Laparoscopic pancreatectomy for cancer in high volume centers is associated with an increased use and fewer delays of adjuvant chemotherapy

Kutlu, Onur; Vega, Eduardo; Salehi, Omid; Lathan, Christopher S.; Kim, Sun‐Hee; Krishnan, Sandeep; Stallwood, Christopher; Kozyreva, Olga; Conrad, Claudius

doi:10.1016/j.hpb.2020.09.003

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…Despite the benefits of adjuvant chemotherapy, only 50.9% of our patients received adjuvant treatment, which was comparable with other institutions and large series reporting rates of approximately 35% to 60%. 31 , 32 , 33 , 34 There are numerous reasons why patients do not receive adjuvant chemotherapy. These include post‐operative complications leading to poor performance status post‐surgery, tumor recurrence or metastases detected prior to initiation of adjuvant chemotherapy, and patient's preferences.…”

Section: Discussionmentioning

confidence: 99%

Resected pancreatic adenocarcinoma: An Asian institution's experience

Chow

Jiang

et al. 2021

Cancer Reports

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Background: Pancreatic adenocarcinoma (PDAC) is highly lethal. Surgery offers the only chance of cure, but 5-year overall survival (OS) after surgical resection and adjuvant therapy remains dismal. Adjuvant trials were mostly conducted in the West enrolling fit patients. Applicability to a general population, especially Asia has not been described adequately.Aim: We aimed to evaluate the clinical outcomes, prognostic factors of survival, pattern, and timing of recurrence after curative resection in an Asian institution. Methods and Results:The clinicopathologic and survival outcomes of 165 PDAC patients who underwent curative resection between 1998 and 2013 were reviewed retrospectively. Median age at surgery was 62.0 years. 55.2% were male, and 73.3% had tumors involving the head of pancreas. The median OS of the entire cohort was 19.7 months. Median OS of patients who received adjuvant chemotherapy was 23.8 months. Negative predictors of survival include lymph node ratio (LNR) of >0.3 (HR = 3.36, P = .001), tumor site involving the body or tail of pancreas (HR = 1.59, P = .046), presence of perineural invasion (PNI) (HR = 2.36, P = .018) and poorly differentiated/undifferentiated tumor grade (HR = 1.86, P = .058). The median time to recurrence was 8.87 months, with 66.1% and 81.2% of patients developing recurrence at 12 months and 24 months respectively. The most common site of recurrence was the liver. Conclusion:The survival of Asian patients with resected PDAC who received adjuvant chemotherapy is comparable to reported randomized trials. Clinical characteristics seem similar to Western patients. Hence, geographical locations may not be a necessary stratification factor in RCTs. Conversely, lymph node ratio and status of PNI ought to be incorporated.

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Section: Discussionmentioning

confidence: 99%

Resected pancreatic adenocarcinoma: An Asian institution's experience

Chow

Jiang

et al. 2021

Cancer Reports

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“…Most prior research found no or limited evidence of different prognosis according to timing of treatment initiation, regardless of the definitions of early or late initiation. 13 , 15 , 16 , 18 , 20 , 22 – 24 , 29 Few studies found that early initiation (definition ranging from 5 to 10 weeks) was associated with an improved survival, 17 , 21 , 26 – 28 whereas one study found that initiation after approximately 5 weeks conferred a survival benefit. 25 In most studies, the magnitude of the differences was small and of limited clinical relevance; however, the studies were prone to immortal time bias and selection bias.…”

Section: Discussionmentioning

confidence: 99%

Impact on Survival of Early Versus Late Initiation of Adjuvant Chemotherapy After Pancreatic Adenocarcinoma Surgery: A Target Trial Emulation

