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Does the Use of Neoadjuvant Therapy for Pancreatic Adenocarcinoma Increase Postoperative Morbidity and Mortality Rates

Published on Jan 1, 2015in Journal of Gastrointestinal Surgery2.686
· DOI :10.1007/s11605-014-2620-3
Amanda B. Cooper13
Estimated H-index: 13
(Penn State Milton S. Hershey Medical Center),
Abhishek D. Parmar12
Estimated H-index: 12
(UTMB: University of Texas Medical Branch)
+ 4 AuthorsHenry A. Pitt20
Estimated H-index: 20
(TU: Temple University)
Abstract
Introduction The impact of neoadjuvant therapy on postpancreatectomy complications is inadequately described.
  • References (25)
  • Citations (45)
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References25
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#1Abhishek D. Parmar (UTMB: University of Texas Medical Branch)H-Index: 12
#2Gabriela M. Vargas (UTMB: University of Texas Medical Branch)H-Index: 7
Last. Taylor S. Riall (UTMB: University of Texas Medical Branch)H-Index: 35
view all 5 authors...
Introduction Multimodality therapy with chemotherapy and operative resection is recommended for patients with locoregional pancreatic cancer but is not received by many patients. Objective To evaluate patterns in the use and timing of chemotherapy and resection and factors associated with receipt of multimodality therapy in older patients with locoregional pancreatic cancer. Methods We used Surveillance, Epidemiology, and End Results–linked Medicare data (1992–2007) to identify patients with loc...
23 CitationsSource
#1Abhishek D. Parmar (UTMB: University of Texas Medical Branch)H-Index: 12
#2Gabriela M. Vargas (UTMB: University of Texas Medical Branch)H-Index: 7
Last. Taylor S. Riall (UTMB: University of Texas Medical Branch)H-Index: 35
view all 5 authors...
1 CitationsSource
#1Abhishek D. Parmar (UTMB: University of Texas Medical Branch)H-Index: 12
#2Kristin M. Sheffield (UTMB: University of Texas Medical Branch)H-Index: 22
Last. Taylor S. Riall (UTMB: University of Texas Medical Branch)H-Index: 35
view all 7 authors...
Abstract Background The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known. Methods From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons‐National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the fact...
54 CitationsSource
#1Raphael L. C. Araujo (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 12
#2Sébastien Gaujoux (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 31
Last. Peter J. Allen (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 68
view all 11 authors...
Abstract Background Neoadjuvant chemoradiation therapy for locally unresectable and borderline resectable pancreatic cancer may allow some patients to a undergo a resection, but whether or not this increases post‐operative morbidity remains unclear. Methods The post‐operative morbidity of 29 patients with initially locally unresectable/borderline pancreatic cancer who underwent a resection were compared with 29 patients with initially resectable tumours matched for age, gender, the presence of c...
22 CitationsSource
#1Keith RobertsH-Index: 18
#2Rowland StoreyH-Index: 1
Last. Gareth Morris-StiffH-Index: 30
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Abstract Background/objectives Understanding a patient's risk of pancreatic fistula (PF) prior to pancreatoduodenectomy (PD) would permit an individualised approach to patient selection, consent and, potentially, treatment. Various intra and post operative factors including pancreatic duct width and steatosis are associated with PF. We sought to identify whether information available in the pre-operative phase can predict PF. Methods Associations between patient characteristics, pre-operative bl...
28 CitationsSource
#1Nicolò Pecorelli (UniSR: Vita-Salute San Raffaele University)H-Index: 14
#2Marco Braga (UniSR: Vita-Salute San Raffaele University)H-Index: 47
Last. Valerio Di Carlo (UniSR: Vita-Salute San Raffaele University)H-Index: 24
view all 10 authors...
Background Preoperative chemotherapy (PCHT) has recently been proposed also in patients with resectable pancreatic adenocarcinoma. Few data are currently available on the impact of PCHT on short-term postoperative outcome after pancreatic resection. The objective of this study is to assess the impact of PCHT on pancreatic structure and short-term outcome after surgical resection.
