Prognosis following surgical bypass compared with laparotomy alone in unresectable pancreatic adenocarcinoma
Background Resection with curative intent has been shown to prolong survival of patients with locoregional pancreatic ductal adenocarcinoma (PDAC). However, up to 33 per cent of patients are deemed unresectable at exploratory laparotomy owing to unanticipated locally advanced or metastatic disease....
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| Veröffentlicht in: | British journal of surgery 2016-08, Vol.103 (9), p.1200-1208 |
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| creator | Insulander, J. Sanjeevi, S. Haghighi, M. Ivanics, T. Analatos, A. Lundell, L. Del Chiaro, M. Andrén-Sandberg, Å. Ansorge, C. |
| description | Background
Resection with curative intent has been shown to prolong survival of patients with locoregional pancreatic ductal adenocarcinoma (PDAC). However, up to 33 per cent of patients are deemed unresectable at exploratory laparotomy owing to unanticipated locally advanced or metastatic disease. In these patients, prophylactic double bypass (PDB) procedures have been considered the standard of care. The aim of this study was to compare PDB with exploratory laparotomy alone in terms of impact on postoperative course, chemotherapy and overall survival.
Methods
This retrospective observational cohort study (2004–2013) was conducted using a prospective institutional database. Patients with histologically confirmed, unresectable PDAC were included. Relationships between PDB procedures, exploratory laparotomy alone, postoperative chemotherapy and best supportive care were investigated by means of Cox regression. Overall survival was compared using Kaplan–Meier estimations and log rank test.
Results
Of 503 patients with PDAC scheduled for resection with curative intent, 104 were deemed unresectable at laparotomy (resection rate 79·3 per cent). Seventy‐four patients underwent PDB procedures and 30 had exploratory laparotomy alone. PDB and exploratory laparotomy were similar in terms of perioperative mortality, initiation of chemotherapy and overall survival. Compared with best supportive care, postoperative chemotherapy prolonged survival (8·0 versus 14·4 months in locally advanced PDAC, P = 0·007; 2·3 versus 8·0 months in metastatic PDAC, P < 0·001). Patients undergoing chemotherapy following exploratory laparotomy alone had longer median overall survival than patients undergoing chemotherapy following PDB procedures (16·3 versus 10·3 months; P = 0·040).
Conclusion
Patients with pancreatic cancer deemed unresectable at laparotomy may derive survival benefit from subsequent chemotherapy as opposed to supportive care alone. At laparotomy, proceeding with a bypass procedure for prophylactic symptom control may be prognostically unfavourable.
Double bypass may be worse |
| doi_str_mv | 10.1002/bjs.10190 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_504793</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1805488922</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5720-6d891518d0ceaea7ba55fdd7148813469f756ea5599be298382f83cfb4da272b3</originalsourceid><addsrcrecordid>eNp10c1vFCEUAHBiNHatHvwHDIkXDx3LxzDAsdZaNU21qVpvhGGYlS0DI8xk3f9e2l3XxMQTj8ePj8cD4DlGrzFC5Lhd5RJgiR6ABaYNqwhuxEOwQAjxClNCD8CTnFcIYYoYeQwOCCcMScoXwH9OcRlidhn20fu4dmEJ85yWzmgP282oc4YmDqNOtoNrN_2AXpdJnOKwgdrHYKELcA7JZmsm3XoLRx1MsnpyBurOhmh0Mi7EQT8Fj3rts322Gw_B13dnX07fVxefzj-cnlxUhnGCqqYTEjMsOmSstpq3mrG-6ziuhcC0bmTPWWNLUsrWEimoIL2gpm_rTpfKWnoIqu25eW3HuVVjcoNOGxW1U7vUbYmsYqjmkhZ_9F__1n07UTEt1TwXLnndFP5qy8cUf842T2pw2VjvdbBxzgoLxMpTJSGFvvyHruKcQin-TtUCS1LXRb3YqbkdbLe__0-bCjjegrXzdrNfx0jd9V-V_qv7_qs3H6_vg79f4PJkf-136HSrGk45UzeX5-ry-orfXKHvStLf9WmzXw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1804819244</pqid></control><display><type>article</type><title>Prognosis following surgical bypass compared with laparotomy alone in unresectable pancreatic adenocarcinoma</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Insulander, J. ; Sanjeevi, S. ; Haghighi, M. ; Ivanics, T. ; Analatos, A. ; Lundell, L. ; Del Chiaro, M. ; Andrén-Sandberg, Å. ; Ansorge, C.</creator><creatorcontrib>Insulander, J. ; Sanjeevi, S. ; Haghighi, M. ; Ivanics, T. ; Analatos, A. ; Lundell, L. ; Del Chiaro, M. ; Andrén-Sandberg, Å. ; Ansorge, C.</creatorcontrib><description>Background
Resection with curative intent has been shown to prolong survival of patients with locoregional pancreatic ductal adenocarcinoma (PDAC). However, up to 33 per cent of patients are deemed unresectable at exploratory laparotomy owing to unanticipated locally advanced or metastatic disease. In these patients, prophylactic double bypass (PDB) procedures have been considered the standard of care. The aim of this study was to compare PDB with exploratory laparotomy alone in terms of impact on postoperative course, chemotherapy and overall survival.
