Journal Article

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

Wang, Huamin, Krishnan, Sunil, Fleming, Jason B., Das, Prajnan, Bhutani, Manoop S., Fogelman, David, Kim, Michael P., Crane, Christopher H., Minsky, Bruce D., Lee, Jeffrey E., Varadhachary, Gauri R., Koay, Eugene J., Tamm, Eric P., Pisters, Peter W. T., Evans, Douglas B., Weston, Brian, Maitra, Anirban, Katz, Matthew H. G., Vauthey, Jean-Nicholas, Ross, William, Aloia, Thomas A., Wolff, Robert A., Shroff, Rachna T., Lee, Jeffrey H., Javle, Milind, Cloyd, Jordan M., Bhosale, Priya, Prakash, Laura, Abbruzzese, James L., Overman, Michael

2017

Overview

Background 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). Methods 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. Results 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). Conclusions 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.

• Publisher: Springer US,Springer Nature B.V
• Subject: 2016 SSAT Plenary Presentation / Adenocarcinoma - surgery / Cancer therapies / Carcinoma, Pancreatic Ductal - drug therapy / Carcinoma, Pancreatic Ductal - radiotherapy / Carcinoma, Pancreatic Ductal - surgery / Chemoradiotherapy / Chemotherapy / Chemotherapy, Adjuvant / Female / Gastroenterology / Humans / Male / Medicine / Medicine & Public Health / Middle Aged / Neoadjuvant Therapy / Neoplasm Recurrence, Local - drug therapy / Neoplasm Recurrence, Local - radiotherapy / Neoplasm Recurrence, Local - surgery / Oncology / Pancreatic cancer / Pancreatic Neoplasms / Pancreaticoduodenectomy / Patients / Preoperative Care / Radiation / Retrospective Studies / Surgery / Surgical outcomes / Tumors