9 CitationsSource
#1Cetin (Yeshiva University)H-Index: 1
#2Bilal PiperdiH-Index: 17
Last. Wang Y (UMMS: University of Massachusetts Medical School)H-Index: 1
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BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer deaths in the United States. A minority of patients present with localized disease and surgical resection still offers patients the only hope for long-term survival. Locally advanced pancreatic cancer is defined as surgically unresectable, but has no evidence of distant metastases. The purpose of this study is to evaluate the efficacy and safety of cetuximab in combination with gemcitabine and 5-FU along with radiation therapy i...
4 Citations
#1Hyuk-JoonLee (UOU: University of Ulsan)H-Index: 188
#2Song Cheol Kim (UOU: University of Ulsan)H-Index: 22
Last. Duck Jong Han (UOU: University of Ulsan)H-Index: 17
view all 13 authors...
Background To determine the safety and efficacy of neoadjuvant gemcitabine/capecitabine followed by surgery for the treatment of locally advanced pancreatic adenocarcinoma (LAPC). Methods Patients with histologically confirmed LAPC were given 3–6 cycles of fixed-dose rate gemcitabine/capecitabine every 3 weeks. At the end of chemotherapy, patients were restaged and underwent surgery if the disease was not classified as unresectable. Our institutional criteria were used to classify respectability...
74 CitationsSource
#1Yuan Fang (Sichuan University)H-Index: 5
#2Kurinchi Selvan Gurusamy (UCL: University College London)H-Index: 45
Last. Chaohua Wang (Sichuan University)H-Index: 3
view all 7 authors...
Background Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy as to whether temporary relief of biliary obstruction prior to major definitive surgery (pre-operative biliary drainage) is of any benefit to the patient.
114 CitationsSource
#1Margaret A. Tempero (UCSF: University of California, San Francisco)H-Index: 44
#2J. Pablo Arnoletti (UAB: University of Alabama at Birmingham)H-Index: 16
Last. Dorothy A. Shead (National Comprehensive Cancer Network)H-Index: 25
view all 31 authors...
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pancreatic Adenocarcinoma discuss the workup and man- agement of tumors of the exocrine pancreas. These NCCN Guidelines Insights provide a summary and explanation of major changes to the 2012 NCCN Guidelines for Pancreatic Adenocarcinoma. The panel made 3 significant updates to the guidelines: 1) more detail was added regarding multiphase CT techniques for diagnosis and staging of pancreatic cancer, and pancreas protocol MRI...
210 CitationsSource
Cited By45
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#1Sivesh K. Kamarajah (Newcastle University)H-Index: 6
#2James Bundred (University of Birmingham)H-Index: 1
Last. Benjamin Loveday (University of Auckland)H-Index: 11
view all 6 authors...
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 in...
Source
BACKGROUND: Postoperative pancreatic fistula (POPF) is the most serious complication following pancreaticoduodenectomy (PD). Identifying patients at high or low risk of developing POPF is important in perioperative management. This study aimed to determine a predictive risk score for POPF following PD, and compare it to preexisting scores. METHODS: All patients who underwent open PD from 2012 to 2017 in two high-volume centers were included. The training dataset was used for the development of t...
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#1Alessandro Paniccia (University of Pittsburgh)H-Index: 1
#1Alessandro Paniccia (University of Pittsburgh)H-Index: 10
Last. Herbert J. Zeh (UTSW: University of Texas Southwestern Medical Center)H-Index: 61
view all 11 authors...
INTRODUCTION: Neoadjuvant therapy (NT) is a growing strategy in localized head pancreatic adenocarcinoma (PDC). However, a significant portion of NT patients do not reach resection due to disease progression or performance status decline. We sought to identify predictors of disease progression or performance status decline during NT. METHODS: Retrospective cohort analysis of consecutive patients with localized head-PDC who received NT at a tertiary referral center between 2005 and 2017. Univaria...
