Outcomes of Surgical Management for Borderline (br)/locally Advanced (LA) Pancreatic Adenocarcinoma (PAC) after Neoadjuvant FOLFIRINOX Chemotherapy: Results of an AGEO/French Multicenter Study.

e15250 Background: FOLFIRINOX has been shown to increase survival in patients with metastatic PAC with an objective response rate of 32%. In BR and LA PAC, a resection rate of 36% has been reported in a retrospective study. The aim of our study was to analyse post-operative outcomes in patients resected for BR or LA PAC who received neoadjuvant treatment based on FOLFIRINOX. Methods: Data of patients who underwent a curative intent resection after neoadjuvant FOLFIRINOX in 18 French centers were reviewed in this retrospective study. BR or LA PAC were classified following the National Comprehensive Cancer Network classification using CT-scan by investigators. Post-operative morbidity was graded according to the Dindo classification. Disease free survival (DFS) and overall survival (OS) were analysed using Kaplan Meier method from the date of surgical resection. Results: From November 2010 to December 2013, 58 patients (36 men, median age of 59 years, 34 BR and 24 LA at baseline CT-scan staging) underwent a pancreatic resection after a median number of 6 cycles (1-30) of FOLFIRINOX. Additional preoperative chemoradiotherapy was administred in 42 patients (72%). Initial median tumor size was 31 mm (16-66) with 79% located in the pancreatic head. 24% (n=14) of tumors required en bloc vascular resection. Post-operative mortality and severe morbidities (grade 3-4) were 3.4% and 19%, respectively. R0 resection was achieved in 86% of patients. The histological complete response (ypT0N0) rate was 19%. After a median follow-up of 11.0 months (0.4-37.2) from surgery, a recurrence occurred in 15 patients (local n=5; metastatic n=9; both n=1) including 9 deaths during follow-up. Median DFS and OS were not reached. One year DFS and OS rates were 53% (16/34) and 71% (9/34), respectively. Conclusions: In this retrospective study, pancreatic resection after neoadjuvant FOLFIRINOX was safe even when combined with radiochemotherapy. Rates of R0 resection and histological complete response were high suggesting that this strategy should be further evaluated in a prospective manner in patients with BR/ LA PAC.