Published in:
01-01-2006 | Original Article
Effect of Neoadjuvant Chemoradiation on Operative Mortality and Morbidity for Pancreaticoduodenectomy
Authors:
Tsung-Yen Cheng, MD, Ketan Sheth, MD, Rebekah R. White, MD, Tomio Ueno, MD, PhD, Cheng-Fang Hung, MS, Bryan M. Clary, MD, Theodore N. Pappas, MD, Douglas S. Tyler, MD
Published in:
Annals of Surgical Oncology
|
Issue 1/2006
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Abstract
Background
Neoadjuvant chemoradiotherapy (neo-CRT) is being used with increasing frequency for periampullary tumors, but how it alters the complication rate of pancreaticoduodenectomy (PD) is unclear.
Methods
A retrospective analysis was conducted of 79 patients with periampullary malignancies who received 5-fluorouracil–based neo-CRT followed by PD.
Results
There was no difference in mortality between PD after neo-CRT (3.8%) and conventional PD for either malignant (4.5%) or benign (2.2%) disease. Focusing only on patients with malignancy, the neo-CRT group had a significantly lower pancreatic leak rate than the conventional group (10% vs. 43%; P < .001). Intra-abdominal abscesses were less common in the neo-CRT group (8.8% vs. 21%; P = .019), and there was one (1.2%) amylase-rich abscess in neo-CRT group, compared with eight (12%) in the conventional group. In addition, two patients in the conventional group died of leak-associated sepsis, compared with none in the neo-CRT group. Multivariate analysis revealed that neoadjuvant chemoradiation (odds ratio, .15) was the most significant factor associated with a reduced risk of pancreatic leak.
Conclusions
Neo-CRT does not increase the mortality or morbidity of PD. In contrast, neo-CRT was associated with a marked reduction in the incidence of pancreatic leak, as well as leak-associated morbidity and mortality.