Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer
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 pan...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2012, Vol.16 (1), p.68-79 |
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| creator | Katz, Matthew H. G. Wang, Huamin Balachandran, Aparna Bhosale, Priya Crane, Christopher H. Wang, Xuemei Pisters, Peter W. T. Lee, Jeffrey E. Vauthey, Jean-Nicolas Abdalla, Eddie K. Wolff, Robert Abbruzzese, James Varadhachary, Gauri Chopin-Laly, Xavier Charnsangavej, Chusilp Fleming, Jason B. |
| description | 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. |
| doi_str_mv | 10.1007/s11605-011-1748-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1095655011</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2785293711</sourcerecordid><originalsourceid>FETCH-LOGICAL-c437t-f87b4b9fff44140a1360242c2ee6ec4d49a4d7ff85264b8b2d3dcfe2a8da79d3</originalsourceid><addsrcrecordid>eNp1kF1LwzAUhoMobk5_gDcS8LqapGnSXkqZHzBUdBfehTQ52Tq2dKatoL_ejE7xxqscOM_7nvAgdE7JFSVEXreUCpIlhNKESp4n8gCNaS7ThAsmDuNMCpqwLHsboZO2XRFCJaH5MRoxRkSW0nyMllPnwHS4cfgRGm1X_Yf2HS6XsGmCtrXu6sZj7S1-7cOiNnqN52CWvn7vAcfNC5g-BPAGdhWzJgL1F1j8rL0JENMGl3GEcIqOnF63cLZ_J2h-O52X98ns6e6hvJklhqeyS1wuK14VzjnOKSeapoIwzgwDEGC45YXmVjqXZ0zwKq-YTa1xwHRutSxsOkGXQ-02NPGLbadWTR98vKiijUxkWbQVKTpQJjRtG8Cpbag3OnxGSO3UqkGtirDaqVUyZi72zX21Afub-HEZATYAbVz5BYS_p_9r_QYaF4UJ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1095655011</pqid></control><display><type>article</type><title>Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Katz, Matthew H. G. ; Wang, Huamin ; Balachandran, Aparna ; Bhosale, Priya ; Crane, Christopher H. ; Wang, Xuemei ; Pisters, Peter W. T. ; Lee, Jeffrey E. ; Vauthey, Jean-Nicolas ; Abdalla, Eddie K. ; Wolff, Robert ; Abbruzzese, James ; Varadhachary, Gauri ; Chopin-Laly, Xavier ; Charnsangavej, Chusilp ; Fleming, Jason B.</creator><creatorcontrib>Katz, Matthew H. G. ; Wang, Huamin ; Balachandran, Aparna ; Bhosale, Priya ; Crane, Christopher H. ; Wang, Xuemei ; Pisters, Peter W. T. ; Lee, Jeffrey E. ; Vauthey, Jean-Nicolas ; Abdalla, Eddie K. ; Wolff, Robert ; Abbruzzese, James ; Varadhachary, Gauri ; Chopin-Laly, Xavier ; Charnsangavej, Chusilp ; Fleming, Jason B.</creatorcontrib><description>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.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-011-1748-7</identifier><identifier>PMID: 22065318</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>2011 SSAT Plenary Presentation ; Adenocarcinoma - diagnostic imaging ; Adenocarcinoma - pathology ; Adenocarcinoma - therapy ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents - therapeutic use ; Blood Loss, Surgical ; Capecitabine ; Chemoradiotherapy, Adjuvant ; Deoxycytidine - analogs & derivatives ; Deoxycytidine - therapeutic use ; Disease-Free Survival ; Dissection ; Dose Fractionation, Radiation ; Female ; Fluorouracil - analogs & derivatives ; Fluorouracil - therapeutic use ; Gastroenterology ; Gemcitabine ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Medicine ; Medicine & Public Health ; Mesenteric Artery, Superior - pathology ; Mesenteric Artery, Superior - surgery ; Middle Aged ; Multivariate Analysis ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local - pathology ; Pancreatic cancer ; Pancreatic Neoplasms - diagnostic imaging ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - therapy ; Pancreaticoduodenectomy - methods ; Proportional Hazards Models ; Retrospective Studies ; Surgery ; Tomography, X-Ray Computed ; Young Adult</subject><ispartof>Journal of gastrointestinal surgery, 2012, Vol.16 (1), p.68-79</ispartof><rights>The Society for Surgery of the Alimentary Tract 2011</rights><rights>The Society for Surgery of the Alimentary Tract 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c437t-f87b4b9fff44140a1360242c2ee6ec4d49a4d7ff85264b8b2d3dcfe2a8da79d3</citedby><cites>FETCH-LOGICAL-c437t-f87b4b9fff44140a1360242c2ee6ec4d49a4d7ff85264b8b2d3dcfe2a8da79d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-011-1748-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-011-1748-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22065318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Katz, Matthew H. G.