• Hidenori Takahashi, Hirofumi Akita, Kunihito Gotoh, Shogo Kobayashi, Shigeru Marubashi, Norikatsu Miyoshi, Keijiro Sugimura, Masaaki Motoori, Kentaro Kishi, Shingo Noura, Yoshiyuki Fujiwara, Masayuki Ohue, Hiroaki Ohigashi, Masahiko Yano, Masato Sakon, and Osamu Ishikawa.
• Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan. Electronic address: takahasi-hi@mc.pref.osaka.jp.
• Surgery. 2015 Mar 1;157(3):484-95.

BackgroundAmong the various multimodal treatment strategies for pancreatic ductal adenocarcinoma (PDA), preoperative chemoradiation therapy (CRT) and subsequent operation is a promising strategy. The aim of this study is to evaluate the outcome of preoperative gemcitabine-based CRT for PDA of the body and tail, focusing on the associations among splenic vessel involvement, surgical outcomes, and pattern of recurrence.MethodsA total of 99 patients with PDA of the body and tail received preoperative CRT. The status of tumor involvement of the splenic artery (SA) and vein (SV) were evaluated based on radiographical findings obtained before the initiation of preoperative CRT. We assessed the following in association with the status of SA and SV involvement: (1) resection rate, (2) survival, and (3) pattern of recurrence.ResultsThe resection rate of SA-positive cases (71%) was significantly lesser than that of SA-negative cases (94%; P = .004), whereas SV involvement was not associated with the resection rate. The 5-year survival rates of the resected SA-negative and SA-positive cases were 76% and 20%, respectively (P < .001). The 5-year cumulative incidence of distant recurrence was significantly higher in the SA-positive patients than in the SA-negative patients (74% vs. 17%; P < .001).ConclusionIn preoperative CRT for PDA of the body and tail, positive SA involvement was associated with a lesser resection rate, and the survival rate for the patients with SA-positive tumors was lesser than that for patients with SA-negative tumors because of the greater incidence of distant recurrence in SA-positive patients.Copyright © 2015 Elsevier Inc. All rights reserved.

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