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17-12-2023 | Pancreatic Cancer | Pancreatic Tumors

Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy

Authors: Thomas F. Stoop, MD, Leonard W. F. Seelen, MD, Freek R. van ’t Land, MD, Kishan R. D. Lutchman, BSc, Susan van Dieren, MSc, PhD, Daan J. Lips, MD, PhD, Erwin van der Harst, MD, PhD, Geert Kazemier, MD, PhD, Gijs A. Patijn, MD, PhD, Ignace H. de Hingh, MD, PhD, Jan H. Wijsman, MD, PhD, Joris I. Erdmann, MD, PhD, Sebastiaan Festen, MD, PhD, Bas Groot Koerkamp, MD, PhD, J. Sven D. Mieog, MD, PhD, Marcel den Dulk, MD, PhD, Martijn W. J. Stommel, MD, PhD, Olivier R. Busch, MD, PhD, Roeland F. de Wilde, MD, PhD, Vincent E. de Meijer, MD, PhD, Wouter te Riele, MD, PhD, I. Quintus Molenaar, MD, PhD, Casper H. J. van Eijck, MD, PhD, Hjalmar C. van Santvoort, MD, PhD, Marc G. Besselink, MD, MSc, PhD, for the Dutch Pancreatic Cancer Group

Published in: Annals of Surgical Oncology | Issue 4/2024

Abstract

Background

Several international high-volume centers have reported good outcomes after resection of locally advanced pancreatic cancer (LAPC) following chemo(radio)therapy, but it is unclear how this translates to nationwide clinical practice and outcome. This study aims to assess the nationwide use and outcome of resection of LAPC following induction chemo(radio)therapy.

Patients and Methods

A multicenter retrospective study including all patients who underwent resection for LAPC following chemo(radio)therapy in all 16 Dutch pancreatic surgery centers (2014–2020), registered in the mandatory Dutch Pancreatic Cancer Audit. LAPC is defined as arterial involvement > 90° and/or portomesenteric venous > 270° involvement or occlusion.

Results

Overall, 142 patients underwent resection for LAPC, of whom 34.5% met the 2022 National Comprehensive Cancer Network criteria. FOLFIRINOX was the most commonly (93.7%) used chemotherapy [median 5 cycles (IQR 4–8)]. Venous and arterial resections were performed in 51.4% and 14.8% of patients. Most resections (73.9%) were performed in high-volume centers (i.e., ≥ 60 pancreatoduodenectomies/year). Overall median volume of LAPC resections/center was 4 (IQR 1–7). In-hospital/30-day major morbidity was 37.3% and 90-day mortality was 4.2%. Median OS from diagnosis was 26 months (95% CI 23–28) and 5-year OS 18%. Surgery in high-volume centers [HR = 0.542 (95% CI 0.318–0.923)], ypN1-2 [HR = 3.141 (95% CI 1.886–5.234)], and major morbidity [HR = 2.031 (95% CI 1.272–3.244)] were associated with OS.

Conclusions

Resection of LAPC following chemo(radio)therapy is infrequently performed in the Netherlands, albeit with acceptable morbidity, mortality, and OS. Given these findings, a structured nationwide approach involving international centers of excellence would be needed to improve selection of patients with LAPC for surgical resection following induction therapy.

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Title: Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy
Authors: Thomas F. Stoop, MD
Leonard W. F. Seelen, MD
Freek R. van ’t Land, MD
Kishan R. D. Lutchman, BSc
Susan van Dieren, MSc, PhD
Daan J. Lips, MD, PhD
Erwin van der Harst, MD, PhD
Geert Kazemier, MD, PhD
Gijs A. Patijn, MD, PhD
Ignace H. de Hingh, MD, PhD
Jan H. Wijsman, MD, PhD
Joris I. Erdmann, MD, PhD
Sebastiaan Festen, MD, PhD
Bas Groot Koerkamp, MD, PhD
J. Sven D. Mieog, MD, PhD
Marcel den Dulk, MD, PhD
Martijn W. J. Stommel, MD, PhD
Olivier R. Busch, MD, PhD
Roeland F. de Wilde, MD, PhD
Vincent E. de Meijer, MD, PhD
Wouter te Riele, MD, PhD
I. Quintus Molenaar, MD, PhD
Casper H. J. van Eijck, MD, PhD
Hjalmar C. van Santvoort, MD, PhD
Marc G. Besselink, MD, MSc, PhD
for the Dutch Pancreatic Cancer Group
Publication date: 17-12-2023
Publisher: Springer International Publishing
Keywords: Pancreatic Cancer
Pancreatic Cancer
Cytostatic Therapy
Pancreatoduodenostomy
Pancreatoduodenostomy
Pancreatectomy
Published in: Annals of Surgical Oncology / Issue 4/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-14650-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy

Abstract

Background

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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