Methods
This retrospective observational cohort study (2004–2013) was conducted using a prospective institutional database. Patients with histologically confirmed, unresectable PDAC were included. Relationships between PDB procedures, exploratory laparotomy alone, postoperative chemotherapy and best supportive care were investigated by means of Cox regression. Overall survival was compared using Kaplan–Meier estimations and log rank test.
Results
Of 503 patients with PDAC scheduled for resection with curative intent, 104 were deemed unresectable at laparotomy (resection rate 79·3 per cent). Seventy‐four patients underwent PDB procedures and 30 had exploratory laparotomy alone. PDB and exploratory laparotomy were similar in terms of perioperative mortality, initiation of chemotherapy and overall survival. Compared with best supportive care, postoperative chemotherapy prolonged survival (8·0 versus 14·4 months in locally advanced PDAC, P = 0·007; 2·3 versus 8·0 months in metastatic PDAC, P < 0·001). Patients undergoing chemotherapy following exploratory laparotomy alone had longer median overall survival than patients undergoing chemotherapy following PDB procedures (16·3 versus 10·3 months; P = 0·040).
Conclusion
Patients with pancreatic cancer deemed unresectable at laparotomy may derive survival benefit from subsequent chemotherapy as opposed to supportive care alone. At laparotomy, proceeding with a bypass procedure for prophylactic symptom control may be prognostically unfavourable.
Double bypass may be worse</description><identifier>ISSN: 0007-1323</identifier><identifier>ISSN: 1365-2168</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.10190</identifier><identifier>PMID: 27250937</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Antineoplastic Agents - therapeutic use ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Carcinoma, Pancreatic Ductal - complications ; Carcinoma, Pancreatic Ductal - drug therapy ; Carcinoma, Pancreatic Ductal - mortality ; Carcinoma, Pancreatic Ductal - surgery ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Hepatic Duct, Common - surgery ; Humans ; Jaundice, Obstructive - etiology ; Jaundice, Obstructive - surgery ; Jejunum - surgery ; Laparotomy ; Male ; Middle Aged ; Palliative Care - methods ; Pancreatic Neoplasms - complications ; Pancreatic Neoplasms - drug therapy ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - surgery ; Prognosis ; Retrospective Studies ; Survival Analysis ; Treatment Outcome</subject><ispartof>British journal of surgery, 2016-08, Vol.103 (9), p.1200-1208</ispartof><rights>2016 BJS Society Ltd Published by John Wiley & Sons Ltd</rights><rights>2016 BJS Society Ltd Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2016 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5720-6d891518d0ceaea7ba55fdd7148813469f756ea5599be298382f83cfb4da272b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.10190$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.10190$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27250937$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-509746$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:134389882$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Insulander, J.</creatorcontrib><creatorcontrib>Sanjeevi, S.</creatorcontrib><creatorcontrib>Haghighi, M.</creatorcontrib><creatorcontrib>Ivanics, T.</creatorcontrib><creatorcontrib>Analatos, A.</creatorcontrib><creatorcontrib>Lundell, L.</creatorcontrib><creatorcontrib>Del Chiaro, M.</creatorcontrib><creatorcontrib>Andrén-Sandberg, Å.</creatorcontrib><creatorcontrib>Ansorge, C.</creatorcontrib><title>Prognosis following surgical bypass compared with laparotomy alone in unresectable pancreatic adenocarcinoma</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
Resection with curative intent has been shown to prolong survival of patients with locoregional pancreatic ductal adenocarcinoma (PDAC). However, up to 33 per cent of patients are deemed unresectable at exploratory laparotomy owing to unanticipated locally advanced or metastatic disease. In these patients, prophylactic double bypass (PDB) procedures have been considered the standard of care. The aim of this study was to compare PDB with exploratory laparotomy alone in terms of impact on postoperative course, chemotherapy and overall survival.
