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

  • 2016 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

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.

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References

  1. American Cancer Society. Cancer Facts & Figures 2016 [Internet]. Atlanta: Atlanta: American Cancer Society; 2016. Available from: http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf

  2. Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.

    Article  CAS  PubMed  Google Scholar 

  3. Bilimoria KY, Bentrem DJ, Ko CY, Tomlinson JS, Stewart AK, Winchester DP, et al. Multimodality therapy for pancreatic cancer in the U.S.: utilization, outcomes, and the effect of hospital volume. Cancer. 2007;110:1227–34.

    Article  PubMed  Google Scholar 

  4. Tzeng C-WD, Fleming JB, Lee JE, Xiao L, Pisters PWT, Vauthey J-N, et al. Defined clinical classifications are associated with outcome of patients with anatomically resectable pancreatic adenocarcinoma treated with neoadjuvant therapy. Ann. Surg. Oncol. 2012;19:2045–53.

    Article  PubMed  Google Scholar 

  5. Tzeng C-WD, Tran Cao HS, Lee JE, Pisters PWT, Varadhachary GR, Wolff RA, et al. Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2014;18:16-24-25.

    Google Scholar 

  6. Aloia TA, Aloia TE, Lee JE, Vauthey J-N, Abdalla EK, Wolff RA, et al. Delayed recovery after pancreaticoduodenectomy: a major factor impairing the delivery of adjuvant therapy? J. Am. Coll. Surg. 2007;204:347–55.

    Article  PubMed  Google Scholar 

  7. Fathi A, Christians KK, George B, Ritch PS, Erickson BA, Tolat P, et al. Neoadjuvant therapy for localized pancreatic cancer: guiding principles. J. Gastrointest. Oncol. 2015;6:418–29.

    PubMed  PubMed Central  Google Scholar 

  8. Sutton JM, Abbott DE. Neoadjuvant therapy for pancreas cancer: past lessons and future therapies. World J. Gastroenterol. 2014;20:15564–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Pilepich MV, Miller HH. Preoperative irradiation in carcinoma of the pancreas. Cancer. 1980;46:1945–9.

    Article  CAS  PubMed  Google Scholar 

  10. Le Scodan R, Mornex F, Partensky C, Mercier C, Valette P-J, Ychou M, et al. Histopathological response to preoperative chemoradiation for resectable pancreatic adenocarcinoma: the French Phase II FFCD 9704-SFRO Trial. Am. J. Clin. Oncol. 2008;31:545–52.

    Article  PubMed  Google Scholar 

  11. Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PWT, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2008;26:3496–502.

    Article  CAS  Google Scholar 

  12. Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PWT, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2008;26:3487–95.

    Article  CAS  Google Scholar 

  13. Turrini O, Ychou M, Moureau-Zabotto L, Rouanet P, Giovannini M, Moutardier V, et al. Neoadjuvant docetaxel-based chemoradiation for resectable adenocarcinoma of the pancreas: New neoadjuvant regimen was safe and provided an interesting pathologic response. Eur. J. Surg. Oncol. J. Eur. Soc. Surg. Oncol. Br. Assoc. Surg. Oncol. 2010;36:987–92.

    CAS  Google Scholar 

  14. Sahora K, Kuehrer I, Eisenhut A, Akan B, Koellblinger C, Goetzinger P, et al. NeoGemOx: Gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer. Surgery. 2011;149:311–20.

    Article  PubMed  Google Scholar 

  15. Pipas JM, Zaki BI, McGowan MM, Tsapakos MJ, Ripple GH, Suriawinata AA, et al. Neoadjuvant cetuximab, twice-weekly gemcitabine, and intensity-modulated radiotherapy (IMRT) in patients with pancreatic adenocarcinoma. Ann. Oncol. Off. J. Eur. Soc. Med. Oncol. ESMO. 2012;23:2820–7.

    Article  CAS  Google Scholar 

  16. Kim EJ, Ben-Josef E, Herman JM, Bekaii-Saab T, Dawson LA, Griffith KA, et al. A multi-institutional phase 2 study of neoadjuvant gemcitabine and oxaliplatin with radiation therapy in patients with pancreatic cancer. Cancer. 2013;119:2692–700.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hwang RF, Wang H, Lara A, Gomez H, Chang T, Sieffert N, et al. Development of an integrated biospecimen bank and multidisciplinary clinical database for pancreatic cancer. Ann. Surg. Oncol. 2008;15:1356–66.

