The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy With Concomitant Portomesenteric Venous Resection: An International Multicenter Analysis. Issue 5 (4th November 2021)

• Record Type: Journal Article
• Authors: Machairas, Nikolaos; Raptis, Dimitri A; Velázquez, Patricia Sánchez; Sauvanet, Alain; Rueda de Leon, Alexandra; Oba, Atsushi; Koerkamp, Bas Groot; Lovasik, Brendan; Chan, Carlos; Yeo, Charles J.; Bassi, Claudio; Ferrone, Cristina R.; Kooby, David; Moskal, David; Tamburrino, Domenico; Yoon, Dong-Sup; Barroso, Eduardo; de Santibañes, Eduardo; Kauffmann, Emanuele F.; Vigia, Emanuel; Robin, Fabien; Casciani, Fabio; Burdío, Fernando; Belfiori, Giulio; Malleo, Giuseppe; Lavu, Harish; Hartog, Hermien; Hwang, Ho-Kyoung; Han, Ho-Seong; Marques, Hugo P.; Poves, Ignasi; Domínguez-Rosado, Ismael; Park, Joon-Seong; Lillemoe, Keith D.; Roberts, Keith; Sulpice, Laurent; Besselink, Marc G.; Abuawwad, Mahmoud; Del Chiaro, Marco; de Santibañes, Martin; Falconi, Massimo; D'Silva, Mizelle; Silva, Michael; Hilal, Mohammed Abu; Qadan, Motaz; Sell, Naomi M.; Beghdadi, Nassiba; Napoli, Niccolò; Busch, Olivier R. C.; Mazza, Oscar; Muiesan, Paolo; Müller, Philip C.; Ravikumar, Reena; Schulick, Richard; Powell-Brett, Sarah; Abbas, Syed Hussain; Mackay, Tara M.; Stoop, Thomas F.; Gallagher, Tom K.; Boggi, Ugo; van Eijck, Casper; Clavien, Pierre-Alain; Conlon, Kevin C. P.; Fusai, Giuseppe Kito;
• Is Part Of: Annals of surgery. Volume 274:Issue 5(2021)
• Page Start: 721
• Page End: 728
• Publication Date: 2021-11-04
• Subjects: borderline resectable -- chemotherapy -- neoadjuvant treatment -- pancreatic cancer -- pancreaticoduodenectomy -- portal vein resection -- portomesenteric vein invasion -- radiotherapy -- resectable -- survival; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000005132
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Supplemental Digital Content is available in the text Abstract : 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.