Impact of neoadjuvant therapy on postoperative outcomes after pancreaticoduodenectomy

Cools, Katherine S.; Sanoff, Hanna K.; Kim, Hee Jin; Yeh, Jen Jen; Stitzenberg, Karyn B.

doi:10.1002/jso.25183

Cited by 41 publications

(49 citation statements)

References 40 publications

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“…Indeed, in two studies, hard gland texture was more frequently observed in patients receiving NAT, and this was associated with a reduced POPF rate. 40,42 The results of this study should be interpreted in light of some limitations. First, due to its retrospective design, this study compared oncological outcomes in patients who successful proceeded to resection after NAT, but did not include outcomes of patients who may have potentially progressed or became unfit during NAT.…”

Section: Discussionmentioning

confidence: 91%

See 1 more Smart Citation

Impact of Neoadjuvant Therapy in Resected Pancreatic Ductal Adenocarcinoma of the Pancreatic Body or Tail on Surgical and Oncological Outcome: A Propensity-Score Matched Multicenter Study

et al. 2019

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Background. Several studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head. Data concerning NAT for PDAC located in pancreatic body or tail are lacking. Methods. Post hoc analysis of an international multicenter retrospective cohort of distal pancreatectomy for PDAC in 34 centers from 11 countries (2007-2015). Patients who underwent resection after NAT were matched (1:1 ratio), using propensity scores based on baseline characteristics, to patients who underwent upfront resection. Median overall survival was compared using the stratified log-rank test. Results. Among 1236 patients, 136 (11.0%) received NAT, most frequently FOLFIRINOX (25.7%). In total, 94 patients receiving NAT were matched to 94 patients undergoing upfront resection. NAT was associated with less postoperative major morbidity (Clavien-Dindo C 3a, 10.6% vs. 23.4%, P = 0.020) and pancreatic fistula grade B/C (9.6% vs. 21.3%, P = 0.026). NAT did not improve overall survival [27 (95% CI 14-39) versus 31 months (95% CI 19-42), P = 0.277], as compared with upfront resection. In a sensitivity analysis of 251 patients with radiographic tumor involvement of splenic vessels, NAT Mohammed Abu Hilal and Marc G. Besselink share senior authorship.

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Section: Discussionmentioning

confidence: 91%

“…(n = 37, 14.7%) was associated with prolonged overall survival [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]) versus 20 months (95% CI [15][16][17][18][19][20][21][22][23][24], P = 0.049], as compared with upfront resection. Conclusion.…”

mentioning

confidence: 99%

Impact of Neoadjuvant Therapy in Resected Pancreatic Ductal Adenocarcinoma of the Pancreatic Body or Tail on Surgical and Oncological Outcome: A Propensity-Score Matched Multicenter Study

et al. 2019

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“…Short‐term outcomes of total pancreatectomy following chemotherapy have not been evaluated previously. Although some studies indicated that morbidity and mortality rates following pancreatic resection did not increase after chemotherapy, other studies reported increased operative morbidity in patients receiving preoperative anticancer therapy. Patients who have undergone preoperative chemotherapy require time to recover before surgery; however, the most appropriate interval between chemotherapy and surgery is unknown.…”

Section: Discussionmentioning

confidence: 99%

Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database

Hashimoto

Mizuma

Kumamaru

et al. 2020

British Journal of Surgery

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Background: Total pancreatectomy is required to completely clear tumours that are locally advanced or located in the centre of the pancreas. However, reports describing clinical outcomes after total pancreatectomy are rare. The aim of this retrospective observational study was to assess clinical outcomes following total pancreatectomy using a nationwide registry and to create a risk model for severe postoperative complications. Methods: Patients who underwent total pancreatectomy from 2013 to 2017, and who were recorded in the Japan Society of Gastroenterological Surgery and Japanese Society of Hepato-Biliary-Pancreatic Surgery database, were included. Severe complications at 30 days were defined as those with a Clavien-Dindo grade III needing reoperation, or grade IV-V. Occurrence of severe complications was modelled using data from patients treated from 2013 to 2016, and the accuracy of the model tested among patients from 2017 using c-statistics and a calibration plot. Results: A total of 2167 patients undergoing total pancreatectomy were included. Postoperative 30-day and in-hospital mortality rates were 1⋅0 per cent (22 of 2167 patients) and 2⋅7 per cent (58 of 167) respectively, and severe complications developed in 6⋅0 per cent (131 of 2167). Factors showing a strong positive association with outcome in this risk model were the ASA performance status grade and combined arterial resection. In the test cohort, the c-statistic of the model was 0⋅70 (95 per cent c.i. 0⋅59 to 0⋅81).Conclusion: The risk model may be used to predict severe complications after total pancreatectomy.

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“…Neoadjuvant treatment, including chemotherapy or chemoradiation for borderline resectable and locally unresectable pancreatic cancer offers several advantages including: the potential to downstage tumors to enable surgical resection and better prognosis. Therefore, current consensus guidelines have recommended the use of neoadjuvant therapy for these BRPC . However, there are few studies on surgical outcomes and prognosis of PDAC with adjacent organ infiltration.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of adjacent organ resection in patients with left‐sided pancreatic ductal adenocarcinoma following distal pancreatectomy

Song

Kwon

Kim

et al. 2019

J Hepato Biliary Pancreat

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Background We evaluated whether distal pancreatectomy (DP) with adjacent organ resection (AOR) affected perioperative outcomes and survival in patients with left-sided pancreatic ductal adenocarcinoma (PDAC). Methods Retrospective cohort study was conducted at single large volume academic medical center from January 2000 to December 2016. Results Five hundred and twenty-three patients had undergone standard DP (without additional vessel/organ resection) and 40 had undergone DP with AOR due to adjacent organ infiltration. There were no differences of postoperative morbidity and hospital stay between the two groups. In the patients with AJCC 8th stage I and II PDAC, there were significant differences of median disease-specific and progression-free survivals between the standard and AOR groups (37.9 vs. 20.2 months; P = 0.05, 20 vs. 10 months; P = 0.028, respectively). DP with AOR was identified as independent prognostic factor of stage I and II PDAC by multivariate Cox regression analysis. Conclusions Distal pancreatectomy with AOR could be an acceptable surgical treatment for left-sided PDAC. However, AOR group shows poor prognosis than that of the standard group in patients with AJCC 8th stage I and II PDAC. AOR should be considered indicative of a more aggressive tumor in AJCC 8th stage I and II PDAC.

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Impact of neoadjuvant therapy on postoperative outcomes after pancreaticoduodenectomy

Abstract: NAT does not increase the overall postoperative morbidity or mortality of PD for PDA. There is a decreased likelihood of pancreatic fistulas in patients that receive neoadjuvant therapy.

Cited by 41 publications

References 40 publications

Impact of Neoadjuvant Therapy in Resected Pancreatic Ductal Adenocarcinoma of the Pancreatic Body or Tail on Surgical and Oncological Outcome: A Propensity-Score Matched Multicenter Study

Impact of Neoadjuvant Therapy in Resected Pancreatic Ductal Adenocarcinoma of the Pancreatic Body or Tail on Surgical and Oncological Outcome: A Propensity-Score Matched Multicenter Study

Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database

Prognostic value of adjacent organ resection in patients with left‐sided pancreatic ductal adenocarcinoma following distal pancreatectomy

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