2 CitationsSource
#1Michael Xiang (Stanford University)H-Index: 11
#2Gregory M. Heestand (Stanford University)H-Index: 6
Last. Erqi L. Pollom (Stanford University)H-Index: 10
view all 4 authors...
Abstract Background and purpose The optimal neoadjuvant approach in patients with resectable pancreas cancer is unclear. We investigated outcomes after preoperative chemotherapy alone, chemotherapy with conventionally-fractionated radiation (CFRT), or chemotherapy with stereotactic body radiotherapy (SBRT). Materials and methods The NCDB was queried for patients with resectable pancreatic adenocarcinoma (pretreatment stage T1-3, N0-1, M0) who received preoperative, multiagent chemotherapy and de...
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#1Sergio Alfieri (UCSC: Catholic University of the Sacred Heart)H-Index: 22
#2Ugo BoggiH-Index: 37
Last. Giuseppe Quero (UCSC: Catholic University of the Sacred Heart)H-Index: 5
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Introduction. Despite the widespread use of the robotic technology, only a few studies with small sample sizes report its application to pancreatic diseases treatment. Our aim is to present the res...
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#1Jinzhi XuH-Index: 3
#2Wen-Quan WangH-Index: 11
Last. Liang LiuH-Index: 19
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BACKGROUND: Awareness of the benefits of neoadjuvant therapy is increasing, but its use as an initial therapeutic option for patients with resectable pancreatic cancer remains controversial, especially for those patients without high-risk prognostic features. Even for patients with high-risk features who are candidates to receive neoadjuvant therapy, no standard regimen exists. METHODS: In this review, we examined available data on neoadjuvant therapy in patients with resectable pancreatic cance...
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#1An Thuy Ngo-Huang (University of Texas MD Anderson Cancer Center)H-Index: 3
#2Nathan H. Parker (University of Texas MD Anderson Cancer Center)H-Index: 8
Last. Matthew Harold Katz (University of Texas MD Anderson Cancer Center)H-Index: 41
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Purpose: To investigate relationships among physical activity, changes in physical function, and health-related quality of life (HRQOL) among patients with pancreatic adenocarcinoma enrolled in a h...
2 CitationsSource
#1Hassan Aziz (Keck Hospital of USC)H-Index: 1
#1Hassan AzizH-Index: 18
view all 4 authors...
The use of neoadjuvant chemoradiation therapy in patients with pancreatic adenocarcinoma is emerging as an acceptable therapy option. The effects of neoadjuvant therapy on 30 days' outcomes in patients with pancreatic cancer are not well defined in the literature. NSQIP (2009-2012) was used. Only patients with a diagnosis of pancreatic cancer and those who underwent a Whipple were included in the analysis. Patient who underwent neoadjuvant chemoradiation therapy were compared with those who did ...
1 CitationsSource
#1Aslam Syed (Allegheny Health Network)H-Index: 1
#2Neil M. Carleton (Allegheny Health Network)
Last. Shyam Thakkar (Allegheny Health Network)H-Index: 6
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Purpose Despite advances in various treatment modalities, surgical resection for pancreatic ductal adenocarcinoma (PDA) remains the only curative treatment. Data remains limited regarding survival rates for resectable PDA when managed by a multidisciplinary pancreas conference (MDPC). The aim of this study is to assess survival rates, identify significant predictors of mortality, and assess the benefits of adjuvant chemotherapy for resectable PDA following presentation at a MDPC.
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#1Fuminori Sonohara (Nagoya University)H-Index: 5
#2Suguru Yamada (Nagoya University)H-Index: 31
Last. Yasuhiro Kodera (Nagoya University)H-Index: 54
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Abstract Introduction In this study, we assessed the prognostic efficacy and feasibility of combined arterial resection (AR) for locally advanced pancreatic cancer (LAPC), and aimed to identify significant prognostic factors for patients who underwent combined AR. Methods Between 1981 and 2018, 733 consecutive patients who underwent pancreatic surgery for PC were identified. The 730 cases with detailed information were enrolled in the analysis. Results Among 730 resected PC patients, 44 (6%) und...
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