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11.10.2016 | Original Article | Ausgabe 12/2016

Journal of Gastrointestinal Surgery 12/2016

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

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 12/2016
Autoren:
Jason W. Denbo, Morgan L. Bruno, Jordan M. Cloyd, Laura Prakash, Jeffrey E. Lee, Michael Kim, Christopher H. Crane, Eugene J. Koay, Sunil Krishnan, Prajnan Das, Bruce D. Minsky, Gauri Varadhachary, Rachna Shroff, Robert Wolff, Milind Javle, Michael J. Overman, David Fogelman, Thomas A. Aloia, Jean-Nicolas Vauthey, Jason B. Fleming, Matthew H. G. Katz

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.

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