Impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX: Trans-Atlantic Pancreatic Surgery (TAPS) Consortium study
Abstract Background Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic lapa...
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| Veröffentlicht in: | British journal of surgery 2024-03, Vol.111 (3) |
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| creator | Theijse, Rutger T Stoop, Thomas F Janssen, Quisette P Prakash, Laura R Katz, Matthew H G Doppenberg, Deesje Tzeng, Ching-Wei D Wei, Alice C Zureikat, Amer H Groot Koerkamp, Bas Besselink, Marc G |
| description | Abstract
Background
Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy.
Methods
This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012–2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C).
Results
Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1%) in group A, 425 patients (64.1%) in group B, and 171 patients (25.8%) in group C). A non-therapeutic laparotomy occurred in 28.2% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8%) and a 90-day mortality rate of 3.0% (2 of 67). Administration of palliative therapy (65.9% versus 73.1%; P = 0.307) and median overall survival (20.4 [95% c.i. 15.9 to 27.3] versus 20.2 [95% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4%, 8.7%, and 24.7% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95% c.i. 0.61 to 1.27]).
Conclusion
More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes.
In 28.2% of 663 patients with locally advanced pancreatic cancer, no resection was performed in case of surgical exploration with intention for resection after at least one cycle of (m)FOLFIRINOX. Such non-therapeutic laparotomy had a 90-day mortality rate of 3.0% and similar outcomes with regards to subsequent administration of palliative chemotherapy and overall survival compared with patients who did no |
| doi_str_mv | 10.1093/bjs/znae033 |
| format | Article |
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Background
Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy.
Methods
This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012–2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C).
Results
Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1%) in group A, 425 patients (64.1%) in group B, and 171 patients (25.8%) in group C). A non-therapeutic laparotomy occurred in 28.2% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8%) and a 90-day mortality rate of 3.0% (2 of 67). Administration of palliative therapy (65.9% versus 73.1%; P = 0.307) and median overall survival (20.4 [95% c.i. 15.9 to 27.3] versus 20.2 [95% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4%, 8.7%, and 24.7% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95% c.i. 0.61 to 1.27]).
Conclusion
More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes.
In 28.2% of 663 patients with locally advanced pancreatic cancer, no resection was performed in case of surgical exploration with intention for resection after at least one cycle of (m)FOLFIRINOX. Such non-therapeutic laparotomy had a 90-day mortality rate of 3.0% and similar outcomes with regards to subsequent administration of palliative chemotherapy and overall survival compared with patients who did not undergo surgical exploration.</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1093/bjs/znae033</identifier><identifier>PMID: 38456678</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>British journal of surgery, 2024-03, Vol.111 (3)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c321t-6f14d7027f575f02d11aeaf66c65780058a4ed56af1c1d569afac5789753fc103</citedby><orcidid>0000-0002-2505-959X ; 0000-0003-2650-9350 ; 0000-0003-1917-6973 ; 0000-0003-3328-4516 ; 0000-0003-3870-6968</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,1585,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38456678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Theijse, Rutger T</creatorcontrib><creatorcontrib>Stoop, Thomas F</creatorcontrib><creatorcontrib>Janssen, Quisette P</creatorcontrib><creatorcontrib>Prakash, Laura R</creatorcontrib><creatorcontrib>Katz, Matthew H G</creatorcontrib><creatorcontrib>Doppenberg, Deesje</creatorcontrib><creatorcontrib>Tzeng, Ching-Wei D</creatorcontrib><creatorcontrib>Wei, Alice C</creatorcontrib><creatorcontrib>Zureikat, Amer H</creatorcontrib><creatorcontrib>Groot Koerkamp, Bas</creatorcontrib><creatorcontrib>Besselink, Marc G</creatorcontrib><title>Impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX: Trans-Atlantic Pancreatic Surgery (TAPS) Consortium study</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Abstract
Background
Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy.
Methods
This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012–2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C).
Results
Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1%) in group A, 425 patients (64.1%) in group B, and 171 patients (25.8%) in group C). A non-therapeutic laparotomy occurred in 28.2% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8%) and a 90-day mortality rate of 3.0% (2 of 67). Administration of palliative therapy (65.9% versus 73.1%; P = 0.307) and median overall survival (20.4 [95% c.i. 15.9 to 27.3] versus 20.2 [95% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4%, 8.7%, and 24.7% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95% c.i. 0.61 to 1.27]).
Conclusion
More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes.
