Journal of Gastrointestinal Surgery

, Volume 18, Issue 1, pp 16–25 | Cite as

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

  • Ching-Wei D. Tzeng
  • Hop S. Tran Cao
  • Jeffrey E. Lee
  • Peter W. T. Pisters
  • Gauri R. Varadhachary
  • Robert A. Wolff
  • James L. Abbruzzese
  • Christopher H. Crane
  • Douglas B. Evans
  • Huamin Wang
  • Daniel E. Abbott
  • Jean-Nicolas Vauthey
  • Thomas A. Aloia
  • Jason B. Fleming
  • Matthew H. G. KatzEmail author
2013 SSAT Plenary Presentation


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.


Pancreatic cancer Multimodality Sequencing Complications Neoadjuvant Pancreaticoduodenectomy Whipple 



We thank Joel Cox for his management of our departmental pancreatic surgery database.

Sources of Funding

This study was supported by the Khalifa Bin Zayed Al Nahyan Foundation and the Various Donor Pancreatic Research Fund at The University of Texas MD Anderson Cancer Center.




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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Ching-Wei D. Tzeng
    • 1
  • Hop S. Tran Cao
    • 2
  • Jeffrey E. Lee
    • 2
  • Peter W. T. Pisters
    • 2
  • Gauri R. Varadhachary
    • 3
  • Robert A. Wolff
    • 3
  • James L. Abbruzzese
    • 3
  • Christopher H. Crane
    • 4
  • Douglas B. Evans
    • 5
  • Huamin Wang
    • 6
  • Daniel E. Abbott
    • 7
  • Jean-Nicolas Vauthey
    • 2
  • Thomas A. Aloia
    • 2
  • Jason B. Fleming
    • 2
  • Matthew H. G. Katz
    • 2
    Email author
  1. 1.Department of SurgeryUniversity of KentuckyLexingtonUSA
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  6. 6.Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  7. 7.Division of Surgical OncologyUniversity of CincinnatiCincinnatiUSA

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