Table 1 Characteristics and quality assessment of the included studies
Study, year, country | Study type, period | Resectability status | Definition of status | Neoadjuvant treatment (proportion + protocol) | Quality score |
|---|---|---|---|---|---|
Barbier et al. [23], 2011, France | Retro, 1997–2006 | RPC | Tumor surrounding ≤ 180° of the circumference of SMV/PV, no tumor contact to CA and SMA, and no occlusion of SMV/PV confluence. | Chemo: 100%, 5-FU + cisplatine Radio: 100%, 45 Gy | 14 |
Papalezova et al. [24], 2012, America | Retro, 1999–2007 | RPC | No evidence of tumor extension to SMA, CA, CHA, SMV, and PV. Radiographically borderline resectable or unresectable disease was excluded. | Chemo: 100%, capecitabine or infusional 5-FU Radio: 100%, 45 or 50.4 Gy | 13 |
Tajima et al. [25], 2012, Japan | Retro, 2006–2009 | RPC/BRPC | No detailed statement, but potentially resectable diseases were included. | Chemo: 100%, GEM + S-1 Radio: 0% | 12 |
Cho et al. [26], 2013, Korea | Retro, 2002–2011 | BRPC | Tumor encasement of a short segment of CHA, without evidence of tumor extension to CA; tumor abutment of the SMA involving < 180° of the circumference; or short-segment occlusion of SMV/PV, allowing for vascular reconstruction. | Chemo: 100%, GEM alone (most) or GEM + cisplatin or GEM + capecitabine Radio: 100%, 45 or 50.4 or 58.4 Gy | 14 |
Jiang et al. [27], 2013, China | Retro, 2004–2010 | RPC | Tumors not involving major vascular structures including CA, SMA, and SMV/PV. | Chemo: 72%, GEMa Radio: 28%, 54 Gy | 14 |
Patel et al. [28], 2014, America | Retro, 1995–2010 | RPC/BRPC | Tumor abutment involving SMV/PV with or without narrowing or short-segment occlusion of the lumen allowing for safe resection, or tumor abutment of the SMA ≤ 180° of the circumference, or gastroduodenal artery encasement up to the hepatic artery with either short segment encasement or direct abutment of the hepatic artery, without extension to CA. | Chemo: 100%, GEM + taxotere + capecitabine Radio: 98%, 37.5 (30–50.5) Gy | 12 |
Roland et al. [30], 2015, America | Pro, 1990–2008 | RPC | No statement, but patients with borderline-resectable or locally advanced disease were excluded. | Chemo: 100%, GEM, 5- FU or capecitabine Radio: 98%, 30 or 50.4 Gy | 12 |
Lee et al. [29], 2015, Korea | Retro, 2000–2013 | RPC/BRPC | Tumor abutment (≤ 50% of the circumference) or encasement (> 50% of the circumference) of the SMV or PV. | Chemo: 100%, GEM alone (most), GEM + cisplatin or GEM + capecitabine Radio: 100%, 45 or 50.4 or 58.4 Gy | 12 |
Sho et al. [31], 2015, Japan | Retro, 2006–2013 | RPC | RPC—no tumor contact to CA, SMA, CHA, SMV/PV, or venous abutment of SMV/PV without distortion or narrowing. | Chemo: 100%, GEM Radio: 100%, 50 or 54 Gy | 12 |
|  |  | BRPC | BRPC—tumor with encasement of a short segment of CHA without evidence of tumor extension to CA, or tumor abutment of the SMA within 180° of circumference. |  |  |
Golcher et al. [36], 2015, Germany | Pro, RCT, 2003–2009 | RPC | No organ infiltration except the duodenum and maximal involvement of peripancreatic vessels ≤ 180°. | Chemo: 88%, GEM + cisplatin Radio: 88%, 50.4 Gy | Low risk of biasb |
Hirono et al. [32], 2016, Japan | Retro, 2000–2013 | BRPC | Tumor abutment of SMA within 180° of the circumference, or CHA without extension of hepatic artery bifurcation, or CA without involvement of the aorta. | Chemo: 100%, GEM + S-1 or S-1 Radio: 57%, 50 Gy | 13 |
Masui et al. [33], 2016, Japan | Pro, 2006–2010 | RPC/BRPC | Severe unilateral SMV/PV impingement, circumferential SMA abutment of less than 180°, or encasement of a short segment of the CHA. | Chemo: 100%, GEM + S-1 Radio: 0%, NA | 14 |
Ielpo et al. [3], 2017, Spain | Pro, 2007–2016 | RPC BRPC | RPC—no radiographic evidence of vascular invasion. BRPC—venous involvement of the SMV/PV; tumor abutment of the SMA within 180° of the circumference. | Chemo: 100%, GEM + nab-paclitaxel Radio: 44%, ≤ 52 Gy | 15 |
Murakami et al. [35], 2017, Japan | Retro, 2002–2015 | BRPC | Tumor contact with SMA of ≤ 180° or tumor contact with CHA without extension to the CA or hepatic artery bifurcation, allowing for safe and complete resection and reconstruction. | Chemo: 100%, GEM + S-1 Radio: 0% | 13 |
Fujii et al. [34], 2017, Japan | Pro, 2001–2013 | RPC | RPC—lesions without adjacent major vasculature including SMV/PV, SMA, CHA, and CA. | Chemo: 100%, S-1 Radio: 100%, 50.4 Gy | 15 |
RPC/BRPC BRPC | BR-PV—lesions involved exclusively with the SMV/PV system. BR-A—lesions involving gastroduodenal artery encasement up to the hepatic artery without extension to CA or ≤ 180° of tumor abutment to SMA. | ||||
Jang et al. [9], 2018, Korea | Pro, RCT 2012–2014 | BRPC | Tumor abutment of SMA within 180 degrees of the circumference; tumor abutment of SMV/PV with impingement and narrowing of the lumen, or short-segment venous occlusion, allowing for safe resection and reconstruction. | Chemo: 100%, GEM Radio: 100%, 45 Gy | Low risk of biasb |
Reni et al. [12], 2018, Italy | Pro, RCT 2010–2015 | RPC | Lesions with the absence of invasion of superior mesenteric artery or vein, portal vein, coeliac artery, or hepatic artery. | Chemo: 100%, cisplatin + epirubicin + capecitabine + GEM Radio: 0% | Low risk of biasb |