The Effect of Preoperative Oil Chemoembolization Techniques on the Results of Combined Treatment of Operable Pancreatic Cancer

Abstract

Background: Pancreatogastroduodenal resection is widely used for the treatment of pancreatic cancer but the 5-year survival rate does not exceed 10%. The treatment should be combined, but the question of the expediency of neoadjuvant therapy (NAT) with initially operable cancer has not been resolved. Aims: Substantiation of the expediency of the use of preoperative intra-arterial interventions in the combined treatment of patients with operable pancreatic cancer and the study of the impact of the technical features of the intervention on the treatment results. Materials and methods: The study included 92 patients (45 men and 47 women; mean age 63.910.1 years, T2N0M0 n=13; T3N0M0 n=32; T2N1M0 n=1; T4N0and1M0 n=46) who received combined treatment for the period 2014-2017.In I group, n=45 patients, the NAT was not performed.In II group, n=47 patients underwent intra-arterial oil chemoembolization of the pancreas with an emulsion of oil contrast and gemcitabine concentrate 400 mg/m2.The technique of distributive embolization of the artery gastroepiploica (GEA) differed: in IIA group, n= 22 patients with a spiral; in IIB group, n=25 patients with a temporarily inflated balloon.All 92 patients underwent radical surgery and received adjuvant chemotherapy based on gemcitabine 1000 mg/m2 in 1,8.15 days, 6 cycles. The frequency of specific and general postoperative complications was analyzed. For control, ultrasound, CT with contrast, CA 19-9 antigen level, general and biochemical blood tests were used. For 5 years, the results of each patient were tracked. The primary endpoints were overall (OS) and relapse-free (RFS) survival. Results: Postembolization syndrome did not affect the timing of the operation. The edematous form of acute pancreatitis was noted in 11 (50%) patients of group IIA and in 5 (20%) patients of group IIB, (p=0.043). Destructive pancreatitis was not marked. The overall 1-year survival rate (OS) in I group (n=31) was 68.9%, in II group (n=40) 85.1%, (p=0.062). The 2-years OS was: in I group (n=19) 42.2%, in II group (n=30) 63.8%, (p=0.042). The 3-year OS was: in I group (n=9) 20%, in II group (n=19) 40.4%, (p=0.021). The 4-years OS was: in I group (n=4) 8.9%, in II group (n=7) 14.8%, (p=0.387). The 5-year OS was: in I group 0, in II group (n=2) 4.3%, (p=0.168). The 1-year RFS was: in I group (n=23) 57.1%, in II group (n=29) 61.7%, (p=0.316). The 2-years RFS was: in I group (n=10) 22.2%, in II group (n=23) 48.9%, (p=0.012). The 3-years RFS was: in I group (n=7) 15.6%, in II group (n=16) 34%, (p=0.047). The 4-years RFS was: in I group (n=3) 6.7%, in II group (n=5) 10.6%, (p=0.568). The 5-years RFS was: in I group 0, in II group (n=1) 4%, (p=0.333). Conclusions: The results of the study confirm the feasibility of using preoperative intra-arterial interventions in the combined treatment of pancreatic cancer. There was a significant difference in the rates of 2-year and 3-year OS and RFS in patients receiving such therapy. The technique of occlusion of the artery gastroepiploica with a balloon probably provides more preferable results.