Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer
- Matthew H. G. Katz,
- Huamin Wang,
- Aparna Balachandran,
- Priya Bhosale,
- Christopher H. Crane,
- Xuemei Wang,
- Peter W. T. Pisters,
- Jeffrey E. Lee,
- Jean-Nicolas Vauthey,
- Eddie K. Abdalla,
- Robert Wolff,
- James Abbruzzese,
- Gauri Varadhachary,
- Xavier Chopin-Laly,
- Chusilp Charnsangavej,
- Jason B. Fleming
- … show all 16 hide
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To determine the influence of neoadjuvant chemoradiation and standardized dissection of the superior mesenteric artery upon the oncologic outcome of patients with localized pancreatic adenocarcinoma.
One hundred ninety-four patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy between 2004 and 2008 were evaluated. The retroperitoneal dissection was performed directly along the superior mesenteric artery in all cases. A standard histopathologic protocol that measured the “superior mesenteric artery (SMA) margin distance” between cancer cells and the superior mesenteric artery was employed.
Seventy-six percent of patients received neoadjuvant chemoradiation. The SMA margin was positive in 4% of patients but an additional 22% of patients with a negative margin had a SMA margin distance of ≤1 mm. Preoperative CT images overestimated the SMA margin distance in 73% of cases. Patients who received chemoradiation had longer SMA margin distances than those who did not. Patients who received chemoradiation and had a SMA margin of >1 mm had the lowest recurrence rates. Administration of neoadjuvant chemoradiation and lower estimated blood loss were independently associated with longer progression-free survival on multivariate analysis.
Preoperative chemoradiation and meticulous dissection of the superior mesenteric artery maximize the distance between cancer cells and the SMA margin and may influence locoregional control.
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- Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer
Journal of Gastrointestinal Surgery
Volume 16, Issue 1 , pp 68-79
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Pancreatic cancer
- SMA margin
- Industry Sectors
- Matthew H. G. Katz (1)
- Huamin Wang (2)
- Aparna Balachandran (3)
- Priya Bhosale (3)
- Christopher H. Crane (4)
- Xuemei Wang (5)
- Peter W. T. Pisters (1)
- Jeffrey E. Lee (1)
- Jean-Nicolas Vauthey (1)
- Eddie K. Abdalla (1)
- Robert Wolff (6)
- James Abbruzzese (6)
- Gauri Varadhachary (6)
- Xavier Chopin-Laly (1)
- Chusilp Charnsangavej (3)
- Jason B. Fleming (1)
- Author Affiliations
- 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX, 77030, USA
- 2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 3. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 5. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 6. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA