Use and outcomes of surgery for locally advanced pancreatic cancer after induction chemotherapy in The Netherlands

Several high-volume centers have reported good outcomes after resection of locally advanced pancreatic cancer (LAPC; defined as arterial involvement more than 90 degrees and/or portomesenteric venous involvement more than 270 degrees or occlusion) following chemo(radio)therapy. A retrospective study among patients from all 16 Dutch pancreatic surgery centers assesed the nationwide use and outcomed of resection of LAPC following chemo(radio)therapy. Venous and arterial resections were performed in 51.4% and 14.8% of patients, respectively. Most resections (73.9%) were performed in high-volume centers (i.e. ≥ 60 pancreaticoduodenectomies per year). In-hospital/30-day major morbidity was 37.3% and 90-day mortality was 4.2%. Median overall survival from diagnosis was 26 months (95% CI 23-38) with 5-year OS rate 18%. Factors associated with OS were surgery in high-volume centers (HR 0.542; 95% CI 0.318-0.923), ypN1-2 (3.242; 1.886-5.234), and major morbidity (2.031; 1.272-3.244). The authors conclude that resection of locally advanced pancreatic cancer following chemo(radio)therapy is infrequently performed in The Netherlands, albeit with acceptable morbidity, mortality, and overall survival.