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

Jordan M. Cloyd, Matthew H G Katz, Laura Prakash, Gauri R. Varadhachary, Robert A. Wolff, Rachna T. Shroff, Milind Javle, David Fogelman, Michael Overman, Christopher H. Crane, Eugene J. Koay, Prajnan Das, Sunil Krishnan, Bruce D. Minsky, Jeffrey H. Lee, Manoop S. Bhutani, Brian Weston, William Ross, Priya Bhosale, Eric P. TammHuamin Wang, Anirban Maitra, Michael P. Kim, Thomas A. Aloia, Jean Nicholas Vauthey, Jason B. Fleming, James L. Abbruzzese, Peter W T Pisters, Douglas B. Evans, Jeffrey E. Lee

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)164-174
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume21
Issue number1
DOIs
Publication statusPublished - Jan 1 2017
Externally publishedYes

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Keywords

  • Neoadjuvant therapy
  • Pancreatectomy
  • Pancreatic ductal adenocarcinoma
  • Pancreatoduodenectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Cloyd, J. M., Katz, M. H. G., Prakash, L., Varadhachary, G. R., Wolff, R. A., Shroff, R. T., ... Lee, J. E. (2017). Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience. Journal of Gastrointestinal Surgery, 21(1), 164-174. https://doi.org/10.1007/s11605-016-3265-1