Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Neoadjuvant chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: Meta-analysis and trial sequential analysis of randomized controlled trials

  • Shahab Hajibandeh (Department of General Surgery, University Hospital of Wales, Cardiff & Vale NHS Trust) ;
  • Shahin Hajibandeh (Hepatobiliary and Pancreatic Surgery and Liver transplant Unit, Queen Elizabeth Hospital) ;
  • Christina Intrator (Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal Infirmary Hospital) ;
  • Karim Hassan (Department of General Surgery, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board) ;
  • Mantej Sehmbhi (Department of Internal Medicine, Mount Sinai Morningside and West Hospitals) ;
  • Jigar Shah (Department of General Surgery, North Manchester General Hospital, North Manchester Care Organisation) ;
  • Eshan Mazumdar (Department of General Surgery, University Hospital of Wales, Cardiff & Vale NHS Trust) ;
  • Ambareen Kausar (Department of Hepatobiliary and Pancreatic Surgery, Royal Blackburn Hospital) ;
  • Thomas Satyadas (Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal Infirmary Hospital)
  • Received : 2022.07.13
  • Accepted : 2022.09.07
  • Published : 2023.02.28
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Abstract

We aimed to compare resection and survival outcomes of neoadjuvant chemoradiotherapy (CRT) and immediate surgery in patients with resectable pancreatic cancer (RPC) or borderline resectable pancreatic cancer (BRPC). In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards, a systematic review of randomized controlled trials (RCTs) was conducted. Random effects modeling was applied to calculate pooled outcome data. Likelihood of type 1 or 2 errors in the meta-analysis model was assessed by trial sequential analysis. A total of 400 patients from four RCTs were included. When RPC and BRPC were analyzed together, neoadjuvant CRT resulted in a higher R0 resection rate (risk ratio [RR]: 1.55, p = 0.004), longer overall survival (mean difference [MD]: 3.75 years, p = 0.009) but lower overall resection rate (RR: 0.83, p = 0.008) compared with immediate surgery. When RPC and BRPC were analyzed separately, neoadjuvant CRT improved R0 resection rate (RR: 3.72, p = 0.004) and overall survival (MD: 6.64, p = 0.004) of patients with BRPC. However, it did not improve R0 resection rate (RR: 1.18, p = 0.13) or overall survival (MD: 0.94, p = 0.57) of patients with RPC. Neoadjuvant CRT might be beneficial for patients with BRPC, but not for patients with RPC. Nevertheless, the best available evidence does not include contemporary chemotherapy regimens. Patients with RPC and those with BRPC should not be combined in the same cohort in future studies.

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References

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