Advances in Surgical Treatment Following Conversion Therapy for Pancreatic Cancer

Abstract

Pancreatic cancer is characterized by an insidious onset, high invasiveness, and poor response to treatment. Radical resection remains the only potentially curative approach currently available. However, approximately 80% of patients are already in the locally advanced or metastatic stage at initial diagnosis and have missed the opportunity for radical surgery. In recent years, with the development of novel drugs and updates to chemotherapy regimens, significant progress has been made in improving the efficacy of conversion therapy. Conversion therapy aims to transform initially unresectable tumors, such as locally advanced or metastatic pancreatic cancer, into a resectable state through systemic therapies (including chemotherapy, targeted therapy, immunotherapy, etc.) combined with localized treatments (such as radiotherapy, interventional therapy, etc.). This approach reduces tumor volume and eliminates micrometastases, thereby improving surgical resection rates and patient survival outcomes. However, considerable controversy remains regarding surgical treatment after conversion therapy for pancreatic cancer. This article provides an overview of conversion therapy regimens and treatment cycles, methods for evaluating therapeutic efficacy post-conversion therapy, the resection rates, and treatment outcomes of surgery following conversion therapy. The key technical points of post-conversion therapy surgery, including R0 resection, venous management, arterial resection and reconstruction, and the management of periarterial divestment, are highlighted. The learning curve for arterial resection and reconstruction is also discussed. Additionally, the potential applications of minimally invasive techniques (such as laparoscopy and robotics) are highlighted. The integration of biomarkers, imaging, and artificial intelligence holds promise for optimizing individualized decision-making. Multidisciplinary collaboration, the comprehensive competence of the surgical team, and the mastery and refinement of surgical skills are also critical factors that influence resectability and therapeutic outcomes after conversion therapy.

Keywords: Pancreatic cancer, Conversion therapy, Conversion surgery, Arterial resection, Periarterial divestment, Review