Adjuvant gemcitabine after resection of pancreatic cancer without significant difference in overall survival: a retrospective cohort study

Background: International guidelines recommend adjuvant chemotherapy after resection of pancreatic adenocarcinoma. The administration of gemcitabine has become part of the interdisciplinary treatment concept. The authors aim to prove whether the benefit in overall survival (OS) reported in randomized controlled trials (RCTs) could be reached also for patients treated in their department. Materials and methods: The authors retrospectively analyzed the OS of all patients who underwent pancreatic resection at their clinic because of ductal adenocarcinoma between January 2013 and December 2020 in dependence on adjuvant treatment with gemcitabine. Results: Overall 133 pancreatic resections were performed between 2013 and 2020 due to malignant pancreatic pathology. Seventy-four patients had ductal adenocarcinoma. Forty patients received adjuvant gemcitabine chemotherapy postoperatively, 18 patients underwent only surgical resection, and 16 patients received other chemotherapy regimens. The authors compared the group receiving adjuvant gemcitabine (n = 40) with the group undergoing surgery alone (n = 18). The median age was 74 years (range: 45-85), and the median OS was 16.5 months [95% confidence interval (CI) 13-27]. Follow-up time was at least 23 months (range 23-99). No statistically significant difference in median OS was observed in the group who received adjuvant chemotherapy compared to the operation-only group [17.5 months (range: 5-99, 95% CI 14-27) versus 12.5 months (range: 1-94, 95% CI 5-66), P = 0.75]. Conclusion: OS with and without adjuvant chemotherapy with gemcitabine was comparable to the results of those RCTs which serve as the basis of guideline recommendations. However, the analyzed patient cohort did not profit significantly from the adjuvant treatment.