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 3/2018

01-03-2018 | Pancreatic Tumors

Neoadjuvant Therapy Versus Upfront Resection for Pancreatic Cancer: The Actual Spectrum and Clinical Burden of Postoperative Complications

Authors: Giovanni Marchegiani, MD, Stefano Andrianello, MD, Chiara Nessi, MD, Marta Sandini, MD, Laura Maggino, Giuseppe Malleo, MD, PhD, Salvatore Paiella, MD, Enrico Polati, MD, Claudio Bassi, MD, PhD, FACS, FEBS, Roberto Salvia, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2018

Login to get access

Abstract

Background

Neoadjuvant therapy (NAT) is used for borderline-resectable or locally advanced pancreatic cancer (PDAC) and exhibits promising results in terms of pathological outcomes. However, little is known about its effect on surgical complications.

Methods

We analyzed 445 pancreatic resections for PDAC from 2014 to 2016 at The Pancreas Institute, Verona University Hospital. The Modified Accordion Severity Grading System and average complication burden (ACB) were used to compare patients treated with NAT with patients who underwent upfront surgery (UFS).

Results

Of 305 pancreaticoduodenectomies (PD), patients treated with NAT (n = 99) had less pancreatic fistula (POPF, 9.1% vs. 15.6%, p = 0.05) without grade C cases, but grade B ACB was increased (0.28 for NAT vs. 0.24 for UFS, p = 0.05). The postpancreatectomy hemorrhage (PPH) rate was lower in the NAT group (9.1% vs. 14.6%, p = 0.02), but ACB grades B (0.37 for NAT vs. 0.26 for UFS, p = 0.03) and C (0.43 for NAT vs. 0.29 for UFS, p = 0.05) were increased. Delayed gastric emptying (DGE) was increased in NAT cases (15.2% vs. 8.3%, p = 0.04), with higher grade C ACB (0.43 for NAT vs. 0.29 for UFS, p = 0.03). Of 94 distal pancreatectomies (DP), NAT patients (n = 26) developed more grade C POPF (11.5% vs. 1.5%, p = 0.04) and DGE (11.5% vs. 2.9%, p = 0.01) without differences in ACB.

