• Jennifer L Williams, Brian E Kadera, Andrew H Nguyen, V Raman Muthusamy, Zev A Wainberg, O Joe Hines, Howard A Reber, and Timothy R Donahue.
• Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.
• J. Gastrointest. Surg. 2016 Jul 1; 20 (7): 1331-42.

BackgroundCompared to the widely adopted 2-4 months of pre-operative therapy for patients with borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC), our institution tends to administer a longer duration before considering surgical resection. Using this unique approach, the aim of this study was to determine pre-operative variables associated with survival.MethodsRecords from patients with BR/LA PDAC who underwent attempt at surgical resection from 1992-2014 were reviewed.ResultsAfter a median duration of 6 months of pre-operative treatment, 109 patients with BR/LA PDAC (BR 63, LA 46) were explored; 93 (85.3 %) underwent pancreatectomy. Those who received at least 6 months of pre-operative treatment had longer median overall survival (OS) than those who received less (52.8 vs. 32.1 months, P = 0.044). On multivariate analysis, pre-operative treatment duration was the strongest predictor of survival (hazard ratio (HR) 4.79, P = 0.043). However, OS was similar in those whose CA19-9 normalized regardless of whether they received more or less than 6 months of chemotherapy (71.4 vs. 101.8 months, P = 0.930).ConclusionsPre-operative CA19-9 decline can guide treatment duration in patients with BR/LA PDAC. We endorse 6 months of therapy except in those patients whose values normalize, where surgery can be considered after a shorter course.

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