Skip to main content

Advertisement

SpringerLink
Log in

Preoperative Chemoradiation for Pancreatic Adenocarcinoma Does Not Increase 90-Day Postoperative Morbidity or Mortality

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The impact of preoperative chemoradiation on postoperative morbidity and mortality of patients with pancreatic adenocarcinoma remains controversial.

Methods

Consecutive pancreatectomies for adenocarcinoma performed between 2011 and 2015 were prospectively monitored for 90 days by using a previously reported surveillance system to determine the association between preoperative chemoradiation and adverse events, pancreatic fistulae, readmissions, and mortality.

Results

Among 209 consecutive patients who underwent pancreatectomy, 159 (76 %) experienced at least one adverse event within 90 postoperative days. Patients who received preoperative chemoradiation (n = 137, 66 %) were more likely to have borderline resectable/locally advanced tumors, to have received induction chemotherapy, and to require vascular resection at pancreatectomy than those who did not receive chemoradiation (all P < 0.05). Nonetheless, there were no significant differences in the rates of severe complications, readmission, or mortality between these groups (all P > 0.05). Among patients who underwent pancreatoduodenectomy, the rate of pancreatic fistula was similar between those who received chemoradiation and those who did not (P = 0.96). In contrast, those who received chemoradiation prior to distal pancreatectomy had a lower rate of pancreatic fistula (P < 0.01).

Conclusion

Preoperative chemoradiation is not associated with an increase in 90-day morbidity or mortality, and it may reduce the rate of pancreatic fistula following distal pancreatectomy.

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.

Institutional subscriptions

Similar content being viewed by others

References

  1. Katz MH, Wang H, Balachandran A, Bhosale P, Crane CH, Wang X, Pisters PW, Lee JE, Vauthey JN, Abdalla EK et al: Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract 2012, 16(1):68-78; discussion 78-69.

    Article  Google Scholar 

  2. Chen KT, Devarajan K, Milestone BN, Cooper HS, Denlinger C, Cohen SJ, Meyer JE, Hoffman JP: Neoadjuvant chemoradiation and duration of chemotherapy before surgical resection for pancreatic cancer: does time interval between radiotherapy and surgery matter? Annals of surgical oncology 2014, 21(2):662-669.

    Article  PubMed  Google Scholar 

  3. Cloyd JM, Crane CH, Koay EJ, Das P, Krishnan S, Prakash L, Snyder RA, Varadhachary GR, Wolff RA, Javle M et al: Impact of hypofractionated and standard fractionated chemoradiation before pancreatoduodenectomy for pancreatic ductal adenocarcinoma. Cancer 2016, 122(17):2671-2679.

    Article  CAS  PubMed  Google Scholar 

  4. Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J: Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS medicine 2010, 7(4):e1000267.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Tempero MA, Malafa MP, Behrman SW, Benson AB, 3rd, Casper ES, Chiorean EG, Chung V, Cohen SJ, Czito B, Engebretson A et al: Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. Journal of the National Comprehensive Cancer Network: JNCCN 2014, 12(8):1083-1093.

  6. Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, Mohile SG, Mumber M, Schulick R, Shapiro M et al: Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2016, 34(21):2541-2556.

    Article  Google Scholar 

  7. Abrams RA, Lowy AM, O’Reilly EM, Wolff RA, Picozzi VJ, Pisters PW: Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Annals of surgical oncology 2009, 16(7):1751-1756.

    Article  PubMed  Google Scholar 

  8. Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Wang H, Cleary KR, Staerkel GA et al: Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2008, 26(21):3496-3502.

    Article  CAS  Google Scholar 

  9. Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Abdalla E, Wang H, Staerkel GA et al: Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2008, 26(21):3487-3495.

    Article  CAS  Google Scholar 

  10. Cooper AB, Parmar AD, Riall TS, Hall BL, Katz MH, Aloia TA, Pitt HA: Does the use of neoadjuvant therapy for pancreatic adenocarcinoma increase postoperative morbidity and mortality rates? Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2015, 19(1):80-86; discussion 86-87.

    Article  Google Scholar 

  11. Laurence JM, Tran PD, Morarji K, Eslick GD, Lam VW, Sandroussi C: A systematic review and meta-analysis of survival and surgical outcomes following neoadjuvant chemoradiotherapy for pancreatic cancer. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2011, 15(11):2059-2069.

    Article  Google Scholar 

  12. Sasson AR, Wetherington RW, Hoffman JP, Ross EA, Cooper H, Meropol NJ, Freedman G, Pingpank JF, Eisenberg BL: Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: analysis of histopathology and outcome. International journal of gastrointestinal cancer 2003, 34(2-3):121-128.

    Article  PubMed  Google Scholar 

  13. Holubar SD, Brickman RK, Greaves SW, Ivatury SJ: Neoadjuvant Radiotherapy: A Risk Factor for Short-Term Wound Complications after Radical Resection for Rectal Cancer? Journal of the American College of Surgeons 2016, 223(2):291-298.

    Article  PubMed  Google Scholar 

  14. Milgrom SA, Goodman KA, Nash GM, Paty PB, Guillem JG, Temple LK, Weiser MR, Garcia-Aguilar J: Neoadjuvant radiation therapy prior to total mesorectal excision for rectal cancer is not associated with postoperative complications using current techniques. Annals of surgical oncology 2014, 21(7):2295-2302.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Juloori A, Tucker SL, Komaki R, Liao Z, Correa AM, Swisher SG, Hofstetter WL, Lin SH: Influence of preoperative radiation field on postoperative leak rates in esophageal cancer patients after trimodality therapy. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2014, 9(4):534-540.

  16. Takahata R, Ono S, Tsujimoto H, Hiraki S, Aosasa S, Yamamoto J, Hase K: Preoperative chemoradiation therapy for esophageal cancer is a risk factor for the elevation of high mobility group box-1, leading to an increase in postoperative severe pulmonary complications. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus/ISDE 2016, 29(1):70-78.

    Article  CAS  Google Scholar 

  17. Mukai H, Watanabe T, Mitsumori M, Tsuda H, Nakamura S, Masuda N, Yamamoto N, Shibata T, Sato A, Iwata H et al: Final results of a safety and efficacy trial of preoperative sequential chemoradiation therapy for the nonsurgical treatment of early breast cancer: Japan Clinical Oncology Group Study JCOG0306. Oncology 2013, 85(6):336-341.

    Article  CAS  PubMed  Google Scholar 

  18. Allendorf JD, Lauerman M, Bill A, DiGiorgi M, Goetz N, Vakiani E, Remotti H, Schrope B, Sherman W, Hall M et al: Neoadjuvant chemotherapy and radiation for patients with locally unresectable pancreatic adenocarcinoma: feasibility, efficacy, and survival. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2008, 12(1):91-100.

  19. Vento P, Mustonen H, Joensuu T, Karkkainen P, Kivilaakso E, Kiviluoto T: Impact of preoperative chemoradiotherapy on survival in patients with resectable pancreatic cancer. World journal of gastroenterology 2007, 13(21):2945-2951.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Araujo RL, Gaujoux S, Huguet F, Gonen M, D’Angelica MI, DeMatteo RP, Fong Y, Kingham TP, Jarnagin WR, Goodman KA et al: Does pre-operative chemoradiation for initially unresectable or borderline resectable pancreatic adenocarcinoma increase post-operative morbidity? A case-matched analysis. HPB : the official journal of the International Hepato Pancreato Biliary Association 2013, 15(8):574-580.

  21. Schwarz L, Bruno M, Parker NH, Prakash L, Mise Y, Lee JE, Vauthey JN, Aloia TA, Conrad C, Fleming JB et al: Active Surveillance for Adverse Events Within 90 Days: The Standard for Reporting Surgical Outcomes After Pancreatectomy. Annals of surgical oncology 2015, 22(11):3522-3529.

    Article  PubMed  Google Scholar 

  22. Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, Abdalla EK, Crane CH, Wolff RA et al: Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. Journal of the American College of Surgeons 2008, 206(5):833-846; discussion 846-838.

    Article  PubMed  Google Scholar 

  23. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL, Jr.: Prognostic importance of comorbidity in a hospital-based cancer registry. Jama 2004, 291(20):2441-2447.

  24. Tzeng CW, Fleming JB, Lee JE, Xiao L, Pisters PW, Vauthey JN, Abdalla EK, Wolff RA, Varadhachary GR, Fogelman DR et al: Defined clinical classifications are associated with outcome of patients with anatomically resectable pancreatic adenocarcinoma treated with neoadjuvant therapy. Annals of surgical oncology 2012, 19(6):2045-2053.

