Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2025; 17(1): 97897
Published online Jan 27, 2025. doi: 10.4240/wjgs.v17.i1.97897
Multimodal treatment combining neoadjuvant therapy, laparoscopic subtotal distal pancreatectomy and adjuvant therapy for pancreatic neck-body cancer: Case series
Jia Li, Xi-Tao Wang, Yi Wang, Kang Chen, Guo-Guang Li, Yan-Fei Long, Mei-Fu Chen, Chuang Peng, Yi Liu, Wei Cheng
Jia Li, Xi-Tao Wang, Yi Wang, Kang Chen, Guo-Guang Li, Yan-Fei Long, Mei-Fu Chen, Chuang Peng, Yi Liu, Wei Cheng, Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
Co-first authors: Jia Li and Xi-Tao Wang.
Co-corresponding authors: Yi Liu and Wei Cheng.
Author contributions: Li J and Wang XT wrote the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Wang XT, Li J, Liu Y, and Cheng W contributed to the conception of the study; Liu Y, Cheng W, Chen K, and Wang Y collected the cases; Wang XT, Li J, and Li GG performed the formal analysis; Wang Y and Long YF performed the statistical analysis with software; Chen MF helped perform the analysis with constructive discussions; Peng C helped collect the images; Liu Y and Cheng W revised and edited the draft, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the Hunan Province Clinical Medical Technology Innovation Guidance Project, No. 2020SK50912; Annual Scientific Research Plan Project of Hunan Provincial Health Commission, No. C2019057; and Hunan Provincial Natural Science Foundation of China, No. 2023JJ40381.
Institutional review board statement: This study was conducted in accordance with the ethical standards of the Declaration of Helsinki and approved by the Institutional Review Board of Hunan Provincial People’s Hospital, approval No. 2020-03.
Informed consent statement: Written consent was obtained from all patients for the publication of all images, clinical data, and other data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to patient privacy and confidentiality agreements, some restrictions may apply.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Cheng, MD, PhD, Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), No. 61 Jiefang West Road, Changsha 410005, Hunan Province, China. chengwei@hunnu.edu.cn
Received: June 12, 2024
Revised: October 29, 2024
Accepted: November 18, 2024
Published online: January 27, 2025
Processing time: 198 Days and 7.5 Hours
Abstract
BACKGROUND

Pancreatic cancer involving the pancreas neck and body often invades the retroperitoneal vessels, making its radical resection challenging. Multimodal treatment strategies, including neoadjuvant therapy, surgery, and postoperative adjuvant therapy, are contributing to a paradigm shift in the treatment of pancreatic cancer. This strategy is also promising in the treatment of pancreatic neck-body cancer.

AIM

To evaluate the feasibility and effectiveness of a multimodal strategy for the treatment of borderline/locally advanced pancreatic neck-body cancer.

METHODS

From January 2019 to December 2021, we reviewed the demographic characteristics, neoadjuvant and adjuvant treatment data, intraoperative and postoperative variables, and follow-up outcomes of patients who underwent multimodal treatment for pancreatic neck-body cancer in a prospectively collected database of our hospital. This investigation was reported in line with the Preferred Reporting of Case Series in Surgery criteria.

RESULTS

A total of 11 patients with pancreatic neck-body cancer were included in this study, of whom 6 patients were borderline resectable and 5 were locally advanced. Through multidisciplinary team discussion, all patients received neoadjuvant therapy, of whom 8 (73%) patients achieved a partial response and 3 patients maintained stable disease. After multidisciplinary team reassessment, all patients underwent laparoscopic subtotal distal pancreatectomy and portal vein reconstruction and achieved R0 resection. Postoperatively, two patients (18%) developed ascites, and two patients (18%) developed pancreatic fistulae. The median length of stay of the patients was 11 days (range: 10-15 days). All patients received postoperative adjuvant therapy. During the follow-up, three patients experienced tumor recurrence, with a median disease-free survival time of 13.3 months and a median overall survival time of 20.5 months.

CONCLUSION

A multimodal treatment strategy combining neoadjuvant therapy, laparoscopic subtotal distal pancreatectomy, and adjuvant therapy is safe and feasible in patients with pancreatic neck-body cancer.

Keywords: Pancreatic neck-body cancer; Multimodal treatment; Neoadjuvant therapy; Laparoscopic subtotal distal pancreatectomy; Adjuvant therapy

Core Tip: Radical resection of the tumor and associated vascular reconstruction for pancreatic neck-body cancer is mostly accomplished at our center using laparoscopic subtotal distal pancreatectomy. The application of this minimally invasive technique not only ensures oncologic outcomes but also preserves the intact gastrointestinal tract and part of the pancreas, allowing a quicker recovery after surgery and the accomplishment of subsequent adjuvant therapy. Our current study shows that the multimodal treatment strategy combining neoadjuvant therapy, laparoscopic subtotal distal pancreatectomy, and adjuvant therapy is safe and feasible in patients with pancreatic neck-body cancer.