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

Publication ,  Journal Article
Cloyd, JM; Katz, MHG; Prakash, L; Varadhachary, GR; Wolff, RA; Shroff, RT; Javle, M; Fogelman, D; Overman, M; Crane, CH; Koay, EJ; Das, P ...
Published in: J Gastrointest Surg
January 2017

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.

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Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

January 2017

Volume

21

Issue

1

Start / End Page

164 / 174

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Preoperative Care
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Humans
 

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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. J Gastrointest Surg, 21(1), 164–174. https://doi.org/10.1007/s11605-016-3265-1
Cloyd, Jordan M., Matthew H. G. Katz, Laura Prakash, Gauri R. Varadhachary, Robert A. Wolff, Rachna T. Shroff, Milind Javle, et al. “Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience.J Gastrointest Surg 21, no. 1 (January 2017): 164–74. https://doi.org/10.1007/s11605-016-3265-1.
Cloyd JM, Katz MHG, Prakash L, Varadhachary GR, Wolff RA, Shroff RT, et al. Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience. J Gastrointest Surg. 2017 Jan;21(1):164–74.
Cloyd, Jordan M., et al. “Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience.J Gastrointest Surg, vol. 21, no. 1, Jan. 2017, pp. 164–74. Pubmed, doi:10.1007/s11605-016-3265-1.
Cloyd JM, Katz MHG, Prakash L, Varadhachary GR, Wolff RA, Shroff RT, Javle M, Fogelman D, Overman M, Crane CH, Koay EJ, Das P, Krishnan S, Minsky BD, Lee JH, Bhutani MS, Weston B, Ross W, Bhosale P, Tamm EP, Wang H, Maitra A, Kim MP, Aloia TA, Vauthey J-N, Fleming JB, Abbruzzese JL, Pisters PWT, Evans DB, Lee JE. Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience. J Gastrointest Surg. 2017 Jan;21(1):164–174.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

January 2017

Volume

21

Issue

1

Start / End Page

164 / 174

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Preoperative Care
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Humans