TY - JOUR
T1 - The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy With Concomitant Portomesenteric Venous Resection
T2 - An International Multicenter Analysis
AU - Machairas, Nikolaos
AU - Raptis, Dimitri A.
AU - Velázquez, Patricia S. nchez
AU - Sauvanet, Alain
AU - Rueda de Leon, Alexandra
AU - Oba, Atsushi
AU - Koerkamp, Bas Groot
AU - Lovasik, Brendan
AU - Chan, Carlos
AU - Yeo, Charles J.
AU - Bassi, Claudio
AU - Ferrone, Cristina R.
AU - Kooby, David
AU - Moskal, David
AU - Tamburrino, Domenico
AU - Yoon, Dong-Sup
AU - Barroso, Eduardo
AU - de Santibañes, Eduardo
AU - Kauffmann, Emanuele F.
AU - Vigia, Emanuel
AU - Robin, Fabien
AU - Casciani, Fabio
AU - Burdío, Fernando
AU - Belfiori, Giulio
AU - Malleo, Giuseppe
AU - Lavu, Harish
AU - Hartog, Hermien
AU - Hwang, Ho-Kyoung
AU - Han, Ho-Seong
AU - Marques, Hugo P.
AU - Poves, Ignasi
AU - Domínguez-Rosado, Ismael
AU - Park, Joon-Seong
AU - Lillemoe, Keith D.
AU - Roberts, Keith
AU - Sulpice, Laurent
AU - Besselink, Marc G.
AU - Abuawwad, Mahmoud
AU - del Chiaro, Marco
AU - de Santibañes, Martin
AU - Falconi, Massimo
AU - D'Silva, Mizelle
AU - Silva, Michael
AU - Hilal, Mohammed Abu
AU - Qadan, Motaz
AU - Sell, Naomi M.
AU - Beghdadi, Nassiba
AU - Napoli, Niccolò
AU - Busch, Olivier R. C.
AU - Mazza, Oscar
AU - Muiesan, Paolo
AU - Müller, Philip C.
AU - Ravikumar, Reena
AU - Schulick, Richard
AU - Powell-Brett, Sarah
AU - Abbas, Syed Hussain
AU - Mackay, Tara M.
AU - Stoop, Thomas F.
AU - Gallagher, Tom K.
AU - Boggi, Ugo
AU - van Eijck, Casper
AU - Clavien, Pierre-Alain
AU - Conlon, Kevin C. P.
AU - Fusai, Giuseppe Kito
N1 - Publisher Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - OBJECTIVE: The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers. SUMMARY OF BACKGROUND DATA: Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in R/BR-PDAC patients. METHODS: This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018. RESULTS: Data from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy, respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (P =0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (P <0.001). Multivariable analysis showed no administration of NAT, high tumor grade, lymphovascular invasion, R1/R2 resection, no adjuvant chemotherapy, occurrence of Clavien-Dindo grade 3 or higher postoperative complications within 90 days, preoperative diabetes mellitus, male sex and portal vein involvement were negative independent predictive factors for OS. CONCLUSION: Patients with PDAC of the pancreatic head expected to undergo venous reconstruction should routinely be considered for NAT.
AB - OBJECTIVE: The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers. SUMMARY OF BACKGROUND DATA: Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in R/BR-PDAC patients. METHODS: This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018. RESULTS: Data from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy, respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (P =0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (P <0.001). Multivariable analysis showed no administration of NAT, high tumor grade, lymphovascular invasion, R1/R2 resection, no adjuvant chemotherapy, occurrence of Clavien-Dindo grade 3 or higher postoperative complications within 90 days, preoperative diabetes mellitus, male sex and portal vein involvement were negative independent predictive factors for OS. CONCLUSION: Patients with PDAC of the pancreatic head expected to undergo venous reconstruction should routinely be considered for NAT.
UR - http://www.scopus.com/inward/record.url?scp=85118283095&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000005132
DO - https://doi.org/10.1097/SLA.0000000000005132
M3 - Article
C2 - 34353988
SN - 0003-4932
VL - 274
SP - 721
EP - 728
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -