Clinical Effectiveness of Preoperative Neoadjuvant Chemotherapy for Patients with Borderline Resectable Pancreatic Cancer:An Updated Meta-Analysis`

The benefit of preoperative neoadjuvant chemotherapy (CT) to borderline resectable pancreatic cancer (BRPC) is still not well known. This study aims to define the benefits of neoadjuvant CT for BRPC patients. By searching databases (PubMed, Embase, Cochrane Library) from 1966 to 2015, all prospective studies were analysed, where preoperative neoadjuvant CT or chemoradiotherapy was given to patients with BRPC. Laparotomy and resection rates were the primary outcomes. Secondary outcome was therapyinduced toxicity, tumour response, and overall survival. Data were shown as weighted frequency with 95% confidence interval. Fifteen studies with a total of 356 patients were included. All patients had BRPC and received neoadjuvant CT. Following the preoperative therapy, 78.1% of evaluable patients underwent laparotomy and 76.3% of laparotomy patients were performed resection. Also, 86% of specimens were deemed microscopically negative (R0) resection margins. At restaging following treatment, weighted frequencies for complete/partial response were 23.0%, 54.3% for stable disease 23.4% for progressive disease and 23.6% for treatment-related grade 3-4 toxicity. The mean of overall survial amounted to 21.8 months for the resected patients, and 11.6 months for the unresected ones. This meta-analysis indicates that a benefit of preoperative neoadjuvant CT could be to spare surgery to BRPC patients with progressive disease during CT is administered. But downstaging of the lesion following treatment is uncommon.