Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2006

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

Login to get access

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.
Literature
1.
Breslin TM, Hess KR, Harbison DB, et al. Neoadjuvant chemoradiation for adenocarcinoma of the pancreas: treatment variables and survival duration. Ann Surg Oncol 2001;8:123–32CrossRef
2.
White RR, Hurwitz HI, Morse MA, et al. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol 2001;8:758–65CrossRef
3.
Spitz F, Abruzzese J, Lee J, et al. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997;15:928–37CrossRef
4.
Sohn TA, Yeo CJ, Cameron JL, et al. Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;4:567–79CrossRef
5.
Ishikawa O, Ohhigashi H, Teshima T, et al. Clinical and histopathological appraisal of preoperative irradiation for adenocarcinoma of the pancreatoduodenal region. J Surg Oncol 1989;40:143–51CrossRef
6.
Lowy AM, Lee JE, Pisters PWT, et al. Prospective randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease. Ann Surg 1997;226:632–41CrossRef
7.
Yeo CJ, Cameron JL, Sohn T, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248–57; discussion 257–60CrossRef
8.
Neoptolemos JP, Russell RC, Bramhall S, Theis B. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients. Br J Surg 1997;84:1370–6CrossRef
9.
Balcom JH, Rattner DW, Warshaw AL, Chang Y, Castillo CF. Ten-year experience with 733 pancreatic resections: changing indications, older patients, decreasing length of hospitalization. Arch Surg 2001;136:391–8CrossRef
10.
Chou FF, Sheen-Chen SM, Chen YS, et al. Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer. Eur J Surg 1996;162:477–81PubMed
11.
Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreatico-gastrostomy and pancreatico-jejunostomy after pancreaticoduodenectomy. Ann Surg 1995;222:580–8; discussion 588–92CrossRef
12.
Montorsi M, Zago M, Mosca F, et al. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections—a prospective, controlled, randomized clinical trial. Surgery 1995;117:26–31CrossRef
13.
Friess H, Beger HG, Sulkowski U, et al. Randomized controlled multicentre study of the prevention of complications by octreotide for patients undergoing surgery for chronic pancreatitis. Br J Surg 1995;82:1270–3CrossRef
14.
Yeo CJ, Cameron JL, Lillemoe KD, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000;232:419–29CrossRef
15.
Strasberg SM, Drebin JA, Mokadam NA, et al. Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg 2002;194:746–60CrossRef
16.
Fernandez-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995;130:295–9CrossRef
17.
Howard JM. Pancreatojejunostomy: leakage is a preventable complication of the Whipple resection. J Am Coll Surg 1997;184:454–7PubMed
18.
Sato N, Yamaguchi K, Chijiiwa K, et al. Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 1998;133:1094–8CrossRef
19.
Rios G, Conrad A, Cole D, et al. Trends in indications and outcomes in the Whipple procedure over a 40-year period. Am Surg 1999;65:889–93PubMed
20.
Bottger TC, Junginger T. Factors influencing morbidity and mortality after pancreaticoduodenectomy: critical analysis of 221 resections. World J Surg 1999;23:164–71CrossRef
21.
Brooks AD, Marcus SG, Gradek C, et al. Decreasing length of stay after pancreatoduodenectomy. Arch Surg 2000;135:823–30CrossRef
22.
Grobmyer SR, Rivadeneira DE, Goodman CA, et al. Pancreatic anastomotic failure after pancreaticoduodenectomy. Am J Surg 2000;180:117–20CrossRef
23.
Buchler MW, Friess H, Wagner M, et al. Pancreatic fistula after pancreatic head resection. Br J Surg 2000;87:883–9CrossRef
24.
Gouma DJ, van Geenen RC, van Gulik TM, et al. Rate of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000;232:786–95CrossRef
25.
Ohwada S, Ogawa T, Kawate S, et al. Results of duct-to-mucosa pancreaticojejunostomy for pancreaticoduodenectomy Billroth I type reconstruction in 100 consecutive patients. J Am Coll Surg 2001;193:29–35CrossRef
26.
Cullen JJ, Sarr MG, Ilstrup DM. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg 1994; 168:295–8CrossRef
27.
Hashimoto N, Yasuda C, Ohyanagi H. Pancreatic fistula after pancreatic head resection; incidence, significance and management. Hepatogastroenterology 2003; 50:1658–60PubMed
28.
Hoshal VL Jr, Benedict MB, David LR, Kulick J. Personal experience with the Whipple operation: outcomes and lessons learned. Am Surg 2004; 70:121–5; discussion 126PubMed
29.
Reissman P, Perry Y, Cuenca A, et al. Pancreaticojejunostomy versus controlled pancreaticocutaneous fistula in pancreaticoduodenectomy for periampullary carcinoma. Am J Surg 1995; 169:585–8
30.
Suzuki Y, Fujino Y, Tanioka Y, et al. Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg 1999; 86: 608–11CrossRef
31.
Sutton CD, Garcea G, White SA, et al. Isolated Roux-loop pancreaticojejunostomy: a series of 61 patients with zero postoperative pancreaticoenteric leaks. J Gastrointest Surg 2004; 8:701–5CrossRef
32.
Duffy JP, Hines OJ, Liu JH, et al. Improved survival for adenocarcinoma of the ampulla of Vater, fifty-five consecutive resections. Arch Surg 2003;138:941–50CrossRef
33.
Talamini MA, Moesinger RC, Pitt HA, et al. Adenocarcinoma of the ampulla of Vater: a 28-year experience. Ann Surg 1997;225:590–600CrossRef
34.
Enker WE, Merchant N, Cohen AM, et al. Safety and efficacy of low anterior resection for rectal cancer—681 consecutive cases from a specialty service. Ann Surg 1999;230:544–54CrossRef
Metadata
Title
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
Publication date
01-01-2006
Publisher
Springer New York
Published in
Annals of Surgical Oncology / Issue 1/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.02.003

Other articles of this Issue 1/2006

Annals of Surgical Oncology 1/2006 Go to the issue

Original Article

Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node

Original Article

Treatment with 5-Fluorouracil/Folinic Acid, Oxaliplatin, and Irinotecan Enables Surgical Resection of Metastases in Patients With Initially Unresectable Metastatic Colorectal Cancer

Editorial

Another Role for Ultrasonography in the Management of Breast Cancer

Original Article

Method of Presenting Oncology Treatment Outcomes Influences Patient Treatment Decision-Making in Metastatic Colorectal Cancer

Editorial

Does Prior Adjuvant Chemoradiotherapy Lead to a Safer Pancreatoduodenectomy?

Original Article

Prognostic Effect of Re-Excision in Adult Soft Tissue Sarcoma of the Extremity