Methods
This retrospective observational cohort study (2004–2013) was conducted using a prospective institutional database. Patients with histologically confirmed, unresectable PDAC were included. Relationships between PDB procedures, exploratory laparotomy alone, postoperative chemotherapy and best supportive care were investigated by means of Cox regression. Overall survival was compared using Kaplan–Meier estimations and log rank test.
Results
Of 503 patients with PDAC scheduled for resection with curative intent, 104 were deemed unresectable at laparotomy (resection rate 79·3 per cent). Seventy‐four patients underwent PDB procedures and 30 had exploratory laparotomy alone. PDB and exploratory laparotomy were similar in terms of perioperative mortality, initiation of chemotherapy and overall survival. Compared with best supportive care, postoperative chemotherapy prolonged survival (8·0 versus 14·4 months in locally advanced PDAC, P = 0·007; 2·3 versus 8·0 months in metastatic PDAC, P < 0·001). Patients undergoing chemotherapy following exploratory laparotomy alone had longer median overall survival than patients undergoing chemotherapy following PDB procedures (16·3 versus 10·3 months; P = 0·040).
Conclusion
Patients with pancreatic cancer deemed unresectable at laparotomy may derive survival benefit from subsequent chemotherapy as opposed to supportive care alone. At laparotomy, proceeding with a bypass procedure for prophylactic symptom control may be prognostically unfavourable.
Double bypass may be worse</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anastomosis, Surgical</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Carcinoma, Pancreatic Ductal - complications</subject><subject>Carcinoma, Pancreatic Ductal - drug therapy</subject><subject>Carcinoma, Pancreatic Ductal - mortality</subject><subject>Carcinoma, Pancreatic Ductal - surgery</subject><subject>Chemotherapy, Adjuvant</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hepatic Duct, Common - surgery</subject><subject>Humans</subject><subject>Jaundice, Obstructive - etiology</subject><subject>Jaundice, Obstructive - surgery</subject><subject>Jejunum - surgery</subject><subject>Laparotomy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Palliative Care - methods</subject><subject>Pancreatic Neoplasms - complications</subject><subject>Pancreatic Neoplasms - drug therapy</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0007-1323</issn><issn>1365-2168</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10c1vFCEUAHBiNHatHvwHDIkXDx3LxzDAsdZaNU21qVpvhGGYlS0DI8xk3f9e2l3XxMQTj8ePj8cD4DlGrzFC5Lhd5RJgiR6ABaYNqwhuxEOwQAjxClNCD8CTnFcIYYoYeQwOCCcMScoXwH9OcRlidhn20fu4dmEJ85yWzmgP282oc4YmDqNOtoNrN_2AXpdJnOKwgdrHYKELcA7JZmsm3XoLRx1MsnpyBurOhmh0Mi7EQT8Fj3rts322Gw_B13dnX07fVxefzj-cnlxUhnGCqqYTEjMsOmSstpq3mrG-6ziuhcC0bmTPWWNLUsrWEimoIL2gpm_rTpfKWnoIqu25eW3HuVVjcoNOGxW1U7vUbYmsYqjmkhZ_9F__1n07UTEt1TwXLnndFP5qy8cUf842T2pw2VjvdbBxzgoLxMpTJSGFvvyHruKcQin-TtUCS1LXRb3YqbkdbLe__0-bCjjegrXzdrNfx0jd9V-V_qv7_qs3H6_vg79f4PJkf-136HSrGk45UzeX5-ry-orfXKHvStLf9WmzXw</recordid><startdate>201608</startdate><enddate>201608</enddate><creator>Insulander, J.</creator><creator>Sanjeevi, S.</creator><creator>Haghighi, M.</creator><creator>Ivanics, T.</creator><creator>Analatos, A.</creator><creator>Lundell, L.</creator><creator>Del Chiaro, M.</creator><creator>Andrén-Sandberg, Å.</creator><creator>Ansorge, C.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DF2</scope></search><sort><creationdate>201608</creationdate><title>Prognosis following surgical bypass compared with laparotomy alone in unresectable pancreatic adenocarcinoma</title><author>Insulander, J. ; Sanjeevi, S. ; Haghighi, M. ; Ivanics, T. ; Analatos, A. ; Lundell, L. ; Del Chiaro, M. ; Andrén-Sandberg, Å. ; Ansorge, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5720-6d891518d0ceaea7ba55fdd7148813469f756ea5599be298382f83cfb4da272b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anastomosis, Surgical</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Carcinoma, Pancreatic Ductal - complications</topic><topic>Carcinoma, Pancreatic Ductal - drug therapy</topic><topic>Carcinoma, Pancreatic Ductal - mortality</topic><topic>Carcinoma, Pancreatic Ductal - surgery</topic><topic>Chemotherapy, Adjuvant</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hepatic Duct, Common - surgery</topic><topic>Humans</topic><topic>Jaundice, Obstructive - etiology</topic><topic>Jaundice, Obstructive - surgery</topic><topic>Jejunum - surgery</topic><topic>Laparotomy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Palliative Care - methods</topic><topic>Pancreatic Neoplasms - complications</topic><topic>Pancreatic Neoplasms - drug therapy</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Insulander, J.