Benefits of neoadjuvant chemotherapy with gemcitabine plus S-1 for resectable pancreatic ductal adenocarcinoma

Currently, neoadjuvant chemotherapy (NAC) is usually performed even for resectable pancreatic ductal adenocarcinoma (rPDAC). The present study investigated the benefits of NAC with gemcitabine plus S-1 for rPDAC. The medical records of 170 patients diagnosed as having rPDAC based on preoperative imaging were reviewed retrospectively. Clinicopathological factors in the NAC group were compared with those in the upfront surgery (UpS) group. NAC was administered to 30 of the 170 patients. The period from first visit to treatment in the NAC group was shorter than that in the UpS group (P<0.001). Staging laparoscopy detected occult distant metastases in 12 of the 170 patients (7%), of whom all 12 were in the UpS group. All patients in the NAC group underwent surgical resection (P=0.028). Among the 158 patients who underwent pancreatectomy, the NAC group showed rapid induction of the treatment, non-inferior operative outcomes and a higher R0 rate compared with the UpS group. Rates of early recurrence (within 6 months) after surgery were 10% (3/30) in the NAC group and 29% (37/128) in the UpS group (P=0.021). NAC for rPDAC is beneficial in terms of rapid induction of the treatment, fewer occult metastases, and lower rate of early recurrence.