Effect of Neoadjuvant Chemoradiation on Operative Mortality and Morbidity for Pancreaticoduodenectomy

Abstract

Neo-CRT does not increase the mortality or morbidity of PD. In contrast, neo-CRT was associated with a marked reduction in the incidence of pancreatic leak, as well as leak-associated morbidity and mortality.

Optimal indication of neoadjuvant chemoradiotherapy for pancreatic cancer

“…However, previous studies as well as this study have shown that NACRT is feasible and does not significantly interfere with the postoperative course [20,41]. Furthermore, NACRT may even bring beneficial effect on postoperative complications including pancreatic fistula [42,43]. Although there is no convincing evidence, NACRT may induce the atrophy and distortion of lobular structure with fibrotic change, thereby resulting in the reduction of pancreatic exocrine activity.…”

Downstaging of Pancreatic Carcinoma after Neoadjuvant Chemoradiation

“…However, this effect did not persist as shown by an intrainstitutional comparison [15]. The effect of neoadjuvant CRT on mortality and morbidity for pancreaticoduodenectomy was recently analyzed retrospectively at the Duke University Medical Center comparing 79 patients resected after CRT and 67 patients without pretreatment [10]. Lethality rates were 3.8% and 4.5% in the respective groups and no increase in morbidity after CRT was observed.…”

Incidence of Benign Disease in Patients that Underwent Resection for Presumed Pancreatic Cancer Diagnosed by Endoscopic Ultrasonography (EUS) and Fine-Needle Aspiration (FNA)

“…Pancreatic leak rate refers to increased drain amylase levels (i.e., drain amylase levels threefold above the serum levels as previously published by our group). 4 Amylase levels were measured based on clinical suspicion for leak (e.g., increased in volume output, changes in consistency, color, etc.) or when the patient was started on regular diet.…”