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

被引：115

作者：

Cloyd, Jordan M. ^{[1
]}

Katz, Matthew H. G. ^{[1
]}

Prakash, Laura ^{[1
]}

Varadhachary, Gauri R. ^{[2
]}

Wolff, Robert A. ^{[2
]}

Shroff, Rachna T. ^{[2
]}

Javle, Milind ^{[2
]}

Fogelman, David ^{[2
]}

Overman, Michael ^{[2
]}

Crane, Christopher H. ^{[3
]}

Koay, Eugene J. ^{[3
]}

Das, Prajnan ^{[3
]}

Krishnan, Sunil ^{[3
]}

Minsky, Bruce D. ^{[3
]}

Lee, Jeffrey H. ^{[4
]}

Bhutani, Manoop S. ^{[4
]}

Weston, Brian ^{[4
]}

Ross, William ^{[4
]}

Bhosale, Priya ^{[5
]}

Tamm, Eric P. ^{[5
]}

Wang, Huamin ^{[6
]}

Maitra, Anirban ^{[6
]}

Kim, Michael P. ^{[1
]}

Aloia, Thomas A. ^{[1
]}

Vauthey, Jean-Nicholas ^{[1
]}

Fleming, Jason B. ^{[1
]}

Abbruzzese, James L. ^{[7
]}

Pisters, Peter W. T. ^{[8
]}

Evans, Douglas B. ^{[9
]}

Lee, Jeffrey E. ^{[1
]}

机构：

[1] Univ Texas MD Anderson Canc Ctr, Dept Surg Oncol, 1400 Pressler St,Unit 1484, Houston, TX 77030 USA

[2] Univ Texas MD Anderson Canc Ctr, Dept Med Oncol, Houston, TX 77030 USA

[3] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA

[4] Univ Texas MD Anderson Canc Ctr, Dept Gasteroenterol, Houston, TX 77030 USA

[5] Univ Texas MD Anderson Canc Ctr, Dept Diagnost Imaging, Houston, TX 77030 USA

[6] Univ Texas MD Anderson Canc Ctr, Dept Pathol, Houston, TX 77030 USA

[7] Duke Univ, Dept Med, Div Med Oncol, Durham, NC USA

[8] Univ Hlth Network, Toronto, ON, Canada

[9] Med Coll Wisconsin, Dept Surg, Div Surg Oncol, 8700 W Wisconsin Ave, Milwaukee, WI 53226 USA

来源：

JOURNAL OF GASTROINTESTINAL SURGERY | 2017年 / 21卷 / 01期

关键词：

Pancreatic ductal adenocarcinoma; Neoadjuvant therapy; Pancreatectomy; Pancreatoduodenectomy; GEMCITABINE-BASED CHEMORADIATION; RESECTABLE ADENOCARCINOMA; NEOADJUVANT THERAPY; POSTTHERAPY PANCREATICODUODENECTOMY; MULTIMODALITY THERAPY; RADIATION-THERAPY; CANCER; RESECTION; SURVIVAL; FOLFIRINOX;

D O I：

10.1007/s11605-016-3265-1

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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). 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. 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). 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.

引用

页码：164 / 174

页数：11

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