TRIANGLE operation, combined with adequate adjuvant chemotherapy, can improve the prognosis of pancreatic head cancer: A retrospective study

doi:10.4251/wjgo.v16.i5.1773

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World Journal of Gastrointestinal Oncology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Oncol. May 15, 2024; 16(5): 1773-1786
Published online May 15, 2024. doi: 10.4251/wjgo.v16.i5.1773

TRIANGLE operation, combined with adequate adjuvant chemotherapy, can improve the prognosis of pancreatic head cancer: A retrospective study

Jia-Hao Chen, Li-Yong Zhu, Zhi-Wei Cai, Xiao Hu, Abousalam Abdoulkader Ahmed, Jie-Qiong Ge, Xiao-Yan Tang, Chun-Jing Li, Yun-Long Pu, Chong-Yi Jiang

Jia-Hao Chen, Li-Yong Zhu, Zhi-Wei Cai, Xiao Hu, Abousalam Abdoulkader Ahmed, Xiao-Yan Tang, Chun-Jing Li, Yun-Long Pu, Chong-Yi Jiang, Department of Hepato-Biliary-Pancreatic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China

Zhi-Wei Cai, Shanghai Key Laboratory of Clinical Geriatric Medicine, Fudan University, Shanghai 200040, China

Jie-Qiong Ge, Department of Nursing, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China

Co-first authors: Jia-Hao Chen and Li-Yong Zhu.

Author contributions: Chen JH, Jiang CY, Zhu LY, Cai ZW participated in the study design, data acquisition and interpretation, statistical analysis, drafting of the manuscript; Hu X, Ahmed AA, Ge JQ participated in the data acquisition and interpretation, statistical analysis, critical revision of the manuscript; Tang XY, Li CJ, Pu YL participated in the data acquisition and supervision, statistical analysis, critical revision of the manuscript; all authors had full access to all the data in the study and accept responsibility to submit for publication. Chen JH and Zhu LY contributed equally to this work as co-first authors. Together, Chen JH and Zhu LY paid the time and energy needed to complete the research and the final paper, assumed the related responsibilities and burdens, and completed the design, preparation, submission and other steps of this research. This also ensures that the quality and reliability of the paper is ultimately improved. Moreover, Chen JH and Zhu LY contributed efforts of equal substance throughout the research process, made the most significant intellectual contribution and contributed equally to this work. The choice of these researchers as co-authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study.

Supported by Shanghai Science and Technology Commission of Shanghai Municipality, No. 20Y11908600; Shanghai Municipal Health Commission, No. 20194Y0195; and Medical Engineering Jiont Fund of Fudan University, No. XM03231533.

Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and received approval from the institutional review board of Huadong Hospital affiliated with Fudan University, and its protocol was declared and registered on ClinicalTrials.gov (ID: NCT05703581) before statistical analysis (January 30, 2023). This study was also approved by the Ethics Committee of Huadong Hospital Affiliated to Fudan University (No. 20170014), and all patients provided informed consent before the operation.

Informed consent statement: Informed consent was obtained from all individual participants.

Conflict-of-interest statement: The authors have no conficts of interest to declare.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Chong-Yi Jiang, MD, Chief Doctor, Department of Hepato-Biliary-Pancreatic Surgery, Huadong Hospital Affiliated to Fudan University, No. 221 Yan’an West Road, Shanghai 200040, China. jiangzhongyi9@sina.com

Received: January 7, 2024
Peer-review started: January 7, 2024
First decision: January 30, 2024
Revised: February 4, 2024
Accepted: March 5, 2024
Article in press: March 5, 2024
Published online: May 15, 2024
Processing time: 123 Days and 1.9 Hours

ARTICLE HIGHLIGHTS

Research background

Data on the long-term oncological outcomes of the TRIANGLE operation in resectable pancreatic ductal adenocarcinoma (PDAC) patients undergoing pancreaticoduodenectomy (PD) are limited.

Research motivation

The TRIANGLE operation shows efficacy postneoadjuvant therapy in locally advanced PDAC, but its role in resectable PDAC is unclear. This study explored the safety and prognostic impact of this approach in patients with resectable PDAC.

Research objectives

To assess the safety of the TRIANGLE operation during PD and its prognostic relevance for resectable PDAC recurrence and survival.

Research methods

This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023, with or without the TRIANGLE operation. Patients were divided into the PD_TRIANGLE and PD_non-TRIANGLE groups. Surgical and survival outcomes were compared between the two groups. Adequate adjuvant chemotherapy was defined as adjuvant chemotherapy ≥ 6 months.

Research results

The study included 52 patients in the PD_TRIANGLE group and 55 in the PD_non-TRIANGLE group, with no significant differences in baseline or perioperative outcomes. The PD_TRIANGLE group had a lower recurrence rate (48.1% vs 81.8%, P < 0.001) and a decrease in local PDAC recurrence from 37.8% to 16.0%. Multivariate Cox regression analysis revealed that PD_TRIANGLE, adequate adjuvant chemotherapy (≥ 6 months), and margin status were independent predictors of the recurrence rate.

Research conclusions

The TRIANGLE operation during PD is safe, reduces local recurrence of PDAC, and potentially enhances recurrence-free survival and overall survival with sufficient adjuvant chemotherapy.

Research perspectives

Further research with a larger cohort is essential to validate the survival outcomes of the TRIANGLE operation.