Kirkegård,

Ladekarl,

Lund

et al. 2023

Ann Surg Oncol

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Background We examined the impact of early (0–4 weeks after discharge) versus late (> 4–8 weeks after discharge) initiation of adjuvant chemotherapy on pancreatic adenocarcinoma survival. Methods We used Danish population-based healthcare registries to emulate a hypothetical target trial using the clone-censor-weight approach. All eligible patients were cloned with one clone assigned to ‘early initiation’ and one clone assigned to ‘late initiation’. Clones were censored when the assigned treatment was no longer compatible with the actual treatment. Informative censoring was addressed using inverse probability of censoring weighting. Results We included 1491 patients in a hypothetical target trial, of whom 32.3% initiated chemotherapy within 0–4 weeks and 38.3% between > 4 and 8 weeks after discharge for pancreatic adenocarcinoma surgery; 206 (13.8%) initiated chemotherapy after > 8 weeks, and 232 (15.6%) did not initiate chemotherapy. Median overall survival was 30.4 and 29.9 months in late and early initiators, respectively. The absolute differences in OS, comparing late with early initiators, were 3.2% (95% confidence interval [CI] − 1.5%, 7.9%), − 0.7% (95% CI − 7.2%, 5.8%), and 3.2% (95% CI − 2.8%, 9.3%) at 1, 3, and 5 years, respectively. Late initiators had a higher increase in albumin levels as well as higher pretreatment albumin values. Conclusions Postponement of adjuvant chemotherapy up to 8 weeks after discharge from pancreatic adenocarcinoma surgery is safe and may allow more patients to receive adjuvant therapy due to better recovery.

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“…A recent study of 23,494 patients operated on for pancreatic cancer showed that compared to “low volume” hospitals patients in “high-case-volume” hospitals had the highest rates of adjuvant chemotherapy administration after pancreaticoduodenectomy and distal pancreatectomy. Moreover, compared to open surgery for all resection types, laparoscopic surgery was associated with a higher rate of adjuvant chemotherapy use at high and highest-case-volume hospitals and less delay in chemotherapy at high-volume hospitals [ 57 ].…”

Section: New Issuesmentioning

confidence: 99%

Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021

Turpin

Amrani

Bachet

et al. 2020

Cancers

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Adjuvant chemotherapy is currently used in all patients with resected pancreatic cancer who are able to begin treatment within 3 months after surgery. Since the recent publication of the PRODIGE 24 trial results, modified FOLFIRINOX has become the standard-of-care in the non-Asian population with localized pancreatic adenocarcinoma following surgery. Nevertheless, there is still a risk of toxicity, and feasibility may be limited in heavily pre-treated patients. In more frail patients, gemcitabine-based chemotherapy remains a suitable option, for example gemcitabine or 5FU in monotherapy. In Asia, although S1-based chemotherapy is the standard of care it is not readily available outside Asia and data are lacking in non-Asiatic patients. In patients in whom resection is not initially possible, intensified schemes such as FOLFIRINOX or gemcitabine-nabpaclitaxel have been confirmed as options to enhance the response rate and resectability, promoting research in adjuvant therapy. In particular, should oncologists prescribe adjuvant treatment after a long sequence of chemotherapy +/– chemoradiotherapy and surgery? Should oncologists consider the response rate, the R0 resection rate alone, or the initial chemotherapy regimen? And finally, should they take into consideration the duration of the entire sequence, or the presence of limited toxicities of induction treatment? The aim of this review is to summarize adjuvant management of resected pancreatic cancer and to raise current and future concerns, especially the need for biomarkers and the best holistic care for patients.

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Laparoscopic pancreatectomy for cancer in high volume centers is associated with an increased use and fewer delays of adjuvant chemotherapy

Cited by 12 publications

References 17 publications

Resected pancreatic adenocarcinoma: An Asian institution's experience

Resected pancreatic adenocarcinoma: An Asian institution's experience

Impact on Survival of Early Versus Late Initiation of Adjuvant Chemotherapy After Pancreatic Adenocarcinoma Surgery: A Target Trial Emulation

Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021

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