Comparison of neoadjuvant therapy versus upfront surgery in resectable pancreatic adenocarcinoma: a retrospective study

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive solid tumors and ranks as the fourth leading cause of cancer-related death in Western nations. The aim of the current study was to compare upfront surgery (US) and neoadjuvant therapy (NAT) in patients with resectable PDAC in terms of perioperative outcomes, early and late complications, overall survival, the recurrence rate, and readmission. Materials and Methods: In this study, all patients who underwent US or NAT for resectable pancreatic adenocarcinoma between January 2006 and March 2021 were retrospectively identified from institutional databases. Results: The NAT and US groups included 63 and 113 patients. The NAT group had significantly higher rates of arterial and venous resection and distal and total pancreatectomy, but no significant differences in anastomosis technique, pathology, margin status, invasion, stage, or early/late complications. The US group had significantly longer mean overall survival (63.66 vs. 34.10 months, p = 0.007) and higher 1-year (79.6% vs. 60.3%, p = 0.006) and 3-year (69.0% vs. 41.3%, p<0.001) survival rates, though 5-year survival was similar (p = 0.215). However, in the multivariate Cox regression analysis, the type of intervention (US or NAT) was not independently associated with poor overall survival (p value = 0.584). Recurrence and readmission rates were also comparable (p = 0.234 and 0.377, respectively). Conclusion: Our study revealed that US and NAT do not differ in terms of overall survival, recurrence, readmission, and early and late complications; however, given that the NAT group had worse prognosis, our findings suggest that NAT may provide a survival benefit for high-risk patients suffering from resecteable PDAC.