    Article  PubMed  Google Scholar 

  25. 25. Cloyd JM CC, Koay EJ, Das P, Krishnan S, Prakash L, Snyder RA, Varadhachary GR, Wolff RA, Javle M, Shroff RT, Fogelman D, Overman M, Wang H, Lee JE, Fleming JB, Katz MHG: Impact of hypofractionated and standard fractionated chemoradiation prior to pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Cancer 2016.

  26. Pisters PW, Hudec WA, Hess KR, Lee JE, Vauthey JN, Lahoti S, Raijman I, Evans DB: Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Annals of surgery 2001, 234(1):47-55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, Gomez HF, Sun CC, Crane CH, Wolff RA et al: Pancreaticoduodenectomy with vascular resection: margin status and survival duration. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2004, 8(8):935-949; discussion 949-950.

    Article  Google Scholar 

  28. Katz MH, Lee JE, Pisters PW, Skoracki R, Tamm E, Fleming JB: Retroperitoneal dissection in patients with borderline resectable pancreatic cancer: operative principles and techniques. Journal of the American College of Surgeons 2012, 215(2):e11-18.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW et al: Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007, 142(5):761-768.

    Article  PubMed  Google Scholar 

  30. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG et al: Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007, 142(1):20-25.

    Article  PubMed  Google Scholar 

  31. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M et al: Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005, 138(1):8-13.

    Article  PubMed  Google Scholar 

  32. Swanson RS, Pezzi CM, Mallin K, Loomis AM, Winchester DP: The 90-day mortality after pancreatectomy for cancer is double the 30-day mortality: more than 20,000 resections from the national cancer data base. Annals of surgical oncology 2014, 21(13):4059-4067.

    Article  PubMed  Google Scholar 

  33. Golcher H, Brunner TB, Witzigmann H, Marti L, Bechstein WO, Bruns C, Jungnickel H, Schreiber S, Grabenbauer GG, Meyer T et al: Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer: results of the first prospective randomized phase II trial. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft [et al] 2015, 191(1):7-16.

    Article  Google Scholar 

  34. Preoperative rehabilitation during neoadjuvant therapy for pancreatic cancer: ClinicalTrials.gov Identifier NCT02295956 [https://clinicaltrials.gov/ct2/show/NCT02295956?term=katz+and+prehabilitation&rank=1]

  35. Lowy AM, Lee JE, Pisters PW, Davidson BS, Fenoglio CJ, Stanford P, Jinnah R, Evans DB: Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease. Annals of surgery 1997, 226(5):632-641.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. 36. Vollmer CM, Jr., Sanchez N, Gondek S, McAuliffe J, Kent TS, Christein JD, Callery MP, Pancreatic Surgery Mortality Study G: A root-cause analysis of mortality following major pancreatectomy. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2012, 16(1):89-102; discussion 102-103.

  37. Denbo JW, Orr WS, Zarzaur BL, Behrman SW: Toward defining grade C pancreatic fistula following pancreaticoduodenectomy: incidence, risk factors, management and outcome. HPB : the official journal of the International Hepato Pancreato Biliary Association 2012, 14(9):589-593.

    Article  Google Scholar 

  38. 38. Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, Traverso LW, Pancreatic Anastomotic Leak Study G: Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2007, 11(11):1451-1458; discussion 1459.

  39. Wellner UF, Kulemann B, Lapshyn H, Hoeppner J, Sick O, Makowiec F, Bausch D, Hopt UT, Keck T: Postpancreatectomy hemorrhage--incidence, treatment, and risk factors in over 1,000 pancreatic resections. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2014, 18(3):464-475.

    Article  CAS  Google Scholar 

  40. McMillan MT, Christein JD, Callery MP, Behrman SW, Drebin JA, Hollis RH, Kent TS, Miller BC, Sprys MH, Watkins AA et al: Comparing the burden of pancreatic fistulas after pancreatoduodenectomy and distal pancreatectomy. Surgery 2016, 159(4):1013-1022.

    Article  PubMed  Google Scholar 

  41. Fong ZV, Ferrone CR, Thayer SP, Wargo JA, Sahora K, Seefeld KJ, Warshaw AL, Lillemoe KD, Hutter MM, Fernandez-Del Castillo C: Understanding hospital readmissions after pancreaticoduodenectomy: can we prevent them?: a 10-year contemporary experience with 1,173 patients at the Massachusetts General Hospital. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2014, 18(1):137-144; discussion 144-135.

