The treatment sequence may matter in patients undergoing pancreatoduodenectomy for early stage pancreatic cancer in the era of modern chemotherapy

被引：9

作者：

Watson, Michael D. ^{[1
]}

Thompson, Kyle J. ^{[1
]}

Musselwhite, Laura W. ^{[2
]}

Hwang, Jimmy J. ^{[2
]}

Baker, Erin H. ^{[1
]}

Martinie, John B. ^{[1
]}

Vrochides, Dionisios ^{[1
]}

Iannitti, David A. ^{[1
]}

Ocuin, Lee M. ^{[1
]}

机构：

[1] Atrium Hlth, Div Hepatobiliary & Pancreat Surg, Dept Surg, Charlotte, NC 28025 USA

[2] Atrium Hlth, Div Hematol Oncol, Dept Med, Charlotte, NC 28025 USA

来源：

AMERICAN JOURNAL OF SURGERY | 2021年 / 222卷 / 01期

关键词：

Pancreatic adenocarcinoma; Pancreatoduodenectomy; Neoadjuvant therapy; NEOADJUVANT THERAPY; ADJUVANT THERAPY; GEMCITABINE; FOLFIRINOX; MORTALITY; MORBIDITY; RESECTION; SURVIVAL;

D O I：

10.1016/j.amjsurg.2020.10.030

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: The aim of this study was to investigate outcomes associated with neoadjuvant chemotherapy in patients undergoing pancreatoduodenectomy for early stage pancreatic adenocarcinoma in the era of modern chemotherapy. Methods: The National Cancer Database (2010-2016) was queried for patients with clinical stage 0-2 pancreatic adenocarcinoma who underwent pancreatoduodenectomy. Patients who underwent up-front pancreatoduodenectomy were propensity matched to patients who received neoadjuvant chemotherapy. Postoperative outcomes, pathologic outcomes, and overall survival were compared. Results: A total of 2036 patients were in each group. Neoadjuvant chemotherapy was associated with shorter length of stay, lower 30-day readmission rate, and lower 30 and 90-day mortality rates (all p < 0.05). Neoadjuvant chemotherapy was associated with lower rates of positives nodes and positive resection margins (all p < 0.0001). Neoadjuvant chemotherapy was associated with longer survival (26.8 vs. 22.1months, p < 0.0001). Patients who received neoadjuvant chemotherapy followed by surgery and adjuvant therapy had the longest OS, followed by neoadjuvant + surgery, surgery + adjuvant therapy, and surgery alone (29.8 vs. 25.6 vs. 23.9 vs. 13.1 months; p < 0.0001). Conclusions: Neoadjuvant chemotherapy is associated with improved postoperative outcomes, oncologic outcomes, and overall survival in patients with early stage pancreatic adenocarcinoma. Neoadjuvant chemotherapy should be considered in all patients with early stage pancreatic adenocarcinoma. (C) 2020 Elsevier Inc. All rights reserved.

引用

页码：159 / 166

页数：8

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