Conclusions

Patients undergoing PD for PDAC after NAT exhibited reduced incidence of POPF and PPH but increased incidence of DGE compared with patients treated with UFS. Among patients developing postoperative complications after PD, those receiving NAT were associated with increased clinical burden.
Appendix
Available only for authorised users
Literature
1.
Pedrazzoli S, Beger HG, Obertop H et al. A surgical and pathological based classification of resective treatment of pancreatic cancer. Summary of an International Workshop on surgical procedures in pancreatic cancer. Dig Surg. 1999;16(4):337–45.CrossRefPubMed
2.
3.
McMillan MT, Allegrini V, Asbun HJ et al. Incorporation of procedure-specific risk into the ACS-NSQIP surgical risk calculator improves the prediction of morbidity and mortality after pancreatoduodenectomy. Ann Surg. 2016:265(5):978–86.CrossRef
4.
McMillan MT, Soi S, Asbun HJ, et al. Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation. Ann Surg. 2015;264(2):344–52.CrossRef
5.
McMillan MT, Vollmer CM, Asbun HJ, et al. The characterization and prediction of ISGPF grade C fistulas following pancreatoduodenectomy. J Gastrointest Surg. 2015;20(2):262–76.CrossRefPubMed
6.
Valero V, Grimm JC, Kilic A, et al. A novel risk scoring system reliably predicts readmission after pancreatectomy. J Am Coll Surg. 2015;220(4):701–13.CrossRefPubMedPubMedCentral
7.
Vollmer CM, Sanchez N, Gondek S, et al. A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg. 2012;16(1):89–102; (discussion102–3).
8.
9.
Lewis R, Drebin JA, Callery MP, et al. A contemporary analysis of survival for resected pancreatic ductal adenocarcinoma. HPB (Oxford). 2013;15(1):49–60.CrossRefPubMed
10.
Tol JA, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2014;156(3):591–600.CrossRefPubMed
11.
Bockhorn M, Uzunoglu FG, Adham M, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2014;155(6): 977–88.CrossRefPubMed
12.
Shubert CR, Bergquist JR, Groeschl RT, et al. Overall survival is increased among stage III pancreatic adenocarcinoma patients receiving neoadjuvant chemotherapy compared to surgery first and adjuvant chemotherapy: an intention to treat analysis of the National Cancer Database. Surgery. 2016;160(4):1080–96.CrossRefPubMed
13.
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161(3):584–91.CrossRefPubMed
14.
Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.CrossRefPubMed
15.
Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.CrossRefPubMed
16.
Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015;261(1):12–7.CrossRefPubMedPubMedCentral
17.
Berger AC, Garcia M, Hoffman JP, et al. Postresection CA 19-9 predicts overall survival in patients with pancreatic cancer treated with adjuvant chemoradiation: a prospective validation by RTOG 9704. J Clin Oncol. 2008;26(36):5918–22.CrossRefPubMedPubMedCentral
18.
Besselink MG, van Rijssen LB, Bassi C, et al. Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery. 2016;161(2):365–72.CrossRefPubMed
19.
Vollmer CM, Lewis RS, Hall BL, et al. Establishing a quantitative benchmark for morbidity in pancreatoduodenectomy using ACS-NSQIP, the Accordion Severity Grading System, and the Postoperative Morbidity Index. Ann Surg. 2015;261(3):527–36.CrossRefPubMed
20.
Porembka MR, Hall BL, Hirbe M, et al. Quantitative weighting of postoperative complications based on the accordion severity grading system: demonstration of potential impact using the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210(3):286–98.CrossRefPubMed
21.
Strasberg SM, Hall BL. Postoperative morbidity index: a quantitative measure of severity of postoperative complications. J Am Coll Surg. 2011;213(5):616–26.CrossRefPubMed
22.
McMillan MT, Christein JD, Callery MP, et al. Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy. Surgery. 2016;159(4):1013–22.CrossRefPubMed
23.
Callery MP, Pratt WB, Kent TS. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14.CrossRefPubMed
24.
Shin HW, Kim JK, Park JS, et al. Can we predict postoperative pancreatic leakage after pancreaticoduodenectomy using preoperative fecal elastase-1 level? J Clin Lab Anal. 2013;27(5):379–83.CrossRefPubMed
25.
Noorani A, Rangelova E, Del Chiaro M, et al. Delayed gastric emptying after pancreatic surgery: analysis of factors determinant for the short-term outcome. Front Surg. 2016;3(8):945–6.
26.
Eisenberg JD, Rosato EL, Lavu H, et al. Delayed gastric emptying after pancreaticoduodenectomy: an analysis of risk factors and cost. J Gastrointest Surg. 2015;19(9):1572–80.CrossRefPubMed
27.
Malleo G, Crippa S, Butturini G, et al. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB. 2010;12(9):610–8.CrossRefPubMedPubMedCentral
28.
Park SB, Krishnan AV, Lin CS-Y, et al. Mechanisms underlying chemotherapy-induced neurotoxicity and the potential for neuroprotective strategies. Curr Med Chem. 2008;15(29):3081–94.CrossRefPubMed
29.
Ewertz M, Qvortrup C, Eckhoff L. Chemotherapy-induced peripheral neuropathy in patients treated with taxanes and platinum derivatives. Acta Oncol. 2015;54(5):587–91.CrossRefPubMed
30.
De Iuliis F, Taglieri L, Salerno G, et al. Taxane induced neuropathy in patients affected by breast cancer: literature review. Crit Rev Oncol Hematol. 2015;96(1):34–45.CrossRefPubMed
31.
DeOliveira ML, Winter JM, Schäfer M, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244(6):931–7, (discussion 937–9).
32.
Kumagai K, Rouvelas I, Tsai JA, et al. Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers. Br J Surg. 2014;101(4):321–38.CrossRefPubMed
33.
Wilke TJ, Bhirud AR, Lin C. A review of the impact of preoperative chemoradiotherapy on outcome and postoperative complications in esophageal cancer patients. Am J Clin Oncol. 2015;38(4):415–21.CrossRefPubMed
34.
Nussbaum DP, Speicher PJ, Gulack BC, et al. The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas. Surg Oncol. 2014;23(3):155–60.CrossRefPubMedPubMedCentral
Metadata
Title
Neoadjuvant Therapy Versus Upfront Resection for Pancreatic Cancer: The Actual Spectrum and Clinical Burden of Postoperative Complications
Authors
Giovanni Marchegiani, MD
Stefano Andrianello, MD
Chiara Nessi, MD
Marta Sandini, MD
Laura Maggino
Giuseppe Malleo, MD, PhD
Salvatore Paiella, MD
Enrico Polati, MD
Claudio Bassi, MD, PhD, FACS, FEBS
Roberto Salvia, MD, PhD
Publication date
01-03-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6281-9

Other articles of this Issue 3/2018

Annals of Surgical Oncology 3/2018 Go to the issue

Gynecologic Oncology

Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer

Bone and Soft Tissue Sarcomas

Long-Term Follow-Up of Desmoid Fibromatosis Treated with PF-03084014, an Oral Gamma Secretase Inhibitor

Bone and Soft Tissue Sarcomas

External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis

Gastrointestinal Oncology

Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer

Health Services Research and Global Oncology

Global Variations in the Level of Cancer-Related Research Activity and Correlation to Cancer-Specific Mortality: Proposal for a Global Curriculum

Gastrointestinal Oncology

PCI is Not Predictive of Survival After Complete CRS/HIPEC in Peritoneal Dissemination from High-Grade Appendiceal Primaries