</creatorcontrib><creatorcontrib>Wang, Huamin</creatorcontrib><creatorcontrib>Balachandran, Aparna</creatorcontrib><creatorcontrib>Bhosale, Priya</creatorcontrib><creatorcontrib>Crane, Christopher H.</creatorcontrib><creatorcontrib>Wang, Xuemei</creatorcontrib><creatorcontrib>Pisters, Peter W. T.</creatorcontrib><creatorcontrib>Lee, Jeffrey E.</creatorcontrib><creatorcontrib>Vauthey, Jean-Nicolas</creatorcontrib><creatorcontrib>Abdalla, Eddie K.</creatorcontrib><creatorcontrib>Wolff, Robert</creatorcontrib><creatorcontrib>Abbruzzese, James</creatorcontrib><creatorcontrib>Varadhachary, Gauri</creatorcontrib><creatorcontrib>Chopin-Laly, Xavier</creatorcontrib><creatorcontrib>Charnsangavej, Chusilp</creatorcontrib><creatorcontrib>Fleming, Jason B.</creatorcontrib><title>Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>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.</description><subject>2011 SSAT Plenary Presentation</subject><subject>Adenocarcinoma - diagnostic imaging</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - therapy</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Blood Loss, Surgical</subject><subject>Capecitabine</subject><subject>Chemoradiotherapy, Adjuvant</subject><subject>Deoxycytidine - analogs & derivatives</subject><subject>Deoxycytidine - therapeutic use</subject><subject>Disease-Free Survival</subject><subject>Dissection</subject><subject>Dose Fractionation, Radiation</subject><subject>Female</subject><subject>Fluorouracil - analogs & derivatives</subject><subject>Fluorouracil - therapeutic use</subject><subject>Gastroenterology</subject><subject>Gemcitabine</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mesenteric Artery, Superior - pathology</subject><subject>Mesenteric Artery, Superior - surgery</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - diagnostic imaging</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - therapy</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Tomography, X-Ray Computed</subject><subject>Young Adult</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kF1LwzAUhoMobk5_gDcS8LqapGnSXkqZHzBUdBfehTQ52Tq2dKatoL_ejE7xxqscOM_7nvAgdE7JFSVEXreUCpIlhNKESp4n8gCNaS7ThAsmDuNMCpqwLHsboZO2XRFCJaH5MRoxRkSW0nyMllPnwHS4cfgRGm1X_Yf2HS6XsGmCtrXu6sZj7S1-7cOiNnqN52CWvn7vAcfNC5g-BPAGdhWzJgL1F1j8rL0JENMGl3GEcIqOnF63cLZ_J2h-O52X98ns6e6hvJklhqeyS1wuK14VzjnOKSeapoIwzgwDEGC45YXmVjqXZ0zwKq-YTa1xwHRutSxsOkGXQ-02NPGLbadWTR98vKiijUxkWbQVKTpQJjRtG8Cpbag3OnxGSO3UqkGtirDaqVUyZi72zX21Afub-HEZATYAbVz5BYS_p_9r_QYaF4UJ</recordid><startdate>2012</startdate><enddate>2012</enddate><creator>Katz, Matthew H. G.</creator><creator>Wang, Huamin</creator><creator>Balachandran, Aparna</creator><creator>Bhosale, Priya</creator><creator>Crane, Christopher H.</creator><creator>Wang, Xuemei</creator><creator>Pisters, Peter W. T.</creator><creator>Lee, Jeffrey E.</creator><creator>Vauthey, Jean-Nicolas</creator><creator>Abdalla, Eddie K.</creator><creator>Wolff, Robert</creator><creator>Abbruzzese, James</creator><creator>Varadhachary, Gauri</creator><creator>Chopin-Laly, Xavier</creator><creator>Charnsangavej, Chusilp</creator><creator>Fleming, Jason B.