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

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. FlemingMatthew H.G. Katz

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1975-1985
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Bibliographical note

Funding Information:
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.

Publisher Copyright:
© 2016, The Society for Surgery of the Alimentary Tract.

Keywords

  • Chemoradiation
  • Morbidity
  • Pancreatectomy
  • Pancreatic adenocarcinoma
  • Pancreatic fistula

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