    Article  PubMed  Google Scholar 

  18. Katz MHG, Pisters PWT, Evans DB, Sun CC, Lee JE, Fleming JB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J. Am. Coll. Surg. 2008;206:833-846-848.

    Article  Google Scholar 

  19. Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann. Surg. Oncol. 2006;13:1035–46.

    Article  PubMed  Google Scholar 

  20. Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch. Surg. Chic. Ill 1960. 1992;127:1335–9.

    CAS  Google Scholar 

  21. Pisters PW, Abbruzzese JL, Janjan NA, Cleary KR, Charnsangavej C, Goswitz MS, et al. Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 1998;16:3843–50.

    CAS  Google Scholar 

  22. Pisters PWT, Wolff RA, Janjan NA, Cleary KR, Charnsangavej C, Crane CN, et al. Preoperative paclitaxel and concurrent rapid-fractionation radiation for resectable pancreatic adenocarcinoma: toxicities, histologic response rates, and event-free outcome. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2002;20:2537–44.

    Article  CAS  Google Scholar 

  23. Phase II study of preoperation mFOLFIRINOX and chemoradiation for high-risk resectable and borderline resectable pancreatic adenocarcinoma. J. Clin. Oncol. [Internet]. 2015 [cited 2016 Apr 20];Suppl 3. Available from: http://meetinglibrary.asco.org/content/140403-158

  24. Katz MG, Shi Q, Ahmad SA, et al. Preoperative modified folfirinox treatment followed by capecitabine-based chemoradiation for borderline resectable pancreatic cancer: Alliance for clinical trials in oncology trial a021101. JAMA Surg. 2016;e161137.

  25. Katz MHG, Wang H, Balachandran A, Bhosale P, Crane CH, Wang X, et al. Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2012;16:68-78-79.

    Article  Google Scholar 

  26. Katz MHG, Lee JE, Pisters PWT, Skoracki R, Tamm E, Fleming JB. Retroperitoneal Dissection in Patients with Borderline Resectable Pancreatic Cancer: Operative Principles and Techniques. J. Am. Coll. Surg. 2012;215:e11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Liu L, Katz MH, Lee SM, Fischer LK, Prakash L, Parker N, et al. Superior Mesenteric Artery Margin of Posttherapy Pancreaticoduodenectomy and Prognosis in Patients With Pancreatic Ductal Adenocarcinoma. Am. J. Surg. Pathol. 2015;39:1395–403.

    Article  PubMed  Google Scholar 

  28. Chatterjee D, Katz MH, Rashid A, Varadhachary GR, Wolff RA, Wang H, et al. Histologic grading of the extent of residual carcinoma following neoadjuvant chemoradiation in pancreatic ductal adenocarcinoma: a predictor for patient outcome. Cancer. 2012;118:3182–90.

    Article  PubMed  Google Scholar 

  29. Tzeng C-WD, Abbott DE, Cantor SB, Fleming JB, Lee JE, Pisters PWT, et al. Frequency and intensity of postoperative surveillance after curative treatment of pancreatic cancer: a cost-effectiveness analysis. Ann. Surg. Oncol. 2013;20:2197–203.

    Article  PubMed  Google Scholar 

  30. Tzeng C-WD, Fleming JB, Lee JE, Wang X, Pisters PWT, Vauthey J-N, et al. Yield of clinical and radiographic surveillance in patients with resected pancreatic adenocarcinoma following multimodal therapy. HPB. 2012;14:365–72.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bakkevold KE, Arnesjø B, Dahl O, Kambestad B. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater--results of a controlled, prospective, randomised multicentre study. Eur. J. Cancer Oxf. Engl. 1990. 1993;29A:698–703.

    CAS  Google Scholar 

  32. Kosuge T, Kiuchi T, Mukai K, Kakizoe T, Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer (JSAP). A multicenter randomized controlled trial to evaluate the effect of adjuvant cisplatin and 5-fluorouracil therapy after curative resection in cases of pancreatic cancer. Jpn. J. Clin. Oncol. 2006;36:159–65.

    Article  PubMed  Google Scholar 

  33. Burris HA, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 1997;15:2403–13.

    CAS  Google Scholar 

  34. Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N. Engl. J. Med. 2011;364:1817–25.

    Article  CAS  PubMed  Google Scholar 

  35. Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N. Engl. J. Med. 2013;369:1691–703.