</creatorcontrib><creatorcontrib>Sanjeevi, S.</creatorcontrib><creatorcontrib>Haghighi, M.</creatorcontrib><creatorcontrib>Ivanics, T.</creatorcontrib><creatorcontrib>Analatos, A.</creatorcontrib><creatorcontrib>Lundell, L.</creatorcontrib><creatorcontrib>Del Chiaro, M.</creatorcontrib><creatorcontrib>Andrén-Sandberg, Å.</creatorcontrib><creatorcontrib>Ansorge, C.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Uppsala universitet</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Insulander, J.</au><au>Sanjeevi, S.</au><au>Haghighi, M.</au><au>Ivanics, T.</au><au>Analatos, A.</au><au>Lundell, L.</au><au>Del Chiaro, M.</au><au>Andrén-Sandberg, Å.</au><au>Ansorge, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognosis following surgical bypass compared with laparotomy alone in unresectable pancreatic adenocarcinoma</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2016-08</date><risdate>2016</risdate><volume>103</volume><issue>9</issue><spage>1200</spage><epage>1208</epage><pages>1200-1208</pages><issn>0007-1323</issn><issn>1365-2168</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background
Resection with curative intent has been shown to prolong survival of patients with locoregional pancreatic ductal adenocarcinoma (PDAC). However, up to 33 per cent of patients are deemed unresectable at exploratory laparotomy owing to unanticipated locally advanced or metastatic disease. In these patients, prophylactic double bypass (PDB) procedures have been considered the standard of care. The aim of this study was to compare PDB with exploratory laparotomy alone in terms of impact on postoperative course, chemotherapy and overall survival.
Methods
This retrospective observational cohort study (2004–2013) was conducted using a prospective institutional database. Patients with histologically confirmed, unresectable PDAC were included. Relationships between PDB procedures, exploratory laparotomy alone, postoperative chemotherapy and best supportive care were investigated by means of Cox regression. Overall survival was compared using Kaplan–Meier estimations and log rank test.
Results
Of 503 patients with PDAC scheduled for resection with curative intent, 104 were deemed unresectable at laparotomy (resection rate 79·3 per cent). Seventy‐four patients underwent PDB procedures and 30 had exploratory laparotomy alone. PDB and exploratory laparotomy were similar in terms of perioperative mortality, initiation of chemotherapy and overall survival. Compared with best supportive care, postoperative chemotherapy prolonged survival (8·0 versus 14·4 months in locally advanced PDAC, P = 0·007; 2·3 versus 8·0 months in metastatic PDAC, P < 0·001). Patients undergoing chemotherapy following exploratory laparotomy alone had longer median overall survival than patients undergoing chemotherapy following PDB procedures (16·3 versus 10·3 months; P = 0·040).
Conclusion
Patients with pancreatic cancer deemed unresectable at laparotomy may derive survival benefit from subsequent chemotherapy as opposed to supportive care alone. At laparotomy, proceeding with a bypass procedure for prophylactic symptom control may be prognostically unfavourable.
Double bypass may be worse</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>27250937</pmid><doi>10.1002/bjs.10190</doi><tpages>9</tpages></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Aged, 80 and over Anastomosis, Surgical Antineoplastic Agents - therapeutic use Antineoplastic Combined Chemotherapy Protocols - therapeutic use Carcinoma, Pancreatic Ductal - complications Carcinoma, Pancreatic Ductal - drug therapy Carcinoma, Pancreatic Ductal - mortality Carcinoma, Pancreatic Ductal - surgery Chemotherapy, Adjuvant Female Follow-Up Studies Hepatic Duct, Common - surgery Humans Jaundice, Obstructive - etiology Jaundice, Obstructive - surgery Jejunum - surgery Laparotomy Male Middle Aged Palliative Care - methods Pancreatic Neoplasms - complications Pancreatic Neoplasms - drug therapy Pancreatic Neoplasms - mortality Pancreatic Neoplasms - surgery Prognosis Retrospective Studies Survival Analysis Treatment Outcome |
| title | Prognosis following surgical bypass compared with laparotomy alone in unresectable pancreatic adenocarcinoma |
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