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>2012</creationdate><title>Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer</title><author>Katz, Matthew H. G. ; Wang, Huamin ; Balachandran, Aparna ; Bhosale, Priya ; Crane, Christopher H. ; Wang, Xuemei ; Pisters, Peter W. T. ; Lee, Jeffrey E. ; Vauthey, Jean-Nicolas ; Abdalla, Eddie K. ; Wolff, Robert ; Abbruzzese, James ; Varadhachary, Gauri ; Chopin-Laly, Xavier ; Charnsangavej, Chusilp ; Fleming, Jason B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c437t-f87b4b9fff44140a1360242c2ee6ec4d49a4d7ff85264b8b2d3dcfe2a8da79d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>2011 SSAT Plenary Presentation</topic><topic>Adenocarcinoma - diagnostic imaging</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - therapy</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Blood Loss, Surgical</topic><topic>Capecitabine</topic><topic>Chemoradiotherapy, Adjuvant</topic><topic>Deoxycytidine - analogs & derivatives</topic><topic>Deoxycytidine - therapeutic use</topic><topic>Disease-Free Survival</topic><topic>Dissection</topic><topic>Dose Fractionation, Radiation</topic><topic>Female</topic><topic>Fluorouracil - analogs & derivatives</topic><topic>Fluorouracil - therapeutic use</topic><topic>Gastroenterology</topic><topic>Gemcitabine</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mesenteric Artery, Superior - pathology</topic><topic>Mesenteric Artery, Superior - surgery</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - diagnostic imaging</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - therapy</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Tomography, X-Ray Computed</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Katz, Matthew H. G.</creatorcontrib><creatorcontrib>Wang, Huamin</creatorcontrib><creatorcontrib>Balachandran, Aparna</creatorcontrib><creatorcontrib>Bhosale, Priya</creatorcontrib><creatorcontrib>Crane, Christopher H.</creatorcontrib><creatorcontrib>Wang, Xuemei</creatorcontrib><creatorcontrib>Pisters, Peter W. 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G.</au><au>Wang, Huamin</au><au>Balachandran, Aparna</au><au>Bhosale, Priya</au><au>Crane, Christopher H.</au><au>Wang, Xuemei</au><au>Pisters, Peter W. T.</au><au>Lee, Jeffrey E.</au><au>Vauthey, Jean-Nicolas</au><au>Abdalla, Eddie K.</au><au>Wolff, Robert</au><au>Abbruzzese, James</au><au>Varadhachary, Gauri</au><au>Chopin-Laly, Xavier</au><au>Charnsangavej, Chusilp</au><au>Fleming, Jason B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2012</date><risdate>2012</risdate><volume>16</volume><issue>1</issue><spage>68</spage><epage>79</epage><pages>68-79</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>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.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22065318</pmid><doi>10.1007/s11605-011-1748-7</doi><tpages>12</tpages></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 2012, Vol.16 (1), p.68-79 |
| issn | 1091-255X 1873-4626 |
| language | eng |
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| subjects | 2011 SSAT Plenary Presentation Adenocarcinoma - diagnostic imaging Adenocarcinoma - pathology Adenocarcinoma - therapy Adult Aged Aged, 80 and over Antineoplastic Agents - therapeutic use Blood Loss, Surgical Capecitabine Chemoradiotherapy, Adjuvant Deoxycytidine - analogs & derivatives Deoxycytidine - therapeutic use Disease-Free Survival Dissection Dose Fractionation, Radiation Female Fluorouracil - analogs & derivatives Fluorouracil - therapeutic use Gastroenterology Gemcitabine Humans Kaplan-Meier Estimate Lymphatic Metastasis Male Medicine Medicine & Public Health Mesenteric Artery, Superior - pathology Mesenteric Artery, Superior - surgery Middle Aged Multivariate Analysis Neoadjuvant Therapy Neoplasm Recurrence, Local - pathology Pancreatic cancer Pancreatic Neoplasms - diagnostic imaging Pancreatic Neoplasms - pathology Pancreatic Neoplasms - therapy Pancreaticoduodenectomy - methods Proportional Hazards Models Retrospective Studies Surgery Tomography, X-Ray Computed Young Adult |
| title | Effect of Neoadjuvant Chemoradiation and Surgical Technique on Recurrence of Localized Pancreatic Cancer |
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