2013 SSAT Plenary Presentation

Journal of Gastrointestinal Surgery

, Volume 18, Issue 1, pp 16-25

Treatment Sequencing for Resectable Pancreatic Cancer: Influence of Early Metastases and Surgical Complications on Multimodality Therapy Completion and Survival

  • Ching-Wei D. TzengAffiliated withDepartment of Surgery, University of Kentucky
  • , Hop S. Tran CaoAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center
  • , Jeffrey E. LeeAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center
  • , Peter W. T. PistersAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center
  • , Gauri R. VaradhacharyAffiliated withDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center
  • , Robert A. WolffAffiliated withDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center
  • , James L. AbbruzzeseAffiliated withDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center
  • , Christopher H. CraneAffiliated withDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center
  • , Douglas B. EvansAffiliated withDepartment of Surgery, Medical College of Wisconsin
    • , Huamin WangAffiliated withDepartment of Pathology, The University of Texas MD Anderson Cancer Center
    • , Daniel E. AbbottAffiliated withDivision of Surgical Oncology, University of Cincinnati
    • , Jean-Nicolas VautheyAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center
    • , Thomas A. AloiaAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center
    • , Jason B. FlemingAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center
    • , Matthew H. G. KatzAffiliated withDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center Email author 

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Abstract

Barriers to multimodality therapy (MMT) completion among patients with resectable pancreatic adenocarcinoma include early cancer progression and postoperative major complications (PMC). We sought to evaluate the influence of these factors on MMT completion rates of patients treated with neoadjuvant therapy (NT) and surgery-first (SF) approaches. We evaluated all operable patients treated for clinically resectable pancreatic head adenocarcinoma at our institution from 2002 to 2007. Rates of MMT completion, 90-day PMC, and overall survival (OS) were evaluated. Ninety-five of 115 (83 %) NT and 29/50 (58 %) SF patients completed MMT. Patients who completed MMT lived longer than those who did not (36 vs. 11 months, p < 0.001). The most common reason that NT (11 %) and SF (26 %) patients failed to complete MMT was early disease progression. The rates of PMC among NT and SF patients were similar. Among SF patients, 69 % with no PMC completed MMT versus 29 % after PMC (p = 0.040). PMC were associated with decreased OS in SF patients but not in NT patients. The impact of early cancer progression and PMC upon completion of MMT is reduced by delivery of nonoperative therapies prior to pancreaticoduodenectomy. NT sequencing is a practical treatment strategy, particularly for patients at high biological or perioperative risk.

Keywords

Pancreatic cancer Multimodality Sequencing Complications Neoadjuvant Pancreaticoduodenectomy Whipple