Trends in utilization of neoadjuvant therapy and short-term outcomes in resected pancreatic cancer

Mirkin, Katelin A.; Hollenbeak, Christopher S.; Gusani, Niraj J.; Wong, Joyce Y.

doi:10.1016/j.amjsurg.2016.08.015

Cited by 25 publications

(9 citation statements)

References 42 publications

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“…Therefore, it is plausible that the protective effect of chemotherapy is due to alterations in the pancreatic gland texture, leading to a firmer and fibrotic gland, which contributes to lowering the risk of POPF. While the impact of chemotherapy alone on POPF remains unclear from the current study, there is a sign that neoadjuvant chemotherapy may reduce the risk of POPF over RT alone 0044…”

Section: Discussionmentioning

confidence: 80%

“…While the impact of chemotherapy alone on POPF remains unclear from the current study, there is a sign that neoadjuvant chemotherapy may reduce the risk of POPF over RT alone. 43,44 This study has limitations that are important to address. First, variation in the reported neoadjuvant regimes used limits understanding of the benefits of individual regimes.…”

Section: Discussionmentioning

confidence: 99%

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Impact of neoadjuvant therapy on post‐operative pancreatic fistula: a systematic review and meta‐analysis

Kamarajah

Bundred

Boyle

et al. 2020

ANZ Journal of Surgery

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Introduction: The use of neoadjuvant therapy (NAT) for pancreatic cancer is increasing, although its impact on post-operative pancreatic fistula (POPF) is variably reported. This systematic review and meta-analysis aimed to assess the impact of NAT on POPF. Methods: A systematic literature search until October 2019 identified studies reporting POPF following NAT (radiotherapy, chemotherapy or chemoradiotherapy) versus upfront resection. The primary outcome was overall POPF. Secondary outcomes included grade B/C POPF, delayed gastric emptying (DGE), post-operative pancreatic haemorrhage (PPH) and overall and major complications. Results: The search identified 24 studies: pancreatoduodenectomy (PD), 19 studies (n = 19 416) and distal pancreatectomy (DP), five studies (n = 477). Local staging was reported in 17 studies, with borderline resectable and locally advanced disease comprising 6% (0-100%) and 1% (0-33%) of the population, respectively.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Impact of neoadjuvant therapy on post‐operative pancreatic fistula: a systematic review and meta‐analysis

Kamarajah

Bundred

Boyle

et al. 2020

ANZ Journal of Surgery

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“…PDAC is a challenging disease to manage surgically and positive margin rates may be as high as 25% in surgically resectable patients. These rates are even higher in patients deemed borderline resectable based on preoperative imaging [3,4]. Given the high positive margin rate and associated poorer overall survival outcomes of patients with borderline resectable PDAC, Neoadjuvant Therapy (NAT), consisting of preoperative chemotherapy with or without radiation, is now the standard of care [5,6].…”

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confidence: 99%

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2021

ASSE

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Pancreatic Ductal Adenocarcinoma (PDAC) accounts for the third leading cause of cancer death in the United States and portends a poor prognosis, with over five-year survival rates of about ten percent [1]. The disease has been widely studied in recent years and several portenders of poorer survival outcomes have been identified, including surgical margin status [2]. PDAC is a challenging disease to manage surgically and positive margin rates may be as high as 25% in surgically resectable patients. These rates are even higher in patients deemed borderline resectable based on preoperative imaging [3,4]. Given the high positive margin rate and associated poorer overall survival outcomes of patients with borderline resectable PDAC, Neoadjuvant Therapy (NAT), consisting of preoperative chemotherapy with or without radiation, is now the standard of care [5,6]. Despite high positive margin rates in resectable PDAC patients, however, there are no current recommendations for the use of NAT and practice is widely variable.To address this clinical problem, authors Greco, Langan, et al performed a study comparing margin positivity rates in PDAC patients who did and did not receive NAT, published Surgery Open Science in December 2020 [7]. The National Cancer Database (NCDB), extracting data from 2004-2014, was chosen due to its ability to study surgical margins as well as long term survival outcomes. Clinical T1

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“…In addition, there has been an increasing trend in the utilization of neoadjuvant chemotherapy and radiation regimens among patients with other resectable and locally advanced gastrointestinal cancers, such as esophageal, liver, and pancreatic cancers. [1][2][3] The hiatus between the time of cancer diagnosis and a scheduled operation provides a unique opportunity for patient optimization, both physically and mentally. 4 Patient conditioning in this setting is similar to a runner preparing for a marathon.…”

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confidence: 99%

Contemporary Opportunity for Prehabilitation as Part of an Enhanced Recovery after Surgery Pathway in Colorectal Surgery

Fong

Chang

Lillemoe

et al. 2019

Clinics in Colon and Rectal Surgery

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The implementation of upfront, preoperative habilitation (“prehabilitation”), as opposed to postoperative habilitation (rehabilitation), provides a unique opportunity to optimize surgical outcomes, while ensuring that patients receive necessary conditioning that may otherwise be significantly delayed by postoperative complications. In this review, opportunities to design, implement, monitor, and evaluate a surgical prehabilitation program in colorectal surgery are discussed, and broken down to include emotional, physical, and nutritional aspects of care in the preoperative setting.

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Trends in utilization of neoadjuvant therapy and short-term outcomes in resected pancreatic cancer

Cited by 25 publications

References 42 publications

Impact of neoadjuvant therapy on post‐operative pancreatic fistula: a systematic review and meta‐analysis

Impact of neoadjuvant therapy on post‐operative pancreatic fistula: a systematic review and meta‐analysis

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Contemporary Opportunity for Prehabilitation as Part of an Enhanced Recovery after Surgery Pathway in Colorectal Surgery

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