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A Systematic Review and Meta-analysis of Survival and Surgical Outcomes Following Neoadjuvant Chemoradiotherapy for Pancreatic Cancer

  • Jerome Martin Laurence
  • Peter Duy Tran
  • Kavita Morarji
  • Guy D. Eslick
  • Vincent Wai To Lam
  • Charbel Sandroussi
Original Article

Abstract

Introduction

This systematic review and meta-analysis aims to characterize the surgically important benefits and complications associated with the use of neoadjuvant chemoradiotherapy for the treatment of both resectable and initially unresectable pancreatic cancer. Studies were identified through a systematic literature search and analyzed by two independent reviewers. Survival, peri-operative complications, death rate, pancreatic fistula rate, and the incidence of involved surgical margins were analyzed and subject to meta-analysis.

Methods

Nineteen studies, involving 2,148 patients were identified. Only cohort studies were included.

Results

The meta-analysis found that patients with unresectable pancreatic cancer who underwent neoadjuvant chemoradiotherapy achieved similar survival outcomes to patients with resectable disease, even though only 40% were ultimately resected. Neoadjuvant chemoradiotherapy was not associated with a statistically significant increase in the rate of pancreatic fistula formation or total complications.

Conclusion

Patients receiving neoadjuvant chemoradiotherapy were less likely to have a positive resection margin, although there was an increase in the risk of peri-operative death.

Keywords

Neoadjuvant treatment Pancreatic neoplasms Chemoradiotherapy Systematic review Meta-analysis 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Jerome Martin Laurence
    • 1
    • 2
    • 3
  • Peter Duy Tran
    • 4
  • Kavita Morarji
    • 4
  • Guy D. Eslick
    • 5
  • Vincent Wai To Lam
    • 1
    • 3
  • Charbel Sandroussi
    • 1
    • 2
    • 6
  1. 1.Department of SurgeryUniversity of SydneySydneyAustralia
  2. 2.Royal Prince Alfred HospitalSydneyAustralia
  3. 3.Westmead HospitalSydneyAustralia
  4. 4.Liverpool HospitalSydneyAustralia
  5. 5.The Whiteley-Martin Research Centre, Discipline of SurgeryThe University of Sydney, Nepean HospitalSydneyAustralia
  6. 6.Surgical Outcomes Resource Centre (SOuRCe)The University of SydneySydneyAustralia

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