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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 1/2017

01-01-2017 | 2016 SSAT Plenary Presentation

Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience

Authors: Jordan M. Cloyd, Matthew H. G. Katz, Laura Prakash, Gauri R. Varadhachary, Robert A. Wolff, Rachna T. Shroff, Milind Javle, David Fogelman, Michael Overman, Christopher H. Crane, Eugene J. Koay, Prajnan Das, Sunil Krishnan, Bruce D. Minsky, Jeffrey H. Lee, Manoop S. Bhutani, Brian Weston, William Ross, Priya Bhosale, Eric P. Tamm, Huamin Wang, Anirban Maitra, Michael P. Kim, Thomas A. Aloia, Jean-Nicholas Vauthey, Jason B. Fleming, James L. Abbruzzese, Peter W. T. Pisters, Douglas B. Evans, Jeffrey E. Lee

Published in: Journal of Gastrointestinal Surgery | Issue 1/2017

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Abstract

Background

The purpose of this study was to evaluate a single-institution experience with delivery of preoperative therapy to patients with pancreatic ductal adenocarcinoma (PDAC) prior to pancreatoduodenectomy (PD).

Methods

Consecutive patients (622) with PDAC who underwent PD following chemotherapy and/or chemoradiation between 1990 and 2014 were retrospectively reviewed. Preoperative treatment regimens, clinicopathologic characteristics, operative details, and long-term outcomes in four successive time periods (1990–1999, 2000–2004, 2005–2009, 2010–2014) were evaluated and compared.

Results

The average number of patients per year who underwent PD following preoperative therapy as well as the proportion of operations performed for borderline resectable and locally advanced (BR/LA) tumors increased over time. The use of induction systemic chemotherapy, as well as postoperative adjuvant chemotherapy, also increased over time. Throughout the study period, the mean EBL decreased while R0 margin rates and vascular resection rates increased overall. Despite the increase in BR/LA resections, locoregional recurrence (LR) rates remained similar over time, and overall survival (OS) improved significantly (median 24.1, 28.1, 37.3, 43.4 months, respectively, p < 0.0001).

Conclusions

Despite increases in case complexity, relatively low rates of LR have been maintained while significant improvements in OS have been observed. Further improvements in patient outcomes will likely require disruptive advances in systemic therapy.
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Metadata
Title
Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience
Authors
Jordan M. Cloyd
Matthew H. G. Katz
Laura Prakash
Gauri R. Varadhachary
Robert A. Wolff
Rachna T. Shroff
Milind Javle
David Fogelman
Michael Overman
Christopher H. Crane
Eugene J. Koay
Prajnan Das
Sunil Krishnan
Bruce D. Minsky
Jeffrey H. Lee
Manoop S. Bhutani
Brian Weston
William Ross
Priya Bhosale
Eric P. Tamm
Huamin Wang
Anirban Maitra
Michael P. Kim
Thomas A. Aloia
Jean-Nicholas Vauthey
Jason B. Fleming
James L. Abbruzzese
Peter W. T. Pisters
Douglas B. Evans
Jeffrey E. Lee
Publication date
01-01-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 1/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3265-1

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