    Article  Google Scholar 

  36. Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann. Surg. 2015;261:12–7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Nanda RH, El-Rayes B, Maithel SK, Landry J. Neoadjuvant modified FOLFIRINOX and chemoradiation therapy for locally advanced pancreatic cancer improves resectability. J. Surg. Oncol. 2015;111:1028–34.

    Article  CAS  PubMed  Google Scholar 

  38. Blazer M, Wu C, Goldberg RM, Phillips G, Schmidt C, Muscarella P, et al. Neoadjuvant modified (m) FOLFIRINOX for locally advanced unresectable (LAPC) and borderline resectable (BRPC) adenocarcinoma of the pancreas. Ann. Surg. Oncol. 2015;22:1153–9.

    Article  PubMed  Google Scholar 

  39. Petrelli F, Coinu A, Borgonovo K, Cabiddu M, Ghilardi M, Lonati V, et al. FOLFIRINOX-based neoadjuvant therapy in borderline resectable or unresectable pancreatic cancer: a meta-analytical review of published studies. Pancreas. 2015;44:515–21.

    Article  CAS  PubMed  Google Scholar 

  40. Improving resection rates in borderline resectable pancreatic cancer: Pilot study shows favorable results [Internet]. The Bulletin. [cited 2015 Oct 25]. Available from: http://bulletin.facs.org/2015/10/improving-resection-rates-in-borderline-resectable-pancreatic-cancer-pilot-study-shows-favorable-results/

  41. Verbeke CS, Gladhaug IP. Resection margin involvement and tumour origin in pancreatic head cancer. Br. J. Surg. 2012;99:1036–49.

    Article  CAS  PubMed  Google Scholar 

  42. Iacobuzio-Donahue CA, Fu B, Yachida S, Luo M, Abe H, Henderson CM, et al. DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2009;27:1806–13.

    Article  CAS  Google Scholar 

  43. Cloyd JM, Crane CH, Koay EJ, Das P, Krishnan S, Prakash L, et al. Impact of hypofractionated and standard fractionated chemoradiation before pancreatoduodenectomy for pancreatic ductal adenocarcinoma. Cancer. 2016;122(17):2671–9.

  44. Katz MHG, Fleming JB, Pisters PWT, Lee JE, Evans DB. Anatomy of the superior mesenteric vein with special reference to the surgical management of first-order branch involvement at pancreaticoduodenectomy. Ann. Surg. 2008;248:1098–102.

    Article  PubMed  Google Scholar 

  45. Tseng JF, Raut CP, Lee JE, Pisters PWT, Vauthey J-N, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2004;8:935-949-950.

    Article  Google Scholar 

  46. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J. Am. Coll. Surg. 2015;220:530–6.

    Article  PubMed  Google Scholar 

  47. Serrano PE, Cleary SP, Dhani N, Kim PTW, Greig PD, Leung K, et al. Improved long-term outcomes after resection of pancreatic adenocarcinoma: a comparison between two time periods. Ann. Surg. Oncol. 2015;22:1160–7.

    Article  PubMed  Google Scholar 

  48. Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann. Surg. 1995;221:721-731-733.

    Article  Google Scholar 

  49. Winter JM, Brennan MF, Tang LH, D’Angelica MI, Dematteo RP, Fong Y, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann. Surg. Oncol. 2012;19:169–75.

    Article  PubMed  Google Scholar 

  50. Salem AI, Alfi M, Winslow E, Cho CS, Weber SM. Has survival following pancreaticoduodenectomy for pancreas adenocarcinoma improved over time? J. Surg. Oncol. 2015;112:643–9.

    Article  PubMed  Google Scholar 

  51. Millikan KW, Deziel DJ, Silverstein JC, Kanjo TM, Christein JD, Doolas A, et al. Prognostic factors associated with resectable adenocarcinoma of the head of the pancreas. Am. Surg. 1999;65:618-623-624.

    Google Scholar 

  52. Lewis R, Drebin JA, Callery MP, Fraker D, Kent TS, Gates J, et al. A contemporary analysis of survival for resected pancreatic ductal adenocarcinoma. HPB. 2013;15:49–60.

    Article  PubMed  Google Scholar 

  53. Raigani S, Ammori J, Kim J, Hardacre JM. Trends in the treatment of resectable pancreatic adenocarcinoma. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2014;18:113–23.

    Article  Google Scholar 

  54. Evans DB, George B, Tsai S. Non-metastatic Pancreatic Cancer: Resectable, Borderline Resectable, and Locally Advanced-Definitions of Increasing Importance for the Optimal Delivery of Multimodality Therapy. Ann. Surg. Oncol. 2015;22:3409–13.

    Article  PubMed  Google Scholar 

  55. Tzeng C-WD, Balachandran A, Ahmad M, Lee JE, Krishnan S, Wang H, et al. Serum carbohydrate antigen 19-9 represents a marker of response to neoadjuvant therapy in patients with borderline resectable pancreatic cancer. HPB. 2014;16:430–8.

    Article  PubMed  Google Scholar 

  56. Katz MHG, Varadhachary GR, Fleming JB, Wolff RA, Lee JE, Pisters PWT, et al. Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation. Ann. Surg. Oncol. 2010;17:1794–801.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Mavros MN, Xu L, Maqsood H, Gani F, Ejaz A, Spolverato G, et al. Perioperative Blood Transfusion and the Prognosis of Pancreatic Cancer Surgery: Systematic Review and Meta-analysis. Ann. Surg. Oncol. 2015;

  58. Kantor O, Talamonti MS, Stocker SJ, Wang C-H, Winchester DJ, Bentrem DJ, et al. A Graded Evaluation of Outcomes Following Pancreaticoduodenectomy with Major Vascular Resection in Pancreatic Cancer. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2015;

  59. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2006;10:1199-1210-1211.

    Google Scholar 

  60. Konstantinidis IT, Warshaw AL, Allen JN, Blaszkowsky LS, Castillo CF-D, Deshpande V, et al. Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann. Surg. 2013;257:731–6.

    Article  PubMed  Google Scholar 

  61. Chatterjee D, Katz MH, Rashid A, Wang H, Iuga AC, Varadhachary GR, et al. Perineural and intraneural invasion in posttherapy pancreaticoduodenectomy specimens predicts poor prognosis in patients with pancreatic ductal adenocarcinoma. Am. J. Surg. Pathol. 2012;36:409–17.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Weber CE, Bock EA, Hurtuk MG, Abood GJ, Pickleman J, Shoup M, et al. Clinical and pathologic features influencing survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2014;18:340–7.

    Article  Google Scholar 

  63. Riediger H, Keck T, Wellner U, zur Hausen A, Adam U, Hopt UT, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract. 2009;13:1337–44.

    Article  Google Scholar 

  64. Fischer LK, Katz MH, Lee SM, Liu L, Wang H, Varadhachary GR, et al. The number and ratio of positive lymph nodes affect pancreatic cancer patient survival after neoadjuvant therapy and pancreaticoduodenectomy. Histopathology. 2015;

  65. Roland CL, Katz MHG, Tzeng C-WD, Lin H, Varadhachary GR, Shroff R, et al. The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy. Ann. Surg. Oncol. 2015;

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Acknowledgments

The authors would like to thank the many courageous patients and families who have formed the basis of our experience and reinforce the importance of multidisciplinary care.

This study was supported by the NIH/NCI under award number P30CA016672 and used the Clinical Trials Support Resource.

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Authors and Affiliations

  1. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA

    Jordan M. Cloyd, Matthew H. G. Katz, Laura Prakash, Michael P. Kim, Thomas A. Aloia, Jean-Nicholas Vauthey, Jason B. Fleming & Jeffrey E. Lee

  2. Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gauri R. Varadhachary, Robert A. Wolff, Rachna T. Shroff, Milind Javle, David Fogelman & Michael Overman

  3. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christopher H. Crane, Eugene J. Koay, Prajnan Das, Sunil Krishnan & Bruce D. Minsky

  4. Department of Gasteroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey H. Lee, Manoop S. Bhutani, Brian Weston & William Ross

  5. Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Priya Bhosale & Eric P. Tamm

  6. Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Huamin Wang & Anirban Maitra

  7. Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA

    James L. Abbruzzese

  8. University Health Network, Toronto, ON, Canada

    Peter W. T. Pisters

  9. Division of Surgical Oncology, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Douglas B. Evans

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  1. Jordan M. Cloyd
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Correspondence to Jeffrey E. Lee.

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Cloyd, J.M., Katz, M.H.G., Prakash, L. et al. Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience. J Gastrointest Surg 21, 164–174 (2017). https://doi.org/10.1007/s11605-016-3265-1

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