The treatment sequence may matter in patients undergoing pancreatoduodenectomy for early stage pancreatic cancer in the era of modern chemotherapy.
Publication/Presentation Date
7-1-2021
Abstract
BACKGROUND: The aim of this study was to investigate outcomes associated with neoadjuvant chemotherapy in patients undergoing pancreatoduodenectomy for early stage pancreatic adenocarcinoma in the era of modern chemotherapy.
METHODS: The National Cancer Database (2010-2016) was queried for patients with clinical stage 0-2 pancreatic adenocarcinoma who underwent pancreatoduodenectomy. Patients who underwent up-front pancreatoduodenectomy were propensity matched to patients who received neoadjuvant chemotherapy. Postoperative outcomes, pathologic outcomes, and overall survival were compared.
RESULTS: A total of 2036 patients were in each group. Neoadjuvant chemotherapy was associated with shorter length of stay, lower 30-day readmission rate, and lower 30 and 90-day mortality rates (all p < 0.05). Neoadjuvant chemotherapy was associated with lower rates of positives nodes and positive resection margins (all p < 0.0001). Neoadjuvant chemotherapy was associated with longer survival (26.8 vs. 22.1months, p < 0.0001). Patients who received neoadjuvant chemotherapy followed by surgery and adjuvant therapy had the longest OS, followed by neoadjuvant + surgery, surgery + adjuvant therapy, and surgery alone (29.8 vs. 25.6 vs. 23.9 vs. 13.1 months; p < 0.0001).
CONCLUSIONS: Neoadjuvant chemotherapy is associated with improved postoperative outcomes, oncologic outcomes, and overall survival in patients with early stage pancreatic adenocarcinoma. Neoadjuvant chemotherapy should be considered in all patients with early stage pancreatic adenocarcinoma.
Volume
222
Issue
1
First Page
159
Last Page
166
ISSN
1879-1883
Published In/Presented At
Watson, M. D., Thompson, K. J., Musselwhite, L. W., Hwang, J. J., Baker, E. H., Martinie, J. B., Vrochides, D., Iannitti, D. A., & Ocuin, L. M. (2021). The treatment sequence may matter in patients undergoing pancreatoduodenectomy for early stage pancreatic cancer in the era of modern chemotherapy. American journal of surgery, 222(1), 159–166. https://doi.org/10.1016/j.amjsurg.2020.10.030
Disciplines
Medicine and Health Sciences
PubMedID
33121658
Department(s)
Department of Surgery, Lehigh Valley Topper Cancer Institute
Document Type
Article
