Skip to main content
SpringerLink
Log in

Neoadjuvant Therapy and Vascular Resection During Pancreaticoduodenectomy: Shifting the Survival Curve for Patients with Locally Advanced Pancreatic Cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant therapy and vascular resection may offer patients with locally advanced pancreatic cancer potential cure.

Methods

We reviewed medical records of patients with ductal adenocarcinoma who underwent pancreaticoduodenectomy (PD) from 1992 through 2011. We identified patients who received neoadjuvant therapy (NA+) or required vascular resection (VR+) for locally advanced disease and compared outcomes to those who did not.

Results

Of the 643 patients who were initially explored, 506 (143 NA+ and 363 NA− patients) ultimately underwent PD. There were no significant differences in R0 resection or morbidity. Mortality was higher in the NA+ versus NA− group (7.0 vs 3.0 %, p = 0.04). More NA+ patients underwent PD VR+ (p < 0.001). Among VR+ patients, neoadjuvant therapy resulted in significantly lower R1 resection. Among resected patients, survival of NA+ patients was significantly longer than both NA− patients (27.3 vs 19.7 months, p < 0.05) and patients abandoned because of locally advanced disease. Age, tumor grade, lymph node ratio, and R1 resection were independent predictors of poor survival.

Conclusions

Neoadjuvant therapy and vascular resection offer patients with locally advanced pancreatic cancer the chance for cure with acceptable morbidity and mortality. These patients have improved survival over patients deemed locally inoperable by traditional criteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Xu J et al (2010) Cancer statistics. CA Cancer J Clin 60:277–300

    Google Scholar 

  2. Raimondi S, Masionneuve P, Lowenfels AB (2009) Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol 6:699–708

    Article  PubMed  Google Scholar 

  3. Arvold ND, Ryan DP, Niemierko A et al (2011) Long-term outcomes of neoadjuvant chemotherapy before chemoradiation for locally advanced pancreatic cancer. Cancer 18:3026–3035

    Google Scholar 

  4. Wanebo HJ, Glicksman AS, Vezeridis MP et al (2000) Preoperative chemotherapy, radiotherapy, and surgical resection of locally advanced pancreatic cancer. Arch Surg 135:81–87

    Article  CAS  PubMed  Google Scholar 

  5. Chua TC, Saxena A (2010) Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg 14:1442–1452

    Article  PubMed  Google Scholar 

  6. Martin RCG, Scoggins CR, Egnatashvili V et al (2009) Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg 144:154–159

    Article  PubMed  Google Scholar 

  7. Jia Y, Wang TJC, Allendorf J et al (2012) Management of borderline resectable pancreatic adenocarcinoma: highlights from the 2012 ASCO gastrointestinal cancers symposium. JOP 13:147–150

    PubMed  Google Scholar 

  8. Tucker ON, Rela M (2008) Controversies in the management of borderline resectable proximal pancreatic adenocarcinoma with vascular involvement. HPB Surg. doi:10.1155/2008/839503

    PubMed Central  PubMed  Google Scholar 

  9. Evans DB, Farnell MB, Lillemoe KD et al (2009) Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 16:1736–1744

    Article  PubMed  Google Scholar 

  10. Allendorf JD, Lauerman M, Bill A et al (2008) Neoadjuvant chemotherapy and radiation for patients with locally unresectable pancreatic adenocarcinoma: feasibility, efficacy, and survival. J Gastrointestinal Surg 12:91–100

    Article  Google Scholar 

  11. Katz MHG, Pisters PWT, Evans DB et al (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 206:833–848

    Article  PubMed  Google Scholar 

  12. Tzeng CWD, Fleming JB, Lee JE et al (2012) Defined clinical classifications are associated with outcome of patients with anatomically resectable pancreatic adenocarcinoma treated with neoadjuvant therapy. Ann Surg Oncol 19:2045–2053

    Article  PubMed  Google Scholar 

  13. Chun YS, Milestone BN, Watson JC et al (2010) Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol 17:2832–2838

    Article  PubMed  Google Scholar 

  14. Pancreatic adenocarcinoma version 2 (2012) NCCN Clinical Practice Guidelines in Oncology, 2012. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#pancreatic. Accessed 15 Oct 2013

  15. DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–939

    Article  PubMed Central  PubMed  Google Scholar 

  16. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  17. Schnelldorfer T, Ware AL, Sarr MG et al (2008) Long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 247:456–462

    Article  PubMed  Google Scholar 

  18. Assifi MM, Lu X, Eibl G et al (2011) Neoadjuvant therapy in pancreatic adenocarcinoma: a meta-analysis of phase II trials. Surgery 150:466–473

    Article  PubMed Central  PubMed  Google Scholar 

  19. Ramacciato G, Mercantini P, Petrucciani N et al (2009) Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma? Ann Surg Oncol 16:817–825

    Article  PubMed  Google Scholar 

  20. Barugola G, Partelli S, Crippa S et al (2012) Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy. Am J Surg 203:132–139

    Article  PubMed  Google Scholar 

  21. Bockhorn M, Burdelski C, Bogoevski D et al (2011) Arterial en bloc resection for pancreatic carcinoma. Br J Surg 98:86–92

    Article  CAS  PubMed  Google Scholar 

  22. Mollberg N, Rahbari NN, Koch M et al (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254:882–893

    Article  PubMed  Google Scholar 

  23. Tseng JF, Raut CP, Lee JE et al (2004) Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 8:935–950

    Article  PubMed  Google Scholar 

  24. Yekebas EF, Bogoevski D, Cataldegirmen G et al (2008) En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg 247:300–309

    Article  PubMed  Google Scholar 

  25. Zhou Y, Zhang Z, Liu Y et al (2012) Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg 36:884–891. doi:10.1007/s00268-012-1461-z

    Article  PubMed  Google Scholar 

  26. Kang CM, Chung YE, Park JY et al (2012) Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer. J Gastrointest Surg 16:509–517

    Article  PubMed  Google Scholar 

  27. Morganti AG, Massaccesi M, La Torre G et al (2010) A systematic review of resectability and survival after concurrent chemoradiation in primarily unresectable pancreatic cancer. Ann Surg Oncol 17:194–205

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported with financial aid from the I. W. Foundation.

Author information

Authors and Affiliations

  1. Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA

    Irene Epelboym, J. DiNorcia, M. Winner, M. K. Lee, J. A. Lee, B. A. Schrope, J. A. Chabot & J. D. Allendorf

Authors
  1. Irene Epelboym
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. DiNorcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Winner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. K. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. A. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. A. Schrope
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. A. Chabot
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. D. Allendorf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Irene Epelboym.

Additional information

This study was a plenary presentation at the Society for Surgery of the Alimentary Tract (SSAT) meeting in San Diego, May 18–22, 2012.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Epelboym, I., DiNorcia, J., Winner, M. et al. Neoadjuvant Therapy and Vascular Resection During Pancreaticoduodenectomy: Shifting the Survival Curve for Patients with Locally Advanced Pancreatic Cancer. World J Surg 38, 1184–1195 (2014). https://doi.org/10.1007/s00268-013-2384-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-013-2384-z

Keywords

Search

Navigation