteric artery. Resection rates, perioperative results, and survival were analyzed.<h4 class=""h4"">Resultsh4>
Of 257 patients, 199 (77.4 % ) had received neoadjuvant chemoradiation, and 58 (22.6 % ) chemotherapy only. Of 257 patients, 120 (46.7 % ) underwent successful resection, whereas 137 patients underwent exploration only; 47 (39.2 % ) multivisceral and 45 (37.5 % ) vascular resections (12 arterial reconstructions) were performed. There were 6 (5 % ) ypT0 neoplasms, 36 (30.0 % ) R0, 61 (50.8 % ) R1, and 16 (13.3 % ) R2 resections. The median follow-up of surviving patients (n = 22) was 22 months. Median postoperative survival was greater after resection (12.7 months) than after exploration alone (8.8 months; P < .0001). Median postoperative survival was 24.6 months after R0, 11.9 months after R1, and 8.9 months after R2 resection. The 3-year survival rate after R0 resection was 24 % . To determine survival after start of neoadjuvant therapy, 3.7 months (median) have to be added.<h4 class=""h4"">Conclusionh4>
In locally advanced, unresectable pancreatic cancer, R0/R1 resections can be achieved in up to 40 % of patients who undergo operation after neoadjuvant therapy. In these cases, survival rates are similar to those observed for initially resectable pancreatic cancer.