In 28.2% of 663 patients with locally advanced pancreatic cancer, no resection was performed in case of surgical exploration with intention for resection after at least one cycle of (m)FOLFIRINOX. Such non-therapeutic laparotomy had a 90-day mortality rate of 3.0% and similar outcomes with regards to subsequent administration of palliative chemotherapy and overall survival compared with patients who did not undergo surgical exploration.</description><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNpFkU9v1DAQxS0EotvCiTvyCW0PoXa8thNuqxULK63Yii4St2jq2NRVYgf_AaUfjU9HQhc4jWbe741G8xB6RclbSmp2dXsfrx4caMLYE7SgTPCipKJ6ihaEEFlQVrIzdB7jPSGUEV4-R2esWnEhZLVAv3b9ACphbzBg512R7nSAQedkFe5ggOCT70dsHR4gWe1SxD9tusOdV9B1I4b2Bzil20l2KmiYfWqeBJzmdlL-8Na1WSXrHV72l9vDfrv7vPt0-PoOHwO4WKxTB272Xv9fc5PDNx1GvDyur28u8ca76EOyuccx5XZ8gZ4Z6KJ-eaoX6Mv2_XHzsdgfPuw2632hWElTIQxdtZKU0nDJDSlbSkGDEUIJLitCeAUr3XIBhio61RoMqEmpJWdGUcIu0PJx7xD896xjanoble6mg7XPsSlrvpJSsJpO6OsTmm973TZDsD2Esfn77wl48wj4PPxTKWnmIJspyOYUJPsN35OSIA</recordid><startdate>20240302</startdate><enddate>20240302</enddate><creator>Theijse, Rutger T</creator><creator>Stoop, Thomas F</creator><creator>Janssen, Quisette P</creator><creator>Prakash, Laura R</creator><creator>Katz, Matthew H G</creator><creator>Doppenberg, Deesje</creator><creator>Tzeng, Ching-Wei D</creator><creator>Wei, Alice C</creator><creator>Zureikat, Amer H</creator><creator>Groot Koerkamp, Bas</creator><creator>Besselink, Marc G</creator><general>Oxford University Press</general><scope>TOX</scope><scope>NPM</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2505-959X</orcidid><orcidid>https://orcid.org/0000-0003-2650-9350</orcidid><orcidid>https://orcid.org/0000-0003-1917-6973</orcidid><orcidid>https://orcid.org/0000-0003-3328-4516</orcidid><orcidid>https://orcid.org/0000-0003-3870-6968</orcidid></search><sort><creationdate>20240302</creationdate><title>Impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX: Trans-Atlantic Pancreatic Surgery (TAPS) Consortium study</title><author>Theijse, Rutger T ; Stoop, Thomas F ; Janssen, Quisette P ; Prakash, Laura R ; Katz, Matthew H G ; Doppenberg, Deesje ; Tzeng, Ching-Wei D ; Wei, Alice C ; Zureikat, Amer H ; Groot Koerkamp, Bas ; Besselink, Marc G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c321t-6f14d7027f575f02d11aeaf66c65780058a4ed56af1c1d569afac5789753fc103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Theijse, Rutger T</creatorcontrib><creatorcontrib>Stoop, Thomas F</creatorcontrib><creatorcontrib>Janssen, Quisette P</creatorcontrib><creatorcontrib>Prakash, Laura R</creatorcontrib><creatorcontrib>Katz, Matthew H G</creatorcontrib><creatorcontrib>Doppenberg, Deesje</creatorcontrib><creatorcontrib>Tzeng, Ching-Wei D</creatorcontrib><creatorcontrib>Wei, Alice C</creatorcontrib><creatorcontrib>Zureikat, Amer H</creatorcontrib><creatorcontrib>Groot Koerkamp, Bas</creatorcontrib><creatorcontrib>Besselink, Marc G</creatorcontrib><collection>Access via Oxford University Press (Open Access Collection)</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Theijse, Rutger T</au><au>Stoop, Thomas F</au><au>Janssen, Quisette P</au><au>Prakash, Laura R</au><au>Katz, Matthew H G</au><au>Doppenberg, Deesje</au><au>Tzeng, Ching-Wei D</au><au>Wei, Alice C</au><au>Zureikat, Amer H</au><au>Groot Koerkamp, Bas</au><au>Besselink, Marc G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX: Trans-Atlantic Pancreatic Surgery (TAPS) Consortium study</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2024-03-02</date><risdate>2024</risdate><volume>111</volume><issue>3</issue><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Abstract
Background
Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy.
Methods
This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012–2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C).
Results
Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1%) in group A, 425 patients (64.1%) in group B, and 171 patients (25.8%) in group C). A non-therapeutic laparotomy occurred in 28.2% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8%) and a 90-day mortality rate of 3.0% (2 of 67). Administration of palliative therapy (65.9% versus 73.1%; P = 0.307) and median overall survival (20.4 [95% c.i. 15.9 to 27.3] versus 20.2 [95% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4%, 8.7%, and 24.7% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95% c.i. 0.61 to 1.27]).
Conclusion
More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes.
In 28.2% of 663 patients with locally advanced pancreatic cancer, no resection was performed in case of surgical exploration with intention for resection after at least one cycle of (m)FOLFIRINOX. Such non-therapeutic laparotomy had a 90-day mortality rate of 3.0% and similar outcomes with regards to subsequent administration of palliative chemotherapy and overall survival compared with patients who did not undergo surgical exploration.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>38456678</pmid><doi>10.1093/bjs/znae033</doi><orcidid>https://orcid.org/0000-0002-2505-959X</orcidid><orcidid>https://orcid.org/0000-0003-2650-9350</orcidid><orcidid>https://orcid.org/0000-0003-1917-6973</orcidid><orcidid>https://orcid.org/0000-0003-3328-4516</orcidid><orcidid>https://orcid.org/0000-0003-3870-6968</orcidid><oa>free_for_read</oa></addata></record> |
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| title | Impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX: Trans-Atlantic Pancreatic Surgery (TAPS) Consortium study |
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