2021 Volume 80 Issue 5 Pages 215-223
We provide here an outline of adjuvant and neoadjuvant treatment along with surgery from the viewpoint ofthe change in pancreatic cancer survival. Since 2000, gemcitabine and S-1 have been authorized, and gemcitabinehas been chosen for adjuvant treatment. We performed a high-quality RCT of S-1 in the adjuvant setting startingin 2014 and became the leading center for adjuvant treatment. We used resectability criteria that were annuallyreported by the American NCCN, but they were introduced in the 7th edition of the JPS guidelines in this countryand are useful for decision-making orientation. Neoadjuvant chemotherapy is a commonly recognized methodfor the management of patients with resectable and borderline resectable pancreatic tumors. However, there hasnot yet been a consensus on the best regimen choice. A RCT of preoperative chemotherapy including S-1 + GEMtreatment was performed in patients with resectable tumors in 2019, and an improvement in the long-term survivalwas demonstrated. We retrospectively evaluated the cases of patients undergoing pancreatic cancer excision at ourinstitution over the past 24 years. On the basis of resectability (R) criteria classifications, preoperative treatmentwas initiated in 38.4% of patients with UR and 53.8% of patients with BR tumors. The OS was 12.3% for patientswith BR tumors, 28.1% for those with R tumors and 24.9% for patients with UR (P = 0.038) tumors. An improvement in the survival rate was observed with adjuvant treatment. Successful execution of adjuvant treatment withS-1 contributed to long-term survival after surgery without cancer remnants. However, it is essential to preoperatively treat patients with UR tumors to control 20% of recurrences, and there is a high recurrence of cancer inpatients with BR tumors treated with chemotherapy. These treatments performed preoperatively can lead to animprovement in OS.
