Outcomes of conversion surgery for patients with locally advanced pancreatic cancer under strict indication criteria

Conversion surgery (CS) is performed for locally advanced pancreatic cancer (LAPC); however, the criteria for CS varies among institutions. This study aimed to evaluate the clinical outcomes of CS for LAPC based on strict indications at our center. This study included patients diagnosed with and treated for LAPC between 2011 and 2021. The CS criteria indicated that the tumors shrunk to the same status as resectable pancreatic cancer (RPC) on imaging and were maintained for > 3 months. Additionally, tumors that had shrunk to a size corresponding to borderline resectable pancreatic cancer (BRPC) were observed on CT. Twenty-two patients underwent CS with a morbidity rate of 40.9% and no mortality. Overall survival after surgery in the LAPC group tended better than that in the BR and R groups (MST, LAPC, 59.7 months; BR, 38.6 months; R, 39.1 months; LAPC vs. BR, p = 0.085, vs. R, p = 0.065). Disease-free survival was similar across all resectability statuses: LAPC, 21.1 months; BR, 16.6 months; and R, 19.6 months (LAPC vs. BR, p = 1.000, vs. R, p = 1.000). CS in patients with LAPC under strict criteria showed promising outcomes, demonstrating the potential benefit of this approach in carefully selected patients.