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Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer.

Publication ,  Journal Article
Katz, MHG; Wang, H; Balachandran, A; Bhosale, P; Crane, CH; Wang, X; Pisters, PWT; Lee, JE; Vauthey, J-N; Abdalla, EK; Wolff, R; Abbruzzese, J ...
Published in: J Gastrointest Surg
January 2012

OBJECTIVES: To determine the influence of neoadjuvant chemoradiation and standardized dissection of the superior mesenteric artery upon the oncologic outcome of patients with localized pancreatic adenocarcinoma. METHODS: One hundred ninety-four patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy between 2004 and 2008 were evaluated. The retroperitoneal dissection was performed directly along the superior mesenteric artery in all cases. A standard histopathologic protocol that measured the "superior mesenteric artery (SMA) margin distance" between cancer cells and the superior mesenteric artery was employed. RESULTS: Seventy-six percent of patients received neoadjuvant chemoradiation. The SMA margin was positive in 4% of patients but an additional 22% of patients with a negative margin had a SMA margin distance of ≤1 mm. Preoperative CT images overestimated the SMA margin distance in 73% of cases. Patients who received chemoradiation had longer SMA margin distances than those who did not. Patients who received chemoradiation and had a SMA margin of >1 mm had the lowest recurrence rates. Administration of neoadjuvant chemoradiation and lower estimated blood loss were independently associated with longer progression-free survival on multivariate analysis. CONCLUSIONS: Preoperative chemoradiation and meticulous dissection of the superior mesenteric artery maximize the distance between cancer cells and the SMA margin and may influence locoregional control.

Duke Scholars

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

January 2012

Volume

16

Issue

1

Start / End Page

68 / 78

Location

United States

Related Subject Headings

  • Young Adult
  • Tomography, X-Ray Computed
  • Surgery
  • Retrospective Studies
  • Proportional Hazards Models
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Multivariate Analysis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Katz, M. H. G., Wang, H., Balachandran, A., Bhosale, P., Crane, C. H., Wang, X., … Fleming, J. B. (2012). Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg, 16(1), 68–78. https://doi.org/10.1007/s11605-011-1748-7
Katz, Matthew H. G., Huamin Wang, Aparna Balachandran, Priya Bhosale, Christopher H. Crane, Xuemei Wang, Peter W. T. Pisters, et al. “Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer.J Gastrointest Surg 16, no. 1 (January 2012): 68–78. https://doi.org/10.1007/s11605-011-1748-7.
Katz MHG, Wang H, Balachandran A, Bhosale P, Crane CH, Wang X, et al. Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg. 2012 Jan;16(1):68–78.
Katz, Matthew H. G., et al. “Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer.J Gastrointest Surg, vol. 16, no. 1, Jan. 2012, pp. 68–78. Pubmed, doi:10.1007/s11605-011-1748-7.
Katz MHG, Wang H, Balachandran A, Bhosale P, Crane CH, Wang X, Pisters PWT, Lee JE, Vauthey J-N, Abdalla EK, Wolff R, Abbruzzese J, Varadhachary G, Chopin-Laly X, Charnsangavej C, Fleming JB. Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg. 2012 Jan;16(1):68–78.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

January 2012

Volume

16

Issue

1

Start / End Page

68 / 78

Location

United States

Related Subject Headings

  • Young Adult
  • Tomography, X-Ray Computed
  • Surgery
  • Retrospective Studies
  • Proportional Hazards Models
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Multivariate Analysis