• Nikolaos Machairas, Dimitri A Raptis, Patricia Sánchez Velázquez, Alain Sauvanet, Alexandra Rueda de Leon, Atsushi Oba, KoerkampBas GrootBGDepartment of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands., Brendan Lovasik, Carlos Chan, Charles J Yeo, Claudio Bassi, Cristina R Ferrone, David Kooby, David Moskal, Domenico Tamburrino, Dong-Sup Yoon, Eduardo Barroso, Eduardo de Santibañes, Emanuele F Kauffmann, Emanuel Vigia, Fabien Robin, Fabio Casciani, Fernando Burdío, Giulio Belfiori, Giuseppe Malleo, Harish Lavu, Hermien Hartog, Ho-Kyoung Hwang, Ho-Seong Han, Hugo P Marques, Ignasi Poves, Ismael Domínguez-Rosado, Joon-Seong Park, Keith D Lillemoe, Keith Roberts, Laurent Sulpice, Marc G Besselink, Mahmoud Abuawwad, Marco Del Chiaro, Martin de Santibañes, Massimo Falconi, Mizelle D'Silva, Michael Silva, HilalMohammed AbuMADepartment of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy., Motaz Qadan, Naomi M Sell, Nassiba Beghdadi, Niccolò Napoli, BuschOlivier R CORCDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Oscar Mazza, Paolo Muiesan, Philip C Müller, Reena Ravikumar, Richard Schulick, Sarah Powell-Brett, Syed Hussain Abbas, Tara M Mackay, Thomas F Stoop, Tom K Gallagher, Ugo Boggi, Casper van Eijck, Pierre-Alain Clavien, Kevin C P Conlon, and Giuseppe Kito Fusai.
• Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK.
• Ann. Surg. 2021 Nov 1; 274 (5): 721-728.

ObjectiveThe aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers.Summary Of Background DataLimited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in R/BR-PDAC patients.MethodsThis multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018.ResultsData from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy, respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (P =0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (P <0.001). Multivariable analysis showed no administration of NAT, high tumor grade, lymphovascular invasion, R1/R2 resection, no adjuvant chemotherapy, occurrence of Clavien-Dindo grade 3 or higher postoperative complications within 90 days, preoperative diabetes mellitus, male sex and portal vein involvement were negative independent predictive factors for OS.ConclusionPatients with PDAC of the pancreatic head expected to undergo venous reconstruction should routinely be considered for NAT.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

29 keywords...

hide…