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Hepato-pancreato-biliary

E287: Trends in the Utilization of Neoadjuvant Therapy and its Impact on Vascular Resection Among Patients Undergoing Resection for Pancreatic Adenocarcinoma

Introduction: The presence and extent of vascular involvement of pancreatic adenocarcinoma (PDAC) impacts resectability and whether neoadjuvant therapy (NAT) is utilized. However, there is little data investigating the correlation between the use of NAT and need for vascular resection. This study examines the trends in utilization of NAT and its impact on vascular resection rates among patients undergoing resection for PDAC over time.

Methods: A retrospective review of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), merged with ACS-NSQIP Targeted Pancreatectomy data from the years 2014-2021 was performed. Patients were excluded if they had incomplete data or M1 disease. A linear regression model was used to assess associations between NAT and likelihood of vascular resection (venous and/or arterial).

Results:

A total of 17,486 patients were included, of which 6,431 patients (37%) received NAT and 11,055 (63%) did not. There were 4,227 patients (24%) who underwent vascular resection during the study period. In the entire cohort, the use of NAT was associated with an increased likelihood of vascular resection (OR 2.12, 95% CI: 1.95-2.32, p< .001) as well as a lower pathologic T-stage (T1/2; OR 1.34, 95% CI: 1.22-1.47, p< .001) and N-stage (N0; OR 1.21, 95% CI: 1.12-1.32, p< .001). Temporal trends of this association are shown in Figure 1. The use of neoadjuvant therapy increased by 18% per year between 2014 and 2021 (OR 1.18, 95% CI: 1.17-1.20, p< .0001), while the overall number of vascular resections increased by 2% per year (OR 1.02, 95% CI: 1.01-1.04), p=0.0036). Within the cohort that received NAT, however, the percentage of patients undergoing vascular resection decreased by 4% per year during the study period (OR 0.96, 95% CI: 0.94-0.99, p=0.0018), while there was a non-significant increase in the rate of vascular resection in the patients who did not receive NAT (OR 1.02, 95% CI: 0.99-1.04, p=0.13).

Conclusions: Neoadjuvant therapy is increasingly being utilized in patients undergoing resection for pancreas cancer. Although the rates of vascular resection have increased slightly overall, the use in patients receiving NAT has decreased over time. This finding is potentially secondary to effective downstaging by NAT, although additional studies are warranted to determine causation.

Learning Objectives:

  • Upon completion, participant will have deeper understanding of trends of neoadjuvant therapy and vascular resection rates for pancreatic ductal adenocarcinoma.
  • Describe the utility of using neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma.
  • Describe changes in patterns of vascular resection with and without use of neoadjuvant chemotherapy