    Article  Google Scholar 

  42. Takahashi H, Ogawa H, Ohigashi H, Gotoh K, Yamada T, Ohue M, Miyashiro I, Noura S, Kishi K, Motoori M et al: Preoperative chemoradiation reduces the risk of pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma. Surgery 2011, 150(3):547-556.

    Article  PubMed  Google Scholar 

  43. Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM, Jr.: A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. Journal of the American College of Surgeons 2013, 216(1):1-14.

    Article  PubMed  Google Scholar 

  44. Figueras J, Sabater L, Planellas P, Munoz-Forner E, Lopez-Ben S, Falgueras L, Sala-Palau C, Albiol M, Ortega-Serrano J, Castro-Gutierrez E: Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. The British journal of surgery 2013, 100(12):1597-1605.

    Article  CAS  PubMed  Google Scholar 

  45. Baker MS, Sherman KL, Stocker SJ, Hayman AV, Bentrem DJ, Prinz RA, Talamonti MS: Using a modification of the Clavien-Dindo system accounting for readmissions and multiple interventions: defining quality for pancreaticoduodenectomy. Journal of surgical oncology 2014, 110(4):400-406.

    Article  PubMed  Google Scholar 

  46. Kelly KJ, Greenblatt DY, Wan Y, Rettammel RJ, Winslow E, Cho CS, Weber SM: Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2011, 15(2):250-259, discussion 259-261.

    Article  Google Scholar 

  47. White RR, Hurwitz HI, Morse MA, Lee C, Anscher MS, Paulson EK, Gottfried MR, Baillie J, Branch MS, Jowell PS et al: Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Annals of surgical oncology 2001, 8(10):758-765.

    Article  CAS  PubMed  Google Scholar 

  48. Mellon EA, Hoffe SE, Springett GM, Frakes JM, Strom TJ, Hodul PJ, Malafa MP, Chuong MD, Shridhar R: Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Acta oncologica 2015, 54(7):979-985.

    Article  CAS  PubMed  Google Scholar 

  49. Polistina F, Costantin G, Casamassima F, Francescon P, Guglielmi R, Panizzoni G, Febbraro A, Ambrosino G: Unresectable locally advanced pancreatic cancer: a multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration. Annals of surgical oncology 2010, 17(8):2092-2101.

    Article  PubMed  Google Scholar 

  50. Das P, Wolff RA, Abbruzzese JL, Varadhachary GR, Evans DB, Vauthey JN, Baschnagel A, Delclos ME, Krishnan S, Janjan NA et al: Concurrent capecitabine and upper abdominal radiation therapy is well tolerated. Radiation oncology 2006, 1:41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank Ashish Verma, Mano Sundar, and the Translational Pancreatic Tumor Database at the MDACC Department of Surgery. This study was supported by the Various Donor Pancreatic Research Fund at The University of Texas MD Anderson Cancer Center. The University of Texas MD Anderson Cancer Center is supported by the National Institutes of Health through Cancer Center Support Grant P30CA016672.

Authors’ Contributions

All authors/coauthors contributed significantly to the manuscript and fulfilled the requirements for authorship as per the guidelines of the International Committee of Medical Journal Editors (ICMJE).

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA

    Jason W. Denbo, Morgan L. Bruno, Jordan M. Cloyd, Laura Prakash, Jeffrey E. Lee, Michael Kim, Thomas A. Aloia, Jean-Nicolas Vauthey, Jason B. Fleming & Matthew H. G. Katz

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

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

  3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gauri Varadhachary, Rachna Shroff, Robert Wolff, Milind Javle, Michael J. Overman & David Fogelman

Authors
  1. Jason W. Denbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Morgan L. Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jordan M. Cloyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeffrey E. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christopher H. Crane
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eugene J. Koay
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sunil Krishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Prajnan Das
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bruce D. Minsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gauri Varadhachary
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Rachna Shroff
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Robert Wolff
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Milind Javle
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Michael J. Overman
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. David Fogelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Thomas A. Aloia
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Jean-Nicolas Vauthey
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Jason B. Fleming
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Matthew H. G. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew H. G. Katz.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Denbo, J.W., Bruno, M.L., Cloyd, J.M. et al. Preoperative Chemoradiation for Pancreatic Adenocarcinoma Does Not Increase 90-Day Postoperative Morbidity or Mortality. J Gastrointest Surg 20, 1975–1985 (2016). https://doi.org/10.1007/s11605-016-3286-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-016-3286-9

Keywords

Search

Navigation