Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy

Tsung Yen Cheng, Ketan Sheth, Rebekah R. White, Tomio Ueno, Cheng Fang Hung, Bryan M. Clary, Theodore N. Pappas, Douglas Tyler

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)66-74
Number of pages9
JournalAnnals of Surgical Oncology
Volume13
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

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Pancreaticoduodenectomy
Chemoradiotherapy
Morbidity
Mortality
Abdominal Abscess
Neoplasms
Amylases
Fluorouracil
Abscess
Sepsis
Multivariate Analysis
Odds Ratio
Incidence

Keywords

  • Morbidity
  • Mortality
  • Neoadjuvant therapy
  • Pancreatic leak
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy. / Cheng, Tsung Yen; Sheth, Ketan; White, Rebekah R.; Ueno, Tomio; Hung, Cheng Fang; Clary, Bryan M.; Pappas, Theodore N.; Tyler, Douglas.

In: Annals of Surgical Oncology, Vol. 13, No. 1, 01.2006, p. 66-74.

Research output: Contribution to journalArticle

Cheng, Tsung Yen ; Sheth, Ketan ; White, Rebekah R. ; Ueno, Tomio ; Hung, Cheng Fang ; Clary, Bryan M. ; Pappas, Theodore N. ; Tyler, Douglas. / Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy. In: Annals of Surgical Oncology. 2006 ; Vol. 13, No. 1. pp. 66-74.
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AB - 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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