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Effect of Neoadjuvant Chemoradiation on Operative Mortality and Morbidity for Pancreaticoduodenectomy

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Abstract

Background

Neoadjuvant chemoradiotherapy (neo-CRT) is being used with increasing frequency for periampullary tumors, but how it alters the complication rate of pancreaticoduodenectomy (PD) is unclear.

Methods

A retrospective analysis was conducted of 79 patients with periampullary malignancies who received 5-fluorouracil–based neo-CRT followed by PD.

Results

There was no difference in mortality between PD after neo-CRT (3.8%) and conventional PD for either malignant (4.5%) or benign (2.2%) disease. Focusing only on patients with malignancy, the neo-CRT group had a significantly lower pancreatic leak rate than the conventional group (10% vs. 43%; P < .001). Intra-abdominal abscesses were less common in the neo-CRT group (8.8% vs. 21%; P = .019), and there was one (1.2%) amylase-rich abscess in neo-CRT group, compared with eight (12%) in the conventional group. In addition, two patients in the conventional group died of leak-associated sepsis, compared with none in the neo-CRT group. Multivariate analysis revealed that neoadjuvant chemoradiation (odds ratio, .15) was the most significant factor associated with a reduced risk of pancreatic leak.

Conclusions

Neo-CRT does not increase the mortality or morbidity of PD. In contrast, neo-CRT was associated with a marked reduction in the incidence of pancreatic leak, as well as leak-associated morbidity and mortality.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Box 3118, Durham, North Carolina, 27710

    Tsung-Yen Cheng MD, Ketan Sheth MD, Rebekah R. White MD, Tomio Ueno MD, PhD, Cheng-Fang Hung MS, Bryan M. Clary MD, Theodore N. Pappas MD & Douglas S. Tyler MD

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  1. Tsung-Yen Cheng MD
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  2. Ketan Sheth MD
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  3. Rebekah R. White MD
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  4. Tomio Ueno MD, PhD
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  5. Cheng-Fang Hung MS
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  6. Bryan M. Clary MD
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  7. Theodore N. Pappas MD
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  8. Douglas S. Tyler MD
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Correspondence to Douglas S. Tyler MD.

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Cheng, TY., Sheth, K., White, R.R. et al. Effect of Neoadjuvant Chemoradiation on Operative Mortality and Morbidity for Pancreaticoduodenectomy. Ann Surg Oncol 13, 66–74 (2006). https://doi.org/10.1245/ASO.2006.02.003

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  • DOI: https://doi.org/10.1245/ASO.2006.02.003

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