To investigate the safety of perioperative neoadjuvant therapy in patients with pancreatic cancer undergoing radical resection.

Clinical data of 117 patients with pancreatic cancer who underwent radical resection in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from July 2018 to June 2021 were retrospectively analyzed. Among them,68 patients were male and 49 female, aged from 39 to 83 years, with a median age of 61 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients who received neoadjuvant therapy and those who did not receive neoadjuvant therapy were matched and assigned to neoadjuvant group (n=39) and control group (n=78) at a ratio of 1∶2. The matching parameters consisted of tumor location, surgical procedure, resection and reconstruction of portal vein-superior mesenteric vein and celiac trunk resection. Perioperative conditions were compared between two groups by t test or Wilcoxon rank-sum test. The incidence of postoperative complications and perioperative mortality rate were analyzed by Chi-square test or Fisher's exact test.

For preoperative adjuvant chemotherapy regimen in the neoadjuvant group, 16 cases received mFOLFIRINOX, 18 albumin-bound paclitaxel+gemcitabine (NG),3 mFOLFIRINOX+NG, and 2 cases received other regimens. Preoperatively, 6 patients received combined radiotherapy, and 4 cases of combined targeted and immune therapy. In the neoadjuvant group, the median intraoperative blood loss was 480(445) ml, significantly higher than 375(250) ml in the control group (Z=2.031, P<0.05). In the neoadjuvant group, intraoperative blood transfusion volume was 0(2) U, significantly higher than 0(0) U in the control group (Z=2.149, P<0.05). In the neoadjuvant group, the length of postoperative ICU stay was 2(1) d, significantly longer than 2(1) d in the control group (Z=5.446, P<0.05). No significant difference was noted in the operation time, length of postoperative hospital stay, incidence of postoperative complications and perioperative mortality between two groups (P>0.05).

It is safe to perform neoadjuvant therapy in pancreatic cancer patients before operation. Under proper perioperative management and strict preoperative evaluation, the risk of surgery is manageable.