Abstract
AIM: We aimed to refine treatment strategies for resected cases of pancreatic ductal adenocarcinoma in patients with unexpectedly uncovered postoperative noncurative factors while also evaluating the effectiveness of neoadjuvant and adjuvant chemotherapy. METHODS: We retrospectively analyzed clinicopathological and follow-up data from 1068 PDAC patients who underwent surgical resection at 13 Kyushu Study Group institutions (January 2016-December 2020). Patients were categorized into two groups: without (Group A) or with (Group B) unexpected postoperative noncurative factors. Kaplan-Meier analysis assessed disease-free and overall survival, while univariate and multivariate analyses using the Cox proportional hazards model identified prognostic factors. RESULTS: Group B (n = 44) had poorer survival than Group A (n = 981) (16.8 vs. 38.6 months; p < 0.001). The noncurative factors were associated with poor disease-free survival (hazard ratio, 1.544; 95% confidence interval, 1.067-2.179; p = 0.022) but not overall survival (hazard ratio, 1.332; 95% confidence interval, 0.910-1.950; p = 0.140). In Group B, patients receiving adjuvant chemotherapy had better disease-free survival (6.8 months vs. 3.4 months; p = 0.092), However, no significant difference was observed in overall survival. Furthermore, patients in Group B who received adjuvant chemotherapy had a worse prognosis compared to both Group A patients who received chemotherapy and those who did not. Preoperative therapy did not improve disease-free survival or overall survival in cases with postoperative noncurative factors. CONCLUSION: Cases with noncurative factors had significantly poorer prognoses than those without. In the present study, effective adjuvant chemotherapy for these patients could not be demonstrated. Therefore, thorough preoperative and intraoperative evaluation of noncurative factors is crucial to prevent futile surgery.