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Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival.

Publication ,  Journal Article
Tzeng, C-WD; Tran Cao, HS; Lee, JE; Pisters, PWT; Varadhachary, GR; Wolff, RA; Abbruzzese, JL; Crane, CH; Evans, DB; Wang, H; Abbott, DE ...
Published in: J Gastrointest Surg
January 2014

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.

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Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

January 2014

Volume

18

Issue

1

Start / End Page

16 / 24

Location

United States

Related Subject Headings

  • Surgery
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Pancreatectomy
  • Neoplasm Metastasis
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
 

Citation

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Tzeng, C.-W., Tran Cao, H. S., Lee, J. E., Pisters, P. W. T., Varadhachary, G. R., Wolff, R. A., … Katz, M. H. G. (2014). Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival. J Gastrointest Surg, 18(1), 16–24. https://doi.org/10.1007/s11605-013-2412-1
Tzeng, Ching-Wei D., Hop S. Tran Cao, Jeffrey E. Lee, Peter W. T. Pisters, Gauri R. Varadhachary, Robert A. Wolff, James L. Abbruzzese, et al. “Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival.J Gastrointest Surg 18, no. 1 (January 2014): 16–24. https://doi.org/10.1007/s11605-013-2412-1.
Tzeng C-WD, Tran Cao HS, Lee JE, Pisters PWT, Varadhachary GR, Wolff RA, et al. Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival. J Gastrointest Surg. 2014 Jan;18(1):16–24.
Tzeng, Ching-Wei D., et al. “Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival.J Gastrointest Surg, vol. 18, no. 1, Jan. 2014, pp. 16–24. Pubmed, doi:10.1007/s11605-013-2412-1.
Tzeng C-WD, Tran Cao HS, Lee JE, Pisters PWT, Varadhachary GR, Wolff RA, Abbruzzese JL, Crane CH, Evans DB, Wang H, Abbott DE, Vauthey J-N, Aloia TA, Fleming JB, Katz MHG. Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival. J Gastrointest Surg. 2014 Jan;18(1):16–24.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

January 2014

Volume

18

Issue

1

Start / End Page

16 / 24

Location

United States

Related Subject Headings

  • Surgery
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Pancreatectomy
  • Neoplasm Metastasis
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans