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Chirurgie 18. Juni 2013

Gemcitabine-based neoadjuvant chemotherapy for locally advanced pancreatic cancer does not affect mortality and morbidity after pancreatic resection

Background: Neoadjuvant strategies for locally advanced pancreatic cancer (PC) have been increasingly studied over the last decade. The effect of only systemic chemotherapy on postoperative morbidity and mortality remains unclear. The objective of this study was to determine the risk of postoperative complications in patients undergoing pancreatic resection for locally advanced, nonmetastatic PC following neoadjuvant gemcitabine-based chemotherapy.

Methods: Between 1994 and 2010, thirty-five patients who received gemcitabine-based neoadjuvant chemotherapy followed by pancreatic resection (Neo-gem group) were compared with 140 patients who had only pancreatic resection without neoadjuvant chemotherapy (Prim-surg group).

Results: Overall postoperative morbidity was similar in the Neo-gem and Prim-surg groups (57 vs. 51 %; P = 0.545). Major postoperative complications (Grade III–V) requiring radiological or surgical intervention occurred in 23 % of patients in the Neo-gem group and 26 % of patients in the Prim-surg group (P = 0.665). Within the Neo-gem group univariate and multivariate analysis identified the number of intraoperative blood transfusions as an independent risk factor for postoperative complications Grade I–V (P = 0.02), and vascular resection for major complications Grade III–V (P = 0.04).

Conclusions: Neoadjuvant gemcitabine-based chemotherapy is not associated with an increase in postoperative complications following pancreatic resection for locally advanced PC.

K. Sahora, M. Schindl, I. Kuehrer, G. Werba, F. Fitzal, P. Goetzinger, M. Gnant